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Zhao T, Tang J, Krumpelman C, Moum SJ, Russin JJ, Ansari SA, Chen Z, Feng L, Yan L. Highly accelerated non-contrast-enhanced time-resolved 4D MRA using stack-of-stars golden-angle radial acquisition with a self-calibrated low-rank subspace reconstruction. Magn Reson Med 2024. [PMID: 39344291 DOI: 10.1002/mrm.30304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 08/08/2024] [Accepted: 08/29/2024] [Indexed: 10/01/2024]
Abstract
PURPOSE To develop a highly accelerated non-contrast-enhanced 4D-MRA technique by combining stack-of-stars golden-angle radial acquisition with a modified self-calibrated low-rank subspace reconstruction. METHODS A low-rank subspace reconstruction framework was introduced in radial 4D MRA (SUPER 4D MRA) by combining stack-of-stars golden-angle radial acquisition with control-label k-space subtraction-based low-rank subspace modeling. Radial 4D MRA data were acquired and reconstructed using the proposed technique on 12 healthy volunteers and 1 patient with steno-occlusive disease. The performance of SUPER 4D MRA was compared with two temporally constrained reconstruction methods (golden-angle radial sparse parallel [GRASP] and GRASP-Pro) at different acceleration rates in terms of image quality and delineation of blood dynamics. RESULTS SUPER 4D MRA outperformed the other two reconstruction methods, offering superior image quality with a clear background and detailed delineation of cerebrovascular structures as well as great temporal fidelity in blood flow dynamics. SUPER 4D MRA maintained excellent performance even at higher acceleration rates. CONCLUSIONS SUPER 4D MRA is a promising technique for highly accelerating 4D MRA acquisition without comprising both temporal fidelity and image quality.
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Affiliation(s)
- Tianrui Zhao
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Jianing Tang
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Chase Krumpelman
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah J Moum
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Jonathan J Russin
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sameer A Ansari
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zhifeng Chen
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Li Feng
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Lirong Yan
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
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Prasad Balasubramanian A, Kumar Kannath S, Thomas B, Enakshy Rajan J, Kesavadas C. Comparative study of non-contrast silent and time-of-flight magnetic resonance angiographic sequences in the evaluation of intracranial dural arteriovenous fistula. Clin Radiol 2024; 79:e393-e400. [PMID: 38182477 DOI: 10.1016/j.crad.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 06/02/2023] [Accepted: 11/21/2023] [Indexed: 01/07/2024]
Abstract
AIM To compare the performance of two non-contrast magnetic resonance angiography (MRA) sequences, silent MRA and time of flight (TOF) MRA, in the evaluation of intracranial dural arteriovenous fistula (DAVF). MATERIALS AND METHODS Forty consecutive patients with DAVF were enrolled and evaluated prospectively using silent MRA, TOF MRA, and digital subtraction angiography (DSA). The location, Cognard classification, arterial feeders, and venous drainage were evaluated. The therapeutic strategy and possible route were predicted on both silent and TOF MRA and these were compared with DSA during subsequent endovascular treatment. RESULTS Sensitivity and accuracy of silent and TOF MRA for localisation (96.4% versus 96% and 96% versus 95%, respectively) and classification (96% versus 94% and 96% versus 93.5%, respectively) were high. Silent MRA showed higher sensitivity than TOF MRA for arterial feeders and draining veins (87% versus 79% and 81.6% versus 67%). This improved to a sensitivity of 96.4% and 89% when prominent feeders were considered. The sensitivity and accuracy were 92.6% and 85.8% for immediate draining veins. Both silent and TOF MRA were accurate for therapeutic planning (96% versus 85%), although silent MRA was more accurate. CONCLUSION Silent MRA can more reliably evaluate the various angioarchtectural components of DAVF compared to TOF MRA.
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Affiliation(s)
- A Prasad Balasubramanian
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - S Kumar Kannath
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
| | - B Thomas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - J Enakshy Rajan
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - C Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Jain V, Policeni B, Juliano AF, Adunka O, Agarwal M, Dubey P, Friedman ER, Gule-Monroe MK, Hagiwara M, Hunt CH, Lo BM, Oh ES, Rath TJ, Roberts JK, Schultz D, Taheri MR, Zander D, Burns J. ACR Appropriateness Criteria® Tinnitus: 2023 Update. J Am Coll Radiol 2023; 20:S574-S591. [PMID: 38040471 DOI: 10.1016/j.jacr.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Tinnitus is abnormal perception of sound and has many subtypes. Clinical evaluation, audiometry, and otoscopy should be performed before ordering any imaging, as the choice of imaging will depend on various factors. Type of tinnitus (pulsatile or nonpulsatile) and otoscopy findings of a vascular retrotympanic lesion are key determinants to guide the choice of imaging studies. High-resolution CT temporal bone is an excellent tool to detect glomus tumors, abnormal course of vessels, and some other abnormalities when a vascular retrotympanic lesion is seen on otoscopy. CTA or a combination of MR and MRA/MRV are used to evaluate arterial or venous abnormalities like dural arteriovenous fistula, arteriovenous malformation, carotid stenosis, dural sinus stenosis, and bony abnormalities like sigmoid sinus wall abnormalities in cases of pulsatile tinnitus without a vascular retrotympanic lesion. MR of the brain is excellent in detecting mass lesions such as vestibular schwannomas in cases of unilateral nonpulsatile tinnitus. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Vikas Jain
- MetroHealth Medical Center, Cleveland, Ohio.
