Limits...
Magnetic Resonance Angiography in the Diagnosis of Cerebral Arteriovenous Malformation and Dural Arteriovenous Fistulas: Comparison of Time-Resolved Magnetic Resonance Angiography and Three Dimensional Time-of-Flight Magnetic Resonance Angiography

View Article: PubMed Central - PubMed

ABSTRACT

Background: Traditional digital subtraction angiography (DSA) is currently the gold standard diagnostic method for the diagnosis and evaluation of cerebral arteriovenous malformation (AVM) and dural arteriovenous fistulas (dAVF).

Objectives: The aim of this study was to analyze different less invasive magnetic resonance angiography (MRA) images, time-resolved MRA (TR-MRA) and three-dimensional time-of-flight MRA (3D TOF MRA) to identify their diagnostic accuracy and to determine which approach is most similar to DSA.

Patients and methods: A total of 41 patients with AVM and dAVF at their initial evaluation or follow-up after treatment were recruited in this study. We applied time-resolved angiography using keyhole (4D-TRAK) MRA to perform TR-MRA and 3D TOF MRA examinations simultaneously followed by DSA, which was considered as a standard reference. Two experienced neuroradiologists reviewed the images to compare the diagnostic accuracy, arterial feeder and venous drainage between these two MRA images. Inter-observer agreement for different MRA images was assessed by Kappa coefficient and the differences of diagnostic accuracy between MRA images were evaluated by the Wilcoxon rank sum test.

Results: Almost all vascular lesions (92.68%) were correctly diagnosed using 4D-TRAK MRA. However, 3D TOF MRA only diagnosed 26 patients (63.41%) accurately. There were statistically significant differences regarding lesion diagnostic accuracy (P = 0.008) and venous drainage identification (P < 0.0001) between 4D-TRAK MRA and 3D TOF MRA. The results indicate that 4D-TRAK MRA is superior to 3D TOF MRA in the assessment of lesions.

Conclusion: Compared with 3D TOF MRA, 4D-TRAK MRA proved to be a more reliable screening modality and follow-up method for the diagnosis of cerebral AVM and dAVF.

No MeSH data available.


A 47-year-old man with a small AVM in the right lateral ventricle. A, Coronal TR-MRA shows the right lateral ventricle AVM with a nidus (arrow) supplied by a branch of the right anterior cerebral artery; B, Sagittal early; C, Late arterial; D, Venous phase TR-MRA images show the nidus (arrow) in the right lateral ventricle. Deep venous drainage occurs via an internal cerebral vein (arrow head) in the straight sinus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5036458&req=5

fig32548: A 47-year-old man with a small AVM in the right lateral ventricle. A, Coronal TR-MRA shows the right lateral ventricle AVM with a nidus (arrow) supplied by a branch of the right anterior cerebral artery; B, Sagittal early; C, Late arterial; D, Venous phase TR-MRA images show the nidus (arrow) in the right lateral ventricle. Deep venous drainage occurs via an internal cerebral vein (arrow head) in the straight sinus.

Mentions: The average scores were based on the 3-point grading system of diagnostic accuracy, arterial feeder and venous drainage. The comparison between the average scores of 4D-TRAK MRA and 3D TOF MRA is shown in Table 4. There was a statistically significant difference between 4D-TRAK MRA and 3D TOF MRA in terms of diagnostic accuracy in AVM (P = 0.006) and total group (summation of the AVM and dAVF, P = 0.002). For arterial identification, AVM, dAVF, and total group exhibited no significant differences. For venous drainage identification, 4D-TRAK MRA showed significant superiority to 3D TOF MRA in AVM (P < 0.0001) and total group (P < 0.0001). Figures 1 - 6 demonstrate the hemodynamic information, especially for drainage vein identification, which was provided by 4D-TRAK MRA. However, 3D TOF MRA poorly showed venous drainage due to its “static” information.


Magnetic Resonance Angiography in the Diagnosis of Cerebral Arteriovenous Malformation and Dural Arteriovenous Fistulas: Comparison of Time-Resolved Magnetic Resonance Angiography and Three Dimensional Time-of-Flight Magnetic Resonance Angiography
A 47-year-old man with a small AVM in the right lateral ventricle. A, Coronal TR-MRA shows the right lateral ventricle AVM with a nidus (arrow) supplied by a branch of the right anterior cerebral artery; B, Sagittal early; C, Late arterial; D, Venous phase TR-MRA images show the nidus (arrow) in the right lateral ventricle. Deep venous drainage occurs via an internal cerebral vein (arrow head) in the straight sinus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036458&req=5

fig32548: A 47-year-old man with a small AVM in the right lateral ventricle. A, Coronal TR-MRA shows the right lateral ventricle AVM with a nidus (arrow) supplied by a branch of the right anterior cerebral artery; B, Sagittal early; C, Late arterial; D, Venous phase TR-MRA images show the nidus (arrow) in the right lateral ventricle. Deep venous drainage occurs via an internal cerebral vein (arrow head) in the straight sinus.
Mentions: The average scores were based on the 3-point grading system of diagnostic accuracy, arterial feeder and venous drainage. The comparison between the average scores of 4D-TRAK MRA and 3D TOF MRA is shown in Table 4. There was a statistically significant difference between 4D-TRAK MRA and 3D TOF MRA in terms of diagnostic accuracy in AVM (P = 0.006) and total group (summation of the AVM and dAVF, P = 0.002). For arterial identification, AVM, dAVF, and total group exhibited no significant differences. For venous drainage identification, 4D-TRAK MRA showed significant superiority to 3D TOF MRA in AVM (P < 0.0001) and total group (P < 0.0001). Figures 1 - 6 demonstrate the hemodynamic information, especially for drainage vein identification, which was provided by 4D-TRAK MRA. However, 3D TOF MRA poorly showed venous drainage due to its “static” information.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Traditional digital subtraction angiography (DSA) is currently the gold standard diagnostic method for the diagnosis and evaluation of cerebral arteriovenous malformation (AVM) and dural arteriovenous fistulas (dAVF).

Objectives: The aim of this study was to analyze different less invasive magnetic resonance angiography (MRA) images, time-resolved MRA (TR-MRA) and three-dimensional time-of-flight MRA (3D TOF MRA) to identify their diagnostic accuracy and to determine which approach is most similar to DSA.

Patients and methods: A total of 41 patients with AVM and dAVF at their initial evaluation or follow-up after treatment were recruited in this study. We applied time-resolved angiography using keyhole (4D-TRAK) MRA to perform TR-MRA and 3D TOF MRA examinations simultaneously followed by DSA, which was considered as a standard reference. Two experienced neuroradiologists reviewed the images to compare the diagnostic accuracy, arterial feeder and venous drainage between these two MRA images. Inter-observer agreement for different MRA images was assessed by Kappa coefficient and the differences of diagnostic accuracy between MRA images were evaluated by the Wilcoxon rank sum test.

Results: Almost all vascular lesions (92.68%) were correctly diagnosed using 4D-TRAK MRA. However, 3D TOF MRA only diagnosed 26 patients (63.41%) accurately. There were statistically significant differences regarding lesion diagnostic accuracy (P = 0.008) and venous drainage identification (P &lt; 0.0001) between 4D-TRAK MRA and 3D TOF MRA. The results indicate that 4D-TRAK MRA is superior to 3D TOF MRA in the assessment of lesions.

Conclusion: Compared with 3D TOF MRA, 4D-TRAK MRA proved to be a more reliable screening modality and follow-up method for the diagnosis of cerebral AVM and dAVF.

No MeSH data available.