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Miyazaki A, Nishio M, Fujita A, Kohta M, Kojita Y, Horii S, Sasayama T, Murakami T. Predicting the O'Kelly-Marotta scale score after flow-diverter stent placement using silent MRA. Jpn J Radiol 2024:10.1007/s11604-024-01632-1. [PMID: 39207642 DOI: 10.1007/s11604-024-01632-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/16/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Flow-diverter (FD) stents were developed to treat aneurysms that are difficult to treat with conventional coiling or surgery. This study aimed to compare usefulness of Silent MRA and TOF (time of flight) -MRA in patients with aneurysms after FD placement. MATERIALS AND METHODS We retrospectively collected images from 22 patients with 23 internal carotid artery aneurysms treated with FD. Two radiologists conducted MRA and DSA experiments. In the first reading experiment, the radiologists evaluated the aneurysm filling by employing Silent MRA and TOF-MRA and utilizing the modified O'Kelly-Marotta (OKM) scale, a four-class classification system for aneurysms after FD placement. We then calculated the agreement between the modified OKM scale on MRA and the original OKM scale on DSA. In the second reading experiment, the radiologists rated blood flow within the FD using a five-point scale. RESULTS The weighted kappa value of the OKM scale between DSA and TOF-MRA was 0.436 (moderate agreement), and that between DSA and Silent MRA was 0.943 (almost perfect agreement). The accuracies for the four-class classification were 0.435 and 0.870 for TOF-MRA and Silent MRA, respectively. The mean score of blood flow within FD for TOF-MRA was 2.43 ± 0.90 and that for Silent MRA was 3.04 ± 1.02 (P < 0.001). CONCLUSION Silent MRA showed a higher degree of agreement than TOF-MRA in aneurysm filling with DSA. In addition, Silent MRA was significantly superior to TOF-MRA in depicting blood flow within the FD. Therefore, Silent MRA is clinically useful for the follow-up of patients after FD placement.
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Affiliation(s)
- Aki Miyazaki
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan.
| | - Mizuho Nishio
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Atsushi Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Masaaki Kohta
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Yasuyuki Kojita
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Shintaro Horii
- Center for Radiology and Radiation Oncology, Kobe University Hospital, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
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Chauvet G, Cheddad El Aouni M, Magro E, Sabardu O, Ben Salem D, Gentric JC, Ognard J. Diagnostic Accuracy of Non-Contrast-Enhanced Time-Resolved MR Angiography to Assess Angioarchitectural Classification Features of Brain Arteriovenous Malformations. Diagnostics (Basel) 2024; 14:1656. [PMID: 39125532 PMCID: PMC11311491 DOI: 10.3390/diagnostics14151656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
This study aims to assess the diagnostic accuracy of non-contrast-enhanced 4D MR angiography (NCE-4D-MRA) compared to contrast-enhanced 4D MR angiography (CE-4D-MRA) for the detection and angioarchitectural characterisation of brain arteriovenous malformations (bAVMs). Utilising a retrospective design, we examined 54 MRA pairs from 43 patients with bAVMs, using digital subtraction angiography (DSA) as the reference standard. Both NCE-4D-MRA and CE-4D-MRA were performed using a 3-T MR imaging system. The primary objectives were to evaluate the diagnostic performance of NCE-4D-MRA against CE-4D-MRA and DSA and to assess concordance between imaging modalities in grading bAVMs according to four main scales: Spetzler-Martin, Buffalo, AVM embocure score (AVMES), and R2eDAVM. Our results demonstrated that NCE-4D-MRA had a higher accuracy and specificity compared to CE-4D-MRA (0.85 vs. 0.83 and 95% vs. 85%, respectively) and similar agreement, with DSA detecting shunts in bAVMs or residuals. Concordance in grading bAVMs was substantial between NCE-4D-MRA and DSA, particularly for the Spetzler-Martin and Buffalo scales, with CE-4D-MRA showing slightly higher kappa values for interobserver agreement. The study highlights the potential of NCE-4D-MRA as a diagnostic tool for bAVMs, offering comparable accuracy to CE-4D-MRA while avoiding the risks associated with gadolinium-based contrast agents. The safety profile of imaging techniques is a significant concern in the long-term follow up of bAVMs, and further prospective research should focus on NCE-4D-MRA protocol improvement for clinical use.