| | - Bruno Policeni
- Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Oliver Adunka
- The Ohio State University Wexner Medical Center, Columbus, Ohio; American Academy of Otolaryngology-Head and Neck Surgery
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | - Mari Hagiwara
- New York University Langone Medical Center, New York, New York
| | - Christopher H Hunt
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | - Bruce M Lo
- Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - Esther S Oh
- Johns Hopkins University School of Medicine, Baltimore, Maryland; American Geriatrics Society
| | | | - J Kirk Roberts
- Columbia University Medical Center, New York, New York; American Academy of Neurology
| | - David Schultz
- Evansville Primary Care, Evansville, Indiana; American Academy of Family Physicians
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia
| | | | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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Samp PF, Keil F, du Mesnil R, Birkhold A, Kowarschik M, Hattingen E, Berkefeld J. 4D-DSA for Assessment of the Angioarchitecture and Grading of Cranial Dural AVF. AJNR Am J Neuroradiol 2023; 44:1291-1295. [PMID: 37827722 PMCID: PMC10631524 DOI: 10.3174/ajnr.a8008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/30/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND PURPOSE Time-resolved 3D rotational angiography (4D-DSA) has been used to demonstrate details of the angioarchitecture of AVM, whereas it has rarely been used to describe features of dural AVF. In this exploratory study, we analyzed dural AVFs with a novel 4D software prototype, developed and provided by Siemens, to determine whether identification of the location of the fistulous point, grading, and treatment planning were feasible. MATERIALS AND METHODS 4D-DSA volumes were calculated from existing 3D rotational angiography data sets of patients with dural AVFs. The 4D-DSA volumes were displayed in a virtual DSA mode and MPR or MIP in 3 orthogonal planes and compared with 2D-DSA by 2 experienced neuroradiologists. Fusions with unenhanced CT or MR images were used to improve visualization of adjacent anatomic structures. RESULTS Comparison with 2D-DSA showed that evaluation of the fistulous point and grading according to the classification of Borden, Cognard, or Barrow was feasible in 26 of 27 cases. In 8 of 27 cases, 4D-DSA was considered advantageous for determining the fistulous point and the course of the draining vein in the dural AVF with cortical venous drainage, especially in the frontoethmoidal and frontoparietal regions. In 6 cases, the display of angioarchitecture was considered inferior to that of 2D-DSA due to motion artifacts, suboptimal selection of the injected vessel, and lack of temporal resolution. CONCLUSIONS Detailed analysis of dural AVFs according to the standardized display of 4D-DSA volumes was feasible and helpful in understanding the angioarchitecture in selected cases. Further improvement and validation of the 4D software should solidify the complementary role of 4D-DSA to conventional 2D-DSA series.
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Affiliation(s)
- P F Samp
- From the Institute of Neuroradiology (P.F.S., F.K., R.d.M., E.H., J.B.), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - F Keil
- From the Institute of Neuroradiology (P.F.S., F.K., R.d.M., E.H., J.B.), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - R du Mesnil
- From the Institute of Neuroradiology (P.F.S., F.K., R.d.M., E.H., J.B.), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - A Birkhold
- Siemens Healthcare (A.B., M.K.), Forchheim, Germany
| | - M Kowarschik
- Siemens Healthcare (A.B., M.K.), Forchheim, Germany
| | - E Hattingen
- From the Institute of Neuroradiology (P.F.S., F.K., R.d.M., E.H., J.B.), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - J Berkefeld
- From the Institute of Neuroradiology (P.F.S., F.K., R.d.M., E.H., J.B.), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
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Kandasamy S, Kannath SK, Enakshy Rajana J, Kesavadas C, Thomas B. Non-invasive angiographic analysis of dural carotid cavernous fistula using time-of-flight MR angiography and silent MR angiography: a comparative study. Acta Radiol 2023; 64:1290-1297. [PMID: 35532027 DOI: 10.1177/02841851221097462] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A non-invasive, reliable imaging modality that characterizes cavernous sinus dural arteriovenous fistula (CSDAVF) is beneficial for diagnosis and to assess resolution on follow-up. PURPOSE To assess the utility of 3D time-of-flight (TOF) and silent magnetic resonance angiography (MRA) for evaluation of CSDAVF from an endovascular perspective. MATERIAL AND METHODS This prospective study included 37 patients with CSDAVF, who were subjected to digital subtraction angiography (DSA) and 3-T MR imaging with 3D TOF and silent MRA. The main arterial feeders, fistula site, and venous drainage pattern were evaluated, and the results were compared with DSA findings. The diagnostic confidence scores were also recorded using a 4-point Likert scale. RESULTS Silent MRA correlated better for shunt site localization and angiographic classification (86% vs. 75% and 83% vs. 75%, respectively) compared to TOF MRA. The proportion of arterial feeders detected was marginally significant for silent MRA over TOF MRA sequences (92.8% vs. 89.5%; P=0.048), though for veins both were comparable. Sensitivity of silent MRA was higher for identification of cortical venous reflux (CVR) (90.9% vs. 81.8%) and deep venous drainage (82.4% vs. 64.7%), while specificity was >90% for both modalities. The overall diagnostic confidence score fared better for silent MRA for venous assessment (P < 0.001) as well as fistula point identification (P < 0.001), while no significant difference was evident with TOF MRA for arterial feeders (P=0.06). CONCLUSION Various angiographic components of CSDAVF could be identified and delineated by 3D TOF and silent MRA, though silent MRA was superior for overall diagnostic assessment.
