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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.


Related in: MedlinePlus

3D TOF MRA of the AVM shown in Figure 1. A, Coronal; B, Sagittal views show no AVM nidus can be identified due to lack of venous phase information. A high signal intensity (arrow) resulting from flow artifacts of the great cerebral vein might be misdiagnosed as a vascular lesion.
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fig32552: 3D TOF MRA of the AVM shown in Figure 1. A, Coronal; B, Sagittal views show no AVM nidus can be identified due to lack of venous phase information. A high signal intensity (arrow) resulting from flow artifacts of the great cerebral vein might be misdiagnosed as a vascular lesion.

Mentions: Our study shows that almost all vascular lesions and venous drainage patterns can be correctly evaluated by 4D-TRAK MRA, which is here shown to be superior to 3D TOF MRA (Tables 3 and 4). For the primary diagnosis of cerebral AVM and dAVF, or follow-up, the detection of early venous drainage is very important (23, 30). 4D-TRAK MRA provides both vascular anatomy and hemodynamic information, which are of great value in clinical assessments (17, 19), especially venous drainage patterns and possible fistula points. Comparatively, 3D TOF MRA only detected 39% of the venous drainage (Table 2). Slow flow fistulae or AVM may be easily missed (Figures 1 - 3) because 3D TOF MRA is a T1-weighted imaging technique for static vascular lesions (31). In addition, subacute thrombosis within a fistula vein may be misdiagnosed as a vascular lesion (32) because any high signal intensity on T1 weighted image could be easily presented on 3D TOF MRA (2, 33).


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
3D TOF MRA of the AVM shown in Figure 1. A, Coronal; B, Sagittal views show no AVM nidus can be identified due to lack of venous phase information. A high signal intensity (arrow) resulting from flow artifacts of the great cerebral vein might be misdiagnosed as a vascular lesion.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig32552: 3D TOF MRA of the AVM shown in Figure 1. A, Coronal; B, Sagittal views show no AVM nidus can be identified due to lack of venous phase information. A high signal intensity (arrow) resulting from flow artifacts of the great cerebral vein might be misdiagnosed as a vascular lesion.
Mentions: Our study shows that almost all vascular lesions and venous drainage patterns can be correctly evaluated by 4D-TRAK MRA, which is here shown to be superior to 3D TOF MRA (Tables 3 and 4). For the primary diagnosis of cerebral AVM and dAVF, or follow-up, the detection of early venous drainage is very important (23, 30). 4D-TRAK MRA provides both vascular anatomy and hemodynamic information, which are of great value in clinical assessments (17, 19), especially venous drainage patterns and possible fistula points. Comparatively, 3D TOF MRA only detected 39% of the venous drainage (Table 2). Slow flow fistulae or AVM may be easily missed (Figures 1 - 3) because 3D TOF MRA is a T1-weighted imaging technique for static vascular lesions (31). In addition, subacute thrombosis within a fistula vein may be misdiagnosed as a vascular lesion (32) because any high signal intensity on T1 weighted image could be easily presented on 3D TOF MRA (2, 33).

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.


Related in: MedlinePlus