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Affiliation(s)
- Grégoire Chauvet
- Department of Radiology, Hôpital Cavale Blanche, Brest University Hospital, 29200 Brest, France;
| | - Mourad Cheddad El Aouni
- Department of Interventional Neuroradiology, Hôpital Cavale Blanche, Brest University Hospital, 29200 Brest, France; (M.C.E.A.); (J.-C.G.)
| | - Elsa Magro
- Department of Neurosurgery, Hôpital Cavale Blanche, Brest University Hospital, 29200 Brest, France;
- Inserm, UMR 1101 (Laboratoire de Traitement de l’Information Médicale-LaTIM), Université de Bretagne Occidentale, 29238 Brest, France;
| | - Ophélie Sabardu
- Service d’Imagerie Médicale, Hôpital d’Instruction des Armées Legouest, rue des Frères-Lacretelle, 57070 Metz, France;
| | - Douraied Ben Salem
- Inserm, UMR 1101 (Laboratoire de Traitement de l’Information Médicale-LaTIM), Université de Bretagne Occidentale, 29238 Brest, France;
- Department of Neuroradiology, Hôpital Cavale Blanche, Brest University Hospital, 29200 Brest, France
| | - Jean-Christophe Gentric
- Department of Interventional Neuroradiology, Hôpital Cavale Blanche, Brest University Hospital, 29200 Brest, France; (M.C.E.A.); (J.-C.G.)
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Université de Bretagne Occidentale, 29238 Brest, France
| | - Julien Ognard
- Department of Interventional Neuroradiology, Hôpital Cavale Blanche, Brest University Hospital, 29200 Brest, France; (M.C.E.A.); (J.-C.G.)
- Inserm, UMR 1101 (Laboratoire de Traitement de l’Information Médicale-LaTIM), Université de Bretagne Occidentale, 29238 Brest, France;
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Mishra D, Kannath SK, Er J, Thomas B, Kesavadas C. Evaluating the diagnostic performance of non-contrast magnetic resonance angiography sequences in the pre-procedural comprehensive analysis of direct carotid cavernous fistula. Neuroradiology 2024; 66:1203-1212. [PMID: 38581636 DOI: 10.1007/s00234-024-03342-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/19/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE Endovascular treatment of direct carotid cavernous fistula (DCCF) requires invasive diagnostic cerebral angiography for diagnosis and planning; however, a less invasive modality like magnetic resonance angiography (MRA) can be useful, especially in high-risk cases. This single-centre study evaluated a newer MR angiography (MRA) sequence, silent MRA and the traditional time of flight (TOF) MRA for pre-procedural treatment planning of DCCF. METHODS All consecutive DCCF patients who underwent TOF, silent MRA and diagnostic cerebral angiography were included in the study. Angiographic features like rent size, location, draining veins and collateral communicating arteries were analysed and compared between the two MRA sequences, with digital subtraction angiography (DSA) as the gold standard. RESULTS Fifteen patients were included in the study. TOF MRA exhibited better sensitivity (76.9% vs 69.2%) in identifying the rent location, correctly pinpointing the location in 93.3% compared to 73.3% with silent MRA. Both MRA sequences showed good agreement with DSA for primary sac and rent size. TOF MRA correctly identified 86.2% of 210 total venous structures compared to 96% by silent MRA. Silent MRA demonstrated higher sensitivity (90% vs 76%) and accuracy (87.69 vs 94.36) in visualisation of involved veins compared to TOF MRA. CONCLUSION Arterial characteristics of DCCF like rent location and rent size were better assessed by TOF MRA. Although both MRA identified venous features, silent MRA correlated better with DSA irrespective of the size and proximity to the site of the fistula. Combining both sequences can evaluate various angioarchitectural features of DCCF useful for therapeutic planning.
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Affiliation(s)
- Dewansh Mishra
- Imaging Sciences and Interventional Radiology, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | - Santhosh Kumar Kannath
- Imaging Sciences and Interventional Radiology, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India.
| | - Jayadevan Er
- Imaging Sciences and Interventional Radiology, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | - Bejoy Thomas
- Imaging Sciences and Interventional Radiology, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | - C Kesavadas
- Imaging Sciences and Interventional Radiology, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
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Jagadeesan B, Tariq F, Nada A, Bhatti IA, Masood K, Siddiq F. Principles Behind 4D Time-Resolved MRA/Dynamic MRA in Neurovascular Imaging. Semin Roentgenol 2024; 59:191-202. [PMID: 38880517 DOI: 10.1053/j.ro.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/28/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Bharathi Jagadeesan
- Departments of Radiology, Neurology and Neurosurgery, University of Minnesota, Minneapolis, MN.
