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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.


3D TOF MRA of the AVM shown in Figure 4. A, Coronal; B, Sagittal views also reveal a focal hyperintense nidus (arrow) in the right parietal region supplied by branches deriving from right anterior and middle cerebral arteries. However, the venous drainage cannot be confirmed due to lack of venous phase information. In addition, a high signal intensity (arrow head) resulting from flow artifacts of the great cerebral vein is visualized.
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fig32549: 3D TOF MRA of the AVM shown in Figure 4. A, Coronal; B, Sagittal views also reveal a focal hyperintense nidus (arrow) in the right parietal region supplied by branches deriving from right anterior and middle cerebral arteries. However, the venous drainage cannot be confirmed due to lack of venous phase information. In addition, a high signal intensity (arrow head) resulting from flow artifacts of the great cerebral vein is visualized.

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
3D TOF MRA of the AVM shown in Figure 4. A, Coronal; B, Sagittal views also reveal a focal hyperintense nidus (arrow) in the right parietal region supplied by branches deriving from right anterior and middle cerebral arteries. However, the venous drainage cannot be confirmed due to lack of venous phase information. In addition, a high signal intensity (arrow head) resulting from flow artifacts of the great cerebral vein is visualized.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig32549: 3D TOF MRA of the AVM shown in Figure 4. A, Coronal; B, Sagittal views also reveal a focal hyperintense nidus (arrow) in the right parietal region supplied by branches deriving from right anterior and middle cerebral arteries. However, the venous drainage cannot be confirmed due to lack of venous phase information. In addition, a high signal intensity (arrow head) resulting from flow artifacts of the great cerebral vein is visualized.
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.