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Affiliation(s)
- Sathish Kandasamy
- Department of Imaging Sciences and Interventional Radiology, 29354Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
- Department of Interventional Radiology, 29904G Kuppusamy Naidu, Memorial Hospital, Coimbatore, Tamil nadu, India
| | - Santhosh Kumar Kannath
- Department of Imaging Sciences and Interventional Radiology, 29354Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jayadevan Enakshy Rajana
- Department of Imaging Sciences and Interventional Radiology, 29354Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Chandrasekaran Kesavadas
- Department of Imaging Sciences and Interventional Radiology, 29354Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Bejoy Thomas
- Department of Imaging Sciences and Interventional Radiology, 29354Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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Rutman AM, Wangaryattawanich P, Aksakal M, Mossa-Basha M. Incidental vascular findings on brain magnetic resonance angiography. Br J Radiol 2023; 96:20220135. [PMID: 35357891 PMCID: PMC9975521 DOI: 10.1259/bjr.20220135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 01/27/2023] Open
Abstract
Given the ever-increasing utilization of magnetic resonance angiography, incidental vascular findings are increasingly discovered on exams performed for unconnected indications. Some incidental lesions represent pathology and require further intervention and surveillance, such as aneurysm, certain vascular malformations, and arterial stenoses or occlusions. Others are benign or represent normal anatomic variation, and may warrant description, but not further work-up. This review describes the most commonly encountered incidental findings on magnetic resonance angiography, their prevalence, clinical implications, and any available management recommendations.
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Affiliation(s)
| | | | - Mehmet Aksakal
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Mahmud Mossa-Basha
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
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7
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Overview of multimodal MRI of intracranial Dural arteriovenous fistulas. J Interv Med 2022; 5:173-179. [DOI: 10.1016/j.jimed.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/05/2022] [Accepted: 04/16/2022] [Indexed: 11/29/2022] Open
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Chen X, Ge L, Wan H, Huang L, Jiang Y, Lu G, Wang J, Zhang X. Differential subsampling with cartesian ordering: A high spatial-temporal resolution dixon imaging sequence for assessment of dural arteriovenous fistula. Front Neurol 2022; 13:1020749. [PMID: 36330430 PMCID: PMC9622796 DOI: 10.3389/fneur.2022.1020749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the accuracy of differential subsampling with cartesian ordering (DISCO) in comparison to time of flight (TOF) in detecting dural arteriovenous fistulas (DAVF), cerebral venous thrombosis (CVT) and hemodynamics. Methods Sixty-two cases (24 female; aged 14–75; mean age, 51.3 years) were included in our study, with 42 positive and 20 negative cases via Digital Subtraction Angiography (DSA). Two neuroradiologists independently evaluated the DISCO and TOF. The sensitivity, specificity, and accuracy of the DISCO and TOF-MRA were individually calculated using DSA as the gold standard. Inter-observer reliability was assessed by using a weighted Cohen's kappa (κ) test; P < 0.05 was set as the threshold for statistical significance. Results Diagnostic sensitivities of DISCO and TOF for DAVF were 92.86 and 64.29%; specificities were 95.0% and 95.0%; while accuracies were 93.55 and 74.19% respectively. For detected CVT, sensitivities of DISCO and TOF were 100 and 92.31%; specificities were 96.55 and 93.10%; with accuracies 97.62 and 92.86% respectively. In hemodynamic analysis, sensitivity of DISCO for reflux was 95.45%; with a specificity of 95.0%; and accuracy 95.24%. The inter-observer kappa values were 0.857 for DISCO (P < 0.001). Conclusion DISCO showed a high degree of sensitivity and specificity, suggesting its effectiveness in detecting DAVF with or without CVT. Intracranial hemodynamics can be identified using DISCO in DAVF patients, providing accurate evaluation of cerebral blood flow dynamics during the pre-treatment phase.