| | - Farzana Tariq
- Departments of Neurosurgery and Radiology, University of Missouri, Columbia, MO
| | - Ayman Nada
- Departments of Neurosurgery and Radiology, University of Missouri, Columbia, MO
| | - Ibrahim A Bhatti
- Departments of Neurosurgery and Radiology, University of Missouri, Columbia, MO
| | - Kamran Masood
- Departments of Radiology, Neurology and Neurosurgery, University of Minnesota, Minneapolis, MN
| | - Farhan Siddiq
- Departments of Neurosurgery and Radiology, University of Missouri, Columbia, MO
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Tanoue S, Tanaka N, Koganemaru M, Kuhara A, Kugiyama T, Sawano M, Abe T. Head and Neck Arteriovenous Malformations: Clinical Manifestations and Endovascular Treatments. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:23-35. [PMID: 37485489 PMCID: PMC10359175 DOI: 10.22575/interventionalradiology.2022-0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/01/2022] [Indexed: 07/25/2023]
Abstract
Arteriovenous malformations (AVMs) are vascular malformations that present high-flow direct communication between the arteries and veins, not involving the capillary beds. They can be progressive and lead to various manifestations, including abnormal skin or mucosal findings, ischemia, hemorrhage, and high-output heart failure in severe cases. AVMs often involve the head and neck region. Head and neck AVMs can present region-specific clinical manifestations, angioarchitecture, and complications, especially in cosmetic appearance and ingestion, respiratory, and neuronal functions. Therefore, when planning endovascular treatment of head and neck AVMs, physicians should consider not only the treatment strategy but also the preservation of the cosmetic appearance and critical functions. Knowledge of the functional vascular anatomy as well as treatment techniques should facilitate a successful management. This review summarizes AVMs' clinical manifestations, imaging findings, treatment strategy, and complications.
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Affiliation(s)
- Shuichi Tanoue
- Department of Radiology, Kurume University School of Medicine, Japan
| | - Norimitsu Tanaka
- Department of Radiology, Kurume University School of Medicine, Japan
| | | | - Asako Kuhara
- Department of Radiology, Kurume University School of Medicine, Japan
| | - Tomoko Kugiyama
- Department of Radiology, Kurume University School of Medicine, Japan
| | - Miyuki Sawano
- Department of Radiology, Kurume University School of Medicine, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Japan
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Raman A, Uprety M, Calero MJ, Villanueva MRB, Joshaghani N, Villa N, Badla O, Goit R, Saddik SE, Dawood SN, Rabih AM, Mohammed A, Selvamani TY, Mostafa J. A Systematic Review Comparing Digital Subtraction Angiogram With Magnetic Resonance Angiogram Studies in Demonstrating the Angioarchitecture of Cerebral Arteriovenous Malformations. Cureus 2022; 14:e25803. [PMID: 35706438 PMCID: PMC9187205 DOI: 10.7759/cureus.25803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/05/2022] Open
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Li R, Jin S, Wu T, Zang X, Li M, Li J. Usefulness of silent magnetic resonance angiography (MRA) for the diagnosis of atherosclerosis of the internal carotid artery siphon in comparison with time-of-flight MRA. Eur J Med Res 2022; 27:44. [PMID: 35314001 PMCID: PMC8935786 DOI: 10.1186/s40001-022-00673-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background and purpose Flow visualization in 3D time-of-flight MRA (3D-TOF MRA) may be limited for internal carotid artery siphon owing to turbulent artifact. The purpose of this study was to compare the usefulness of Silent MRA and 3D-TOF MRA to assess atherosclerosis of the internal carotid artery siphon. Material and methods A total of 106 patients with suspected cerebrovascular disease were included. All patients were scanned with Silent MRA and 3D-TOF MRA sequences and also underwent DSA examination. Two observers independently assessed the TOF MRA and Silent MRA images of atherosclerosis of the internal carotid artery siphon. The diagnostic efficacy of two MRA methods in evaluating atherosclerosis of the carotid siphon was performed by using receiver operating characteristic (ROC) curve analysis. Interobserver reliability was also assessed using weighted kappa statistics. Results Image of Silent MRA sequence had higher subjective evaluation scores and significantly high CNR between the carotid siphon and the background tissues than the image of 3D-TOF MRA sequence (P < 0.05). The AUC was 0.928 (95% CI 0.909–0.986) for Silent MRA, which was significantly higher than that of 3D-TOF MRA (0.671, 95% CI 0.610–0.801, P < 0.05). Silent MRA had high sensitivity, specificity and accuracy than 3D-TOF MRA for visualization of the carotid siphon. Conclusions Silent MRA as a new angiographic modality is superior to 3D-TOF MRA for visualization of the carotid siphon, and maybe an alternative to 3D-TOF MRA in the diagnosis of atherosclerosis of the carotid siphon.
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Affiliation(s)
- Rui Li
- Department of Medical Imaging, Tianjin Huanhu Hospital, 6 Jizhao Road, Tianjin, 300350, China.,Department of Medical Imaging, Affiliated Huanhu Hospital of Nankai University, 6 Jizhao Road, Tianjin, 300350, China
| | - Song Jin
- Department of Medical Imaging, Tianjin Huanhu Hospital, 6 Jizhao Road, Tianjin, 300350, China.,Department of Medical Imaging, Affiliated Huanhu Hospital of Nankai University, 6 Jizhao Road, Tianjin, 300350, China
| | - Tao Wu
- GE Healthcare MR Enhanced Application Team, 1 Tongji South Road, Beijing, 100176, China
| | - Xiao Zang
- Department of Radiology, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Meng Li
- Department of Radiology, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jinfeng Li
- Department of Radiology, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Hwang ZA, Li CW, Lin CYE, Chen JH, Chen CY, Chan WP. Intensity of arterial structure acquired by Silent MRA estimates cerebral blood flow. Insights Imaging 2021; 12:185. [PMID: 34894298 PMCID: PMC8665965 DOI: 10.1186/s13244-021-01132-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral blood flow (CBF) and the morphology of the cerebral arteries are important for characterizing cerebrovascular disease. Silent magnetic resonance angiography (Silent MRA) is a MRA technique focusing on arterial structural delineation. This study was conducted to investigate the correlation between Silent MRA and CBF quantification, which has not yet been reported. METHODS Both the Silent MRA and time-of-flight magnetic resonance angiography scans were applied in seventeen healthy participants to acquire the arterial structure and to find arterial intensities. Phase-contrast MRA (PC-MRA) was then used to perform the quantitative CBF measurement of 13 cerebral arteries. Due to different dataset baseline signal level of Silent MRA, the signal intensities of the selected 13 cerebral arteries were normalized to the selected ROIs of bilateral internal carotid arteries. The normalized signal intensities were used to determine the relationship between Silent MRA and CBF. RESULTS The image intensity distribution of arterial regions generated by Silent MRA showed similar laminar shape as the phase distribution by PC-MRA (correlation coefficient > 0.62). Moreover, in both the results of individual and group-leveled analysis, the intensity value of arterial regions by Silent MRA showed positively correlation with the CBF by PC-MRA. The coefficient of determination (R2) of individual trends ranged from 0.242 to 0.956, and the R2 of group-leveled result was 0.550. CONCLUSIONS This study demonstrates that Silent MRA provides valuable CBF information despite arterial structure, rendering it a potential tool for screening for cerebrovascular disease.
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Affiliation(s)
- Zhen-An Hwang
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing Long Road, Section 3, Taipei 116, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Wei Li
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing Long Road, Section 3, Taipei 116, Taiwan.,GE Healthcare, Taipei, Taiwan
| | | | - Jyh-Horng Chen
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan.,Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
| | - Chia-Yuen Chen
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing Long Road, Section 3, Taipei 116, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing Long Road, Section 3, Taipei 116, Taiwan. .,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Song Y, Kwon B, Al-Abdulwahhab AH, Nam YK, Ahn Y, Jeong SY, Seo EJ, Lee JK, Suh DC. Rare Neurovascular Diseases in Korea: Classification and Related Genetic Variants. Korean J Radiol 2021; 22:1379-1396. [PMID: 34047503 PMCID: PMC8316781 DOI: 10.3348/kjr.2020.1171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/07/2020] [Accepted: 01/23/2021] [Indexed: 01/19/2023] Open
Abstract
Rare neurovascular diseases (RNVDs) have not been well-recognized in Korea. They involve the central nervous system and greatly affect the patients' lives. However, these diseases are difficult to diagnose and treat due to their rarity and incurability. We established a list of RNVDs by referring to the previous literature and databases worldwide to better understand the diseases and their current management status. We categorized 68 RNVDs based on their pathophysiology and clinical manifestations and estimated the prevalence of each disease in Korea. Recent advances in genetic, molecular, and developmental research have enabled further understanding of these RNVDs. Herein, we review each disease, while considering its classification based on updated pathologic mechanisms, and discuss the management status of RNVD in Korea.
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Affiliation(s)
- Yunsun Song
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Boseong Kwon
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Abdulrahman Hamed Al-Abdulwahhab
- Department of Diagnostic and Interventional Radiology, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar City, Eastern Province, Saudi Arabia
| | - Yeo Kyoung Nam
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yura Ahn
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yeong Jeong
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eul Ju Seo
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Keuk Lee
- Asan Institute of Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Chul Suh
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Wu CX, Zang ZX, Hong T, Dong MQ, Shan Y, Zhao ZL, Hou CB, Lu J. Signal intensity ratio of draining vein on silent MR angiography as an indicator of high-flow arteriovenous shunt in brain arteriovenous malformation. Eur Radiol 2021; 31:9252-9261. [PMID: 34263361 PMCID: PMC8589750 DOI: 10.1007/s00330-021-08170-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/26/2021] [Accepted: 06/25/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate whether the signal intensity ratio (rSI) of the draining vein on silent MR angiography is correlated with arteriovenous (A-V) transit time on digital subtraction angiography (DSA), thereby identifying high-flow A-V shunt in brain arteriovenous malformation (BAVM), and to analyze whether the rSI and the characteristic of draining veins on silent MRA are associated with hemorrhage presentation. METHODS Eighty-one draining veins of 46 participants with BAVM (mean age 33.2 ± 16.9 years) who underwent silent MRA and DSA were evaluated retrospectively. The correlation between the rSI of the draining vein on silent MRA and A-V transit time on DSA was examined. The AUC-ROC was obtained to evaluate the performance of the rSI in determining the presence of high-flow A-V shunt. The characteristics of draining veins with the maximum rSI (rSImax) were further compared between the hemorrhagic and non-hemorrhagic untreated BAVM. RESULTS The rSI of each draining vein on silent MRA was significantly correlated with A-V transit time from DSA (r = -0.81, p < .001). The AUC-ROC was 0.89 for using the rSI to determine the presence of high-flow A-V shunt. A cut-off rSI value of 1.09 yielded a sensitivity of 82.4% and a specificity of 82.8%. The draining vein with rSImax and no ectasia was significantly more observed in the hemorrhagic group (p = 0.045). CONCLUSIONS The rSI of the draining vein on silent MRA is significantly correlated with A-V transit time on DSA, and it can be used as an indicator of high-flow A-V shunt in BAVM. KEY POINTS • The signal intensity ratio (rSI) of the draining vein on silent MRA significantly correlated with arteriovenous (A-V) transit time of brain arteriovenous malformation (BAVM) on digital subtraction angiography (DSA). • The area under the receiver operating characteristic curve (AUC) was 0.89 for using the rSI of draining veins to determine high-flow A-V shunt. • Draining veins with maximum rSI and no ectasia were significantly more observed in the hemorrhagic group of BAVM (p = 0.045).