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Togao O, Obara M, Kikuchi K, Helle M, Arimura K, Nishimura A, Wada T, Murazaki H, Van Cauteren M, Hiwatashi A, Ishigami K. Vessel-Selective 4D-MRA Using Superselective Pseudocontinuous Arterial Spin-Labeling with Keyhole and View-Sharing for Visualizing Intracranial Dural AVFs. AJNR Am J Neuroradiol 2022; 43:368-375. [PMID: 35241425 PMCID: PMC8910818 DOI: 10.3174/ajnr.a7426] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/11/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE An accurate assessment of the hemodynamics of an intracranial dural AVF is necessary for treatment planning. We aimed to investigate the utility of 4D-MRA based on superselective pseudocontinuous arterial spin-labeling with CENTRA-keyhole and view-sharing (4D-S-PACK) for the vessel-selective visualization of intracranial dural AVFs. MATERIALS AND METHODS We retrospectively analyzed the images of 21 patients (12 men and 9 women; mean age, 62.2 [SD,19.2] years) with intracranial dural AVFs, each of whom was imaged with DSA, 4D-S-PACK, and nonselective 4D-MRA based on pseudocontinuous arterial spin-labeling combined with CENTRA-keyhole and view-sharing (4D-PACK). The shunt location, venous drainage patterns, feeding artery identification, and Borden classification were evaluated by 2 observers using both MRA methods on separate occasions. Vessel selectivity was evaluated on 4D-S-PACK. RESULTS Shunt locations were correctly evaluated in all 21 patients by both observers on both MRA methods. With 4D-S-PACK, observers 1 and 2 detected 76 (80.0%, P < .001) and 73 (76.8%, P < .001) feeding arteries of the 95 feeding arteries identified on DSA but only 39 (41.1%) and 46 (48.4%) feeding arteries with nonselective 4D-PACK, respectively. Both observers correctly identified 10 of the 11 patients with cortical venous reflux confirmed by DSA with both 4D-S-PACK and 4D-PACK (sensitivity = 90.9%, specificity = 90.9% for each method), and they made accurate Borden classifications in 20 of the 21 patients (95.2%) on both MRA methods. Of the 84 vessel territories examined, vessel selectivity was graded 3 or 4 in 73 (91.2%) and 66 (88.0%) territories by observers 1 and 2, respectively. CONCLUSIONS 4D-S-PACK is useful for the identification of feeding arteries and accurate classifications of intracranial dural AVFs and can be a useful noninvasive clinical tool.
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Affiliation(s)
- O. Togao
- From the Departments of Molecular Imaging & Diagnosis (O.T.)
| | - M. Obara
- Philips Japan (M.O., M.V.C.), Tokyo, Japan
| | | | - M. Helle
- Philips Research (M.H.), Hamburg, Germany
| | - K. Arimura
- Neurosurgery (K.A., A.N.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - A. Nishimura
- Neurosurgery (K.A., A.N.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T. Wada
- Division of Radiology (T.W., H.M.), Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - H. Murazaki
- Division of Radiology (T.W., H.M.), Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
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Differentiation of transverse sinus thrombosis from congenitally atretic transverse sinus with time-resolved contrast-enhanced magnetic resonance angiography. Clin Radiol 2022; 77:e372-e378. [DOI: 10.1016/j.crad.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/01/2022] [Indexed: 01/21/2023]
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11
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Ledbetter LN, Burns J, Shih RY, Ajam AA, Brown MD, Chakraborty S, Davis MA, Ducruet AF, Hunt CH, Lacy ME, Lee RK, Pannell JS, Pollock JM, Powers WJ, Setzen G, Shaines MD, Utukuri PS, Wang LL, Corey AS. ACR Appropriateness Criteria® Cerebrovascular Diseases-Aneurysm, Vascular Malformation, and Subarachnoid Hemorrhage. J Am Coll Radiol 2021; 18:S283-S304. [PMID: 34794589 DOI: 10.1016/j.jacr.2021.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022]
Abstract
Cerebrovascular disease is a broad topic. This document focuses on the imaging recommendations for the varied clinical scenarios involving intracranial aneurysms, vascular malformations, and vasculitis, which all carry high risk of morbidity and mortality. Additional imaging recommendations regarding complications of these conditions, including subarachnoid hemorrhage and vasospasm, are also covered. While each variant presentation has unique imaging recommendations, the major focus of this document is neurovascular imaging techniques. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Luke N Ledbetter
- Director, Head and Neck Imaging, University of California Los Angeles, Los Angeles, California.