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Affiliation(s)
- Chun-Xue Wu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45# Changchun Street, Xicheng District, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Zhen-Xiang Zang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45# Changchun Street, Xicheng District, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Meng-Qi Dong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yi Shan
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45# Changchun Street, Xicheng District, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Zhi-Lian Zhao
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45# Changchun Street, Xicheng District, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Cheng-Bei Hou
- Center for Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45# Changchun Street, Xicheng District, Beijing, China. .,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.
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Balasubramanian AP, Kannath SK, Rajan JE, Singh G, Kesavadas C, Thomas B. Utility of silent magnetic resonance angiography in the evaluation and characterisation of intracranial dural arteriovenous fistula. Clin Radiol 2021; 76:712.e1-712.e8. [PMID: 34144807 DOI: 10.1016/j.crad.2021.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
AIM To evaluate the utility of silent magnetic resonance angiography (MRA) in the diagnosis, characterisation, and therapeutic planning of intracranial dural arteriovenous fistula (DAVF). MATERIALS AND METHODS Twenty consecutive patients with DAVF were enrolled prospectively and were evaluated using silent MRA and digital subtraction angiography (DSA) as a part of routine work-up. The diagnosis and location of fistula, Borden and Cognard classification, entire arterial feeders, and venous drainage were analysed. A therapeutic strategy was formulated, and the accessible route and vessel were predicted, which was confirmed on endovascular treatment. RESULTS Silent MRA was 100% sensitive and accurate for location and classification of fistulas. Silent MRA showed a sensitivity of 82% and 76.5% for entire arterial feeders and draining veins, which improved to a sensitivity of 90% and 94% when prominent feeders and immediate venous drainage was considered. Among the missed veins, thrombosed sinus, slow sinus flow, small calibre, reduced image quality were the causes. The therapeutic decision matched with DSA in all cases and silent MRA accurately identified the potential accessible feeder in 94% cases. CONCLUSION Silent MRA is a promising MR technique that can provide both diagnostic and therapeutic information similar to that obtained from DSA.
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Affiliation(s)
- A Prasad Balasubramanian
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - S Kumar Kannath
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India.
| | - J Enakshy Rajan
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - G Singh
- Achutha Menon Centre for Health Science Studies, Trivandrum, Kerala, India
| | - C Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - B Thomas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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Zhang C, Dou W, Yu K, Ji Y, Wang W, Sami MU, Shen Y, Xu K. The feasibility of non-contrast-enhanced zero echo time magnetic resonance angiography for characterization of intracranial atherosclerotic disease. Quant Imaging Med Surg 2021; 11:2442-2452. [PMID: 34079714 DOI: 10.21037/qims-20-696] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Accurate and non-invasive assessment of intracranial atherosclerotic disease (ICAD) is important because of its effect on treatment planning. The aim of this study is to investigate if zero echo time (zTE) magnetic resonance angiography (zTE-MRA) is feasible in the characterization of ICAD. Methods A total of 175 patients with ICAD were recruited. ZTE-MRA and time-of-flight (TOF)-MRA sequences were conducted for all participants using a 3T clinical MR system. Forty-one patients also underwent digital subtraction angiography (DSA), and were confirmed to have intracranial arterial stenosis (ICAS). Weighted kappa (κ) statistics were used to assess the inter-observer agreement and diagnostic consistency of both zTE- and TOF-MRA, using DSA as a reference. The Wilcoxon signed-rank test was used to evaluate differences in image quality between zTE- and TOF-MRA images. The nonparametric test of multiple paired samples was used to compare the results of vascular stenosis diagnosis between zTE-, TOF-MRA and DSA. Results Supported by high inter-observer agreement (weighted κ=0.78), zTE-MRA generated significantly higher scores than TOF-MRA for susceptibility artifact signal (mean: 3.03±0.98 vs. 2.72±1.09; P=0.017) and flow signal in parent artery (mean: 3.63±0.49 vs. 3.07±0.82; P<0.001). Additionally, zTE-MRA showed more robust diagnostic performance than TOF-MRA for patients with ICAD and degree of vascular stenosis (P<0.05), and was highly consistent with reference DSA images (weighted κ=0.80). Conclusions ZTE-MRA has potential for use as a routine clinical method for patients with ICAD.
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Affiliation(s)
- Chao Zhang
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Weiqiang Dou
- GE Healthcare, MR Research China, Beijing, China
| | - Ke Yu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yun Ji
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Department of Radiology, Traditional Chinese Medical Hospital of Yixing, Yixing, China
| | - Wenliang Wang
- Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Muhammad Umair Sami
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yong Shen
- GE Healthcare, MR Enhanced Application China, Beijing, China
| | - Kai Xu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Shang S, Wang L, Ye J, Luo X, Zhang H, Dou W, Wu J, Li D. Can Hybrid Arterial Spin Labeling-Tagged Zero-Echo-Time Magnetic Resonance Angiography Be an Effective Candidate in the Evaluation of Intracranial Artery Diseases? A Clinical Feasibility Study. J Magn Reson Imaging 2021; 54:938-949. [PMID: 34014010 DOI: 10.1002/jmri.27629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Flow related artifacts in continuous arterial spin labeling (cASL) zero-echo-time (ZTE) magnetic resonance angiography (MRA) could influence the vasculature visualization. PURPOSE To investigate the clinical feasibility for the intracranial artery diseases assessment by utilizing hybrid ASL-ZTE-MRA (hASL-ZTE-MRA). STUDY TYPE Prospective, technical development. POPULATION Sixty-seven subjects with known/suspected cerebrovascular diseases. FIELD STRENGTH/SEQUENCE Gradient echo based cASL-/hASL- ZTE-MRA at 3.0 T. ASSESSMENT Subjective/objective evaluation for sound-levels. Image quality (IQ), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were analyzed within artery segments. Stenotic grading, aneurysm measurement, and signal intensity of lesions were further analyzed. STATISTICAL TESTS Kolmogorov-Smirnov test for data normality check. Between two MRAs: Wilcoxon signed-rank test for sound experience/IQ ratings analysis; Paired t test for SNR/CNR comparison. One-way analysis of variance for sound intensity comparison. For stenosis grading/aneurysm measurement: Kendall's W test/intraclass correlation coefficient (ICC) for interobserver agreement test within each modality, weighted kappa statistics/ICC for intermodality agreement test between each MRA and computed tomography angiography. RESULTS Sound-level perception/intensity was similar (P = 0.86, P = 0.55) between MRAs. The mean IQ score for hASL-ZTE-MRA was on diagnostic scale and slightly higher (P < 0.05) than that of cASL-ZTE-MRA. hASL-ZTE-MRA provided higher (P < 0.05) SNR/CNR than that of cASL-ZTE-MRA. Signal uniformity was improved on hASL-ZTE-MRA, particularly among the anterior circulation (P < 0.05). Comparing to cASL-ZTE-MRA, on hASL-ZTE-MRA, stenotic lesions were accurately assessed; flow in the stent or aneurysm remnant was better depicted (P < 0.05); AVM nidus was preferred with increased SNR (P < 0.05). No significant differences for the aneurysm measurement were found between MRAs (P = 0.95), in addition to the slightly higher SNR (P < 0.05) on hASL-ZTE-MRA. DATA CONCLUSION Comparing to cASL-ZTE-MRA, hASL-ZTE-MRA is robust and feasible for the evaluation of intracranial artery diseases with diagnostic IQ, improved vessel contrast, and better signal heterogeneity. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: 2.