| | - Judah Burns
- Panel Chair and Program Director, Diagnostic Radiology Residency Program, Montefiore Medical Center, Bronx, New York
| | - Robert Y Shih
- Panel Vice-Chair, Uniformed Services University, Bethesda, Maryland
| | - Amna A Ajam
- Ohio State University, Columbus, Ohio; Chief of Neuroradiology & MRI at WRNMMC; and Associate Chief of Neuroradiology for AIRP
| | - Michael D Brown
- Michigan State University, East Lansing, Michigan, American College of Emergency Physicians
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists
| | - Melissa A Davis
- Director of Quality, Radiology, Emory University, Atlanta, Georgia; ACR YPS Communications Liaison
| | - Andrew F Ducruet
- Barrow Neurological Institute, Phoenix, Arizona, Neurosurgery expert
| | | | - Mary E Lacy
- University of New Mexico, Albuquerque, New Mexico, American College of Physicians
| | - Ryan K Lee
- Chair, Department of Radiology, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Jeffrey S Pannell
- University of California San Diego Medical Center, San Diego, California
| | | | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology; Chair, Writing Group, American Heart Association/American Stroke Association Guidelines for the Early Management of Patients with Acute Ischemic Stroke, 2016-2019
| | - Gavin Setzen
- Albany ENT & Allergy Services, PC, Albany, New York; American Academy of Otolaryngology-Head and Neck Surgery; President, Albany ENT & Allergy Services, PC
| | - Matthew D Shaines
- Associate Chief, Hospital Medicine, Albert Einstein College of Medicine Montefiore Medical Center, Bronx, New York; Internal medicine physician
| | - Pallavi S Utukuri
- Clinical Site Director, Department of Radiology, Allen Hospital, New York Presbyterian, New York, New York; and Columbia University Medical Center, New York, New York
| | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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12
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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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The "Shiny and Thick High Heel Sign" : A novel radiologic sign for detecting intracranial dural arteriovenous fistulas with time-of-flight magnetic resonance angiography. Clin Neuroradiol 2021; 32:465-470. [PMID: 34104975 PMCID: PMC9187571 DOI: 10.1007/s00062-021-01036-y] [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: 12/30/2020] [Accepted: 04/29/2021] [Indexed: 10/28/2022]
Abstract
PURPOSE Together with the foramen ovale, the middle meningeal artery (MMA) looks like a high heel shoe print on axial time-of-flight magnetic resonance angiography (TOF-MRA) images, with the MMA resembling the heel. Cranial dural arteriovenous fistulas (DAVF) are often fed by the MMA, which can lead to an increase of signal intensity and diameter of this vessel, resulting in a more "shiny" and "thick" high heel print appearance than on the contralateral side. We describe this finding as a novel radiologic sign and provide cut-off values for the ratios of MMA signal intensities and diameters for predicting the presence of a DAVF. METHODS A total of 84 TOF-MRA examinations of 44 patients with DAVFs (40 with unilateral MMA feeders, 4 with bilateral feeders) and of 40 patients without DAVFs were included. Diameters and signal intensities of both MMAs were measured by two raters and evaluated using receiver operating characteristic analysis. RESULTS The diameters of feeding and non-feeding MMAs differed significantly, as did the ratios of signal intensities and of diameters of DAVF and control patients (P < 0.0001). Cut-off values were 1.25 for average signal intensity ratio (shiny high heel sign) and 1.21 for diameter ratio (thick high heel sign). The combination of the "shiny" and the "thick" high heel sign resulted in the highest sensitivity (92.5%) and positive predictive value (95%). CONCLUSION The described sign seems promising for the detection of DAVFs with noncontrast-enhanced MRI. The TOF-MRA source images should be reviewed with special attention to the MMA.
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Schuchardt FF, Demerath T, Elsheikh S, Wehrum T, Harloff A, Urbach H, Meckel S. Dural Arteriovenous Fistula Formation Secondary to Cerebral Venous Thrombosis: Longitudinal Magnetic Resonance Imaging Assessment Using 4D-Combo-MR-Venography. Thromb Haemost 2021; 121:1345-1352. [PMID: 33657624 DOI: 10.1055/s-0041-1723991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Dural arteriovenous fistulae (DAVFs) can develop secondary to cerebral venous thrombosis (CVT). The incidence of DAVF has not yet been investigated prospectively. METHODS Between July 2012 and January 2018, combined static and dynamic 4D MR venography (4D-combo-MRV) was performed in 24 consecutive patients at diagnosis of CVT and after 6 months. 3 Tesla magnetic resonance imaging with time of flight and contrast-enhanced magnetization-prepared rapid acquisition with gradient echo were performed at baseline to evaluate the extent of thrombosis and affected vessel segments. Baseline and follow-up 4D-combo-MRV were assessed for signs of DAVF. Interrater reliability of DAVF detection and the extent of recanalization were analyzed with kappa statistics. RESULTS DAVFs were detected in 4/30 CVT patients (13.3%, 95% confidence interval [CI] 3.3-26.7). Two of 24 patients (8.3%, 95% CI: 0-20.8) had coincidental DAVF with CVT on admission. At follow-up, de novo formation of DAVF following CVT was seen in 2/24 patients (8.3%, 95% CI: 0-20.8). Both de novo DAVFs were low grade and benign fistulae (Cognard type 1, 2a), which had developed at previously thrombosed segments. Endovascular treatment was required in two high degree lesions (Cognard 2a + b) detected at baseline and in one de novo DAVF (Cognard 1) because of debilitating headache and tinnitus. Thrombus load, vessel recanalization, and frequency of cerebral lesions (hemorrhage, ischemia) were not associated with DAVF occurrence. CONCLUSION This exploratory study showed that de novo DAVF formation occurs more frequently than previously described. Although de novo DAVFs were benign, 75% of all detected DAVFs required endovascular treatment. Therefore, screening for DAVF by dynamic MRV, such as 4D-combo-MRV, seems worthwhile in CVT patients.