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Affiliation(s)
- Song'an Shang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lijuan Wang
- Department of Radiology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Jing Ye
- Department of Radiology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xianfu Luo
- Department of Radiology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Hongying Zhang
- Department of Radiology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Weiqiang Dou
- Department of MR Research China, GE Healthcare, Beijing, China
| | - Jingtao Wu
- Department of Radiology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Daixin Li
- Department of Radiology, Nanjing Second Hospital, Nanjing University of Chinese Medicine, Nanjing, China
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Katsuki M, Narita N, Ishida N, Sugawara K, Watanabe O, Ozaki D, Sato Y, Kato Y, Jia W, Tominaga T. Usefulness of 3 Tesla Ultrashort Echo Time Magnetic Resonance Angiography (UTE-MRA, SILENT-MRA) for Evaluation of the Mother Vessel after Cerebral Aneurysm Clipping: Case Series of 19 Patients. Neurol Med Chir (Tokyo) 2021; 61:193-203. [PMID: 33504734 PMCID: PMC7966203 DOI: 10.2176/nmc.oa.2020-0336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
It is important to assess the cerebral arteries near the clip after cerebral aneurysm clipping. Contrast-enhanced computed tomography angiography has side effects of contrast medium and radiation exposure. Time-of-flight magnetic resonance angiography (TOF-MRA) is a fast and non-invasive method, but clip-induced artifact limits the assessment around the clip. Recently, 3 tesla MRA with ultrashort echo time called SILENT MRA (GE Healthcare Life Sciences, UK) has been reported to have the potential to overcome these disadvantages. We herein present consecutive 19 cerebral aneurysm patients treated by clipping and evaluated using SILENT MRA. The 19 patients (15 women and 4 men) underwent TOF-MRA and SILENT MRA during the same scan session. Two neurosurgeons independently assessed the visibility of the mother vessel at the clipping site in TOF-MRA and SILENT MRA. We also investigated the factors related to visibility in SILENT MRA. All patients’ mother vessels were not described in TOF-MRA, and that of 16 patients (84%) were described in SILENT MRA. Overall agreement was 100% in the two neurosurgeons, and the fixed marginal kappa = 1.00 (95% CI: 0.36–1.00). Univariate analysis revealed that larger aneurysm dome and long clip blade length contributed to the visibility of the mother vessel in SILENT MRA. (p = 0.023, 0.007, each). In conclusion, SILENT MRA can be applied for the assessment of the arteries and aneurysm neck remnants near the clip. Using clips with long blade and ligation with its tip would be related to the visibility of the mother vessels in SILENT MRA.
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Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Norio Narita
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Naoya Ishida
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Kazuya Sugawara
- Department of Radiological Technology, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Ohmi Watanabe
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Dan Ozaki
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Yoshimichi Sato
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Yuya Kato
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Wenting Jia
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Wang M, Yang Y, Wang Y, Li M, Zhang J, Zhang B. Vessel-selective 4D MRA based on ASL might potentially show better performance than 3D TOF MRA for treatment evaluation in patients with intra-extracranial bypass surgery: a prospective study. Eur Radiol 2021; 31:5263-5271. [PMID: 33386981 DOI: 10.1007/s00330-020-07503-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/24/2020] [Accepted: 11/11/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare bypass patency and intracranial collaterals from the external carotid artery (ECA) by four-dimensional MR angiography (MRA) based on super-selective pseudo-continuous arterial spin labeling (pCASL) combined with the keyhole and view-sharing techniques (4D-sPACK) versus three-dimensional time-of-flight (3D TOF) MRA in patients with extra-intracranial revascularization. METHODS The MR data of 45 patients administered bypass surgery were collected. The image quality of 4D-sPACK was evaluated using a 4-point grading system according to whether the diagnosis of intracranial collaterals was affected. Anastomosis patency and intracranial collateral visualization from ECA were assessed by two radiologists on 4D-sPACK and 3D TOF MRA, with digital subtraction angiography (DSA) findings as reference. Intracranial collateral assessment employed another 4-point grading system according to the number of vessels shown. Interobserver agreement was assessed with the weighted kappa statistic. RESULTS Fifty hemispheres in 43 patients were included. The image quality of 4D-sPACK was good in 47 (47/50, 94.0%) hemispheres. 4D-sPACK had a higher sensitivity than 3D TOF MRA (97.73% vs 79.55%) for visualizing anastomoses. There were significant differences between 4D-sPACK (scores, 3.22 ± 1.15) and 3D TOF MRA (scores, 1.80 ± 0.67) in the visualization of intracranial collaterals from ECA (p < 0.001). The interobserver agreement was substantial for intracranial collateral assessment (κ4D-sPACK = 0.788; κ3D TOF MRA = 0.800) and almost perfect for bypass patency (κ4D-sPACK = 0.912; κ3D TOF MRA = 0.816; κDSA = 0.811). CONCLUSION This pilot study shows that, 4D-sPACK has a better performance than 3D TOF MRA in treatment evaluation of patients after bypass surgery, and has high consistency with DSA. KEY POINTS • 4D-sPACK is a non-contrast-enhanced dynamic MRA method for the visualization of intracranial vessels. • 4D-sPACK has higher specificity for the diagnosis of anastomosis occlusion. • 4D-sPACK is better than 3D TOF MRA in the visualization of intracranial collaterals in patients after bypass surgery.
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Affiliation(s)
- Maoxue Wang
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Drum Tower District, Nanjing, Jiangsu Province, 210002, China
| | - Yongbo Yang
- Department of Neurosurgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yi Wang
- Department of Neurosurgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Ming Li
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Drum Tower District, Nanjing, Jiangsu Province, 210002, China
| | | | - Bing Zhang
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Drum Tower District, Nanjing, Jiangsu Province, 210002, China.
- Institute of Brain Science, Nanjing University, Nanjing, Jiangsu, China.
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Sun Z, Hu S, Ge Y, Jin L, Huang J, Dou W. Can Arterial Spin Labeling Perfusion Imaging be Used to Differentiate Nasopharyngeal Carcinoma From Nasopharyngeal Lymphoma? J Magn Reson Imaging 2020; 53:1140-1148. [PMID: 33225524 DOI: 10.1002/jmri.27451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Differentiating nasopharyngeal carcinoma (NPC) from nasopharyngeal lymphoma (NPL) is useful for deciding the appropriate treatment. However, the diagnostic accuracy of current imaging methods is low. PURPOSE To explore the feasibility of arterial spin labeling (ASL) perfusion imaging in the qualitative and quantitative differentiation between NPC and NPL to improve the diagnosis of malignancies in the nasopharynx. STUDY TYPE Retrospective. POPULATION Ninety seven patients: NPC (65 cases) and NPL (32 cases), histologically confirmed. FIELD STRENGTH/SEQUENCE 3T/3D fast spin echo pseudo-continuous ASL imaging with spiral readout scheme, 3D inverse recovery- fast spoiled gradient recalled echo brain volume (BRAVO) imaging. ASSESSMENT Cerebral blood flow (CBF) images from ASL perfusion imaging were assessed by three radiologists. Each tumor was visually scored based on CBF images. Intratumoral CBF and intramuscular CBF values were obtained from intratumoral and lateral pterygoid muscle areas, respectively. Through dividing intratumoral CBF by intramuscular CBF, normalized CBF (nCBF) was further calculated. STATISTICAL TESTS Fleiss's kappa and intraclass correlation coefficients (ICCs) were used to assess interobserver agreement among the three readers. The Mann-Whitney U-test was used to compare visual scoring, and an unpaired t-test was performed to compare CBF value between the NPC and NPL groups. The area under the curve (AUC) value was used to quantify the diagnostic ability of each parameter. RESULTS Good interobserver agreements were validated by high Fleiss's kappa and ICC values (all >0.80). NPCs showed significantly higher visual scores than NPLs (P < 0.05). Both intratumoral CBF and nCBF in NPC were significantly higher than those in NPL (both P < 0.05). Intratumoral CBF showed the highest AUC of 0.861 (P < 0.05) in differentiating NPC (n = 65) from NPL (n = 32), while the AUCs of nCBF and visual scoring were 0.847 and 0.753, respectively. DATA CONCLUSION For the diagnosis of distinguishing NPC from NPL, ASL perfusion imaging demonstrated high diagnostic efficiency. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Zongqiong Sun
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi City, China
| | - Shudong Hu
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi City, China
| | - Yuxi Ge
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi City, China
| | - Linfang Jin
- Department of Pathology, Affiliated Hospital of Jiangnan University, Wuxi City, China
| | - Jianfeng Huang
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, Wuxi City, China
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Evaluation of cerebral arteriovenous shunts: a comparison of parallel imaging time-of-flight magnetic resonance angiography (TOF-MRA) and compressed sensing TOF-MRA to digital subtraction angiography. Neuroradiology 2020; 63:879-887. [PMID: 33063222 DOI: 10.1007/s00234-020-02581-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Time-of-flight (TOF)-MR angiography (MRA) is an important imaging sequence for the surveillance and analysis of cerebral arteriovenous shunt (AVS), including arteriovenous malformation (AVM) and arteriovenous fistula (AVF). However, this technique has the disadvantage of a relatively long scan time. The aim of this study was to compare diagnostic accuracy between compressed sensing (CS)-TOF and conventional parallel imaging (PI)-TOF-MRA for detecting and characterizing AVS. METHODS This study was approved by the institutional review board for human studies. Participants comprised 56 patients who underwent both CS-TOF-MRA and PI-TOF-MRA on a 3-T MR unit with or without cerebral AVS between June 2016 and September 2018. Imaging parameters for both sequences were almost identical, except the acceleration factor of 3× for PI-TOF-MRA and 6.5× for CS-TOF-MRA, and the scan time of 5 min 19 s for PI-TOF-MRA and 2 min 26 s for CS-TOF-MRA. Two neuroradiologists assessed the accuracy of AVS detection on each sequence and analyzed AVS angioarchitecture. Concordance between CS-TOF, PI-TOF, and digital subtraction angiography was calculated using unweighted and weighted kappa statistics. RESULTS Both CS-TOF-MRA and PI-TOF-MRA yielded excellent sensitivity and specificity for detecting intracranial AVS (reviewer 1, 97.3%, 94.7%; reviewer 2, 100%, 100%, respectively). Interrater agreement on the angioarchitectural features of intracranial AVS on CS-MRA and PI-MRA was moderate to good. CONCLUSION The diagnostic performance of CS-TOF-MRA is comparable to that of PI-TOF-MRA in detecting and classifying AVS with a reduced scan time under 2.5 min.
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