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Affiliation(s)
- Florian F Schuchardt
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Theo Demerath
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Samer Elsheikh
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Wehrum
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Harloff
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stephan Meckel
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Neuroradiology, Kepler University Hospital Linz, Neuromed Campus, Linz, Austria
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15
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Dissaux B, Eugène F, Ognard J, Gauvrit JY, Gentric JC, Ferré JC. Assessment of 4D MR Angiography at 3T Compared with DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: A Dual-Center Study. AJNR Am J Neuroradiol 2020; 42:340-346. [PMID: 33334853 DOI: 10.3174/ajnr.a6903] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/27/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE 4D contrast-enhanced MRA in the follow-up of treated dural arteriovenous fistulas has rarely been evaluated. Our aim was to evaluate its diagnostic performance at 3T in the follow-up of embolized dural arteriovenous fistulas using DSA as the standard of reference. MATERIALS AND METHODS Patients treated for dural arteriovenous fistulas in 2 centers between 2008 and 2019 were included if they met the following criteria: 1) dural arteriovenous fistula embolization, and 2) follow-up imaging with <6 months between DSA and 4D contrast-enhanced MRA. Two readers reviewed the 4D contrast-enhanced MRA images, first independently, then in consensus to detect any residual/recurrent dural arteriovenous fistula and to grade cases according to the Cognard classification system. Interobserver and intermodality agreement for the detection of a residual dural arteriovenous fistula and stratification of bleeding risk (0-I-IIa; IIb-IIa+b-III-IV-V) was calculated using κ coefficients. RESULTS A total of 51 pairs of examinations for 44 patients (median age, 65 years; range, 25-81 years) were analyzed. Interobserver agreement for the detection and stratification of bleeding risk was, respectively, κ = 0.8 (95% CI, 0.6-1) and κ = 0.8 (95% CI, 0.5-1). After consensus review, the sensitivity and specificity of 4D contrast-enhanced MRA for the detection of residual/recurrent dural arteriovenous fistula was 63.6% (95% CI, 40.7%-82.8%) and 96.6% (95% CI, 82.2%-99.9%), respectively. The positive and negative predictive values of 4D contrast-enhanced MRA were 93.3% (95% CI, 68.1%-99.8%) and 77.8% (95% CI, 60.8%-89.9%). Intermodality agreement for the detection and stratification of bleeding risk was good, with κ = 0.60 (95% CI, 0.3-0.8). CONCLUSIONS 4D contrast-enhanced MRA at 3T is of interest in the follow-up of treated dural arteriovenous fistulas but lacks the sensitivity to replace arteriography.
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Affiliation(s)
- B Dissaux
- From the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France .,Department of Medical Imaging (B.D., J.O., J.-C.G.), Centre Hospitalier Universitaire La Cavale Blanche, Brest, France.,GETBO group EA3878 (B.D., J.-C.G.), Université de Bretagne Occidentale, Brest, France
| | - F Eugène
- From the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France
| | - J Ognard
- Department of Medical Imaging (B.D., J.O., J.-C.G.), Centre Hospitalier Universitaire La Cavale Blanche, Brest, France.,LATIM U1101 (J.O.), INSERM, Université de Bretagne Occidentale, Brest, France
| | - J-Y Gauvrit
- From the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France.,Empenn Unit U1228 (J.-Y.G., J.-C.F.), INSERM, INRIA, Université Rennes 1, Rennes, France
| | - J-C Gentric
- Department of Medical Imaging (B.D., J.O., J.-C.G.), Centre Hospitalier Universitaire La Cavale Blanche, Brest, France.,GETBO group EA3878 (B.D., J.-C.G.), Université de Bretagne Occidentale, Brest, France
| | - J-C Ferré
- From the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France.,Empenn Unit U1228 (J.-Y.G., J.-C.F.), INSERM, INRIA, Université Rennes 1, Rennes, France
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16
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Iwamura M, Midorikawa H, Shibutani K, Kakuta A, Maruyama S, Yotsuya C, Tatsuo S, Fujita H, Kakehata S, Tsushima F, Nozaki A, Sugimoto K, Kakeda S. High-signal venous sinuses on MR angiography: discrimination between reversal of venous flow and arteriovenous shunting using arterial spin labeling. Neuroradiology 2020; 63:889-896. [PMID: 33089421 DOI: 10.1007/s00234-020-02588-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE It is sometimes difficult to differentiate between high signals originating from a reverse flow on magnetic resonance angiography (MRA) and occult arteriovenous shunting. We attempted to determine whether arterial spin labeling (ASL) can be used to discriminate reversal of venous flow from arteriovenous shunting for high-signal venous sinuses on MR angiography. METHODS Two radiologists evaluated the signals of the venous sinus on MRA and ASL obtained from 364 cases without arteriovenous shunting. In addition, the findings on MRA were compared with those on ASL in an additional 13 patients who had dural arteriovenous fistula (DAVF). RESULTS In the 364 cases (728 sides) without arteriovenous shunting, a high signal due to reverse flow in the cavernous sinuses (CS) was observed on 99 sides (13.6%) on MRA and none on ASL. Of these cases, a high signal in the sigmoid sinus, transverse sinus, and internal jugular vein was seen on 3, 3, and 8 sides, respectively. All of these venous sinuses showed a high signal from the reverse flow on MRA images. CONCLUSION ASL is a simple and useful MR imaging sequence for differentiating between reversal of venous flow and CS DAVF. In the sigmoid and transverse sinus, ASL showed false-positives due to the reverse flow from the jugular vein, which may be a limitation of which radiologists should be aware.
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Affiliation(s)
- Masatoshi Iwamura
- Department of Radiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
- Department of Interventional Neuroradiology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Hiroshi Midorikawa
- Department of Interventional Neuroradiology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Koichi Shibutani
- Department of Radiology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Akihisa Kakuta
- Department of Radiology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Sho Maruyama
- Department of Radiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Chihiro Yotsuya
- Department of Radiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Soichiro Tatsuo
- Department of Radiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hiromasa Fujita
- Department of Radiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Shinya Kakehata
- Department of Radiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Fumiyasu Tsushima
- Department of Radiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Atsushi Nozaki
- MR Applications and Workflow Asia Pacific, GE Healthcare, Hino, Japan
| | - Koichiro Sugimoto
- Department of Radiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shingo Kakeda
- Department of Radiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
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Penailillo E, Bravo-Grau S, Plaza N, Cruz JP. Cerebral Venous Thrombosis: Review of Diagnosis, Follow-Up, Late Complications and Potential Pitfalls. Curr Probl Diagn Radiol 2020; 50:725-733. [PMID: 32950306 DOI: 10.1067/j.cpradiol.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/21/2020] [Indexed: 11/22/2022]
Abstract
Cerebral venous thrombosis is a less common but relevant cause of stroke in adults. The clinical manifestations are nonspecific leading frequently diagnostic delays, so imaging findings are is of vital importance. Conventional imaging modalities, namely computed tomography and magnetic resonance imaging (MRI), allow identification of the thrombus and parenchymal involvement due to venous congestion to a variable degree, but this entity may appears as a nonexpected finding in a nonvenographic study. computed tomography and MRI venographies allow noninvasive confirmation of the diagnosis and adequate characterization of the extent of the thrombus and acute complications, both of them being robust diagnostic techniques. MR venography also can be done without the use of contrast media, which is especially important in certain clinical situations. Cerebral venous thrombosis needs follow-up, and imaging plays a key role in detection of late complications of the disease, including dural arteriovenous fistulas and intracranial hypertension due to veno-occlusive disease. Knowledge of other diseases and conditions that may mimic a thrombus is needed to avoid wrong diagnosis. In this article, we conduct a pictorial comprehensive review of cerebral venous thrombosis, including also the technical aspects of different imaging modalities, diagnosis and acute complications, follow-up, late complications and potential imaging mimics.
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Affiliation(s)
- Eduardo Penailillo
- Department of Radiology, Neuroradiology Section, Pontificia Universidad Catolica de Chile, Santiago Region Metropolitana, Chile
| | - Sebastian Bravo-Grau
- Department of Radiology, Neuroradiology Section, Pontificia Universidad Catolica de Chile, Santiago Region Metropolitana, Chile
| | - Nicole Plaza
- Department of Radiology, Neuroradiology Section, Pontificia Universidad Catolica de Chile, Santiago Region Metropolitana, Chile
| | - Juan Pablo Cruz
- Department of Radiology, Neuroradiology Section, Pontificia Universidad Catolica de Chile, Santiago Region Metropolitana, Chile.
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18
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Kashiwagi N, Miyazaki K, Takahashi H, Tsuji K, Fujiwara M, Arisawa A, Nakamura H, Kishima H, Ishii K, Tomiyama N. Spontaneous closure of non-cavernous sinus dural arteriovenous fistulas: A case series and systematic review of the literature. J Neuroradiol 2020; 49:94-100. [PMID: 32918945 DOI: 10.1016/j.neurad.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE To report 9 new cases of non-cavernous sinus dural arteriovenous fistulas (NCS-DAVFs) that closed spontaneously and systematically review reports of other cases in the literature. MATERIAL AND METHODS We performed a retrospective analysis of 9 cases from 2 institutions of NCS-DAVFs that closed spontaneously. Using PubMed and Scopus in accordance with the PRISMA guidelines, we systematically reviewed English language articles about NCS-DAVFs showing spontaneous closure. RESULTS Review of the cases from 2 institutions identified 9 cases of NCS-DAVFs showing spontaneous closure in follow-up magnetic resonance angiography (MRA), and the systematic review of the literature yielded an additional 38 cases, which had been diagnosed by repeated arteriography. Collectively, the patients included 23 men and 24 women with a mean age of 54 years. The shunts were located in the transverse-sigmoid sinus in 24 cases (51%), anterior condylar confluence in 11, and other locations in 12. Based on the venous drainage pattern on arteriography, 27 cases (57%) were classified as low-risk NCS-DAVF (without cortical venous reflux) and 17 were classified as high-risk NCS-DAVF (with cortical venous reflux). Shunt closure was observed within 3 months in 17 cases (36%). Extrinsic predisposing factors for shunt closure were detected in 14 cases (30%). These included angiography in 7 cases, sinus recanalization in 4, development of sinus occlusion in 2, and sinus compression by a newly developed hematoma in 1. CONCLUSION Spontaneous closures of NCS-DAVFs can occur for both high- and low-risk types. One-third of these closures occur within 3 months.
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Affiliation(s)
- Nobuo Kashiwagi
- Department of Future Diagnostic Radiology, Osaka University Graduate School of Medicine, Japan.
| | - Koichi Miyazaki
- Department of Radiology, Kindai University Faculty of Medicine, Japan.
| | - Hiroto Takahashi
- Center for twin research, Osaka University Graduate School of Medicine, Japan.
| | - Kiyoshi Tsuji
- Department of Neurosurgery, Kindai University Faculty of Medicine, Japan.
| | - Masahiro Fujiwara
- Department of Radiology, Osaka University Graduate School of Medicine, Japan.
| | - Atsuko Arisawa
- Department of Radiology, Osaka University Graduate School of Medicine, Japan.
| | - Hajime Nakamura
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Japan.
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Japan.
| | - Kazunari Ishii
- Department of Radiology, Kindai University Faculty of Medicine, Japan.
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Japan.
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Jugular Venous Reflux Can Mimic Posterior Fossa Dural Arteriovenous Fistulas on MRI-MRA. AJR Am J Roentgenol 2020; 216:1626-1633. [PMID: 32876481 DOI: 10.2214/ajr.20.24012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dural arteriovenous fistulas (DAVFs) are high-flow acquired shunts that can carry high risk of intracranial hemorrhage. Because DAVFs can often be managed by endovascular means, early and accurate diagnosis can markedly improve patient morbidity. Time-of-flight and arterial spin-labeling MRA have increased the diagnostic utility of MRI for DAVF by showing hemodynamic rather than anatomic evidence of shunting. The purpose of this article is to describe the cases of seven patients who had co-localization of arterial spin-labeling signal intensity and time-of-flight flow-related enhancement in the left skull base, resulting in a misdiagnosis of DAVF and a recommendation for catheter angiography by the interpreting radiologist. Benign jugular venous reflux is identified as a common mechanism in each case, and the physiology behind this imaging pitfall is described. An algorithmic diagnostic approach to differentiating physiologic venous reflux from true posterior skull base DAVFs is presented.
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20
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Lim KC, Raj S, Kee TP, Sim S, Ho Mien I, Ho JXM, McAdory LE, Lim WEH, Chan LL. Cryptic asymptomatic parasellar high signal on time-of-flight MR angiography: how to resolve the clinical conundrum. Neuroradiology 2020; 62:1553-1564. [DOI: 10.1007/s00234-020-02482-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
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21
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Tong D, Chen X, Lv X, Li K, Xu K, Yu J. Current status of endovascular treatment for dural arteriovenous fistulae in the tentorial middle region: a literature review. Acta Neurol Belg 2019; 119:5-14. [PMID: 30430430 DOI: 10.1007/s13760-018-1044-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023]
Abstract
The tentorial middle region (TMR) includes the midline and paramedian tentorium. TMR dural arteriovenous fistulae (DAVFs) are complex. We performed a review of the literature on TMR DAVFs. TMR DAVFs are divided into the following four types: incisural DAVF, Galenic DAVF, straight sinus DAVF and torcular DAVF. TMR DAVFs often drain into pial veins; therefore, most TMR DAVFs are classified as Borden II-III and Cognard types IIb-IV, whose characteristics cause TMR DAVFs to be prone to hemorrhage. TMR DAVFs have a very disappointing natural progression, and treatment is necessary. TMR DAVFs have extensive arterial supply and complex venous drainages, making them difficult to treat. Currently, for TMR DAVF, endovascular treatment (EVT) has become a better option. In EVT, transarterial embolization is the first-line treatment. Many complications can occur when treating TMR DAVFs, but complete EVT can generally achieve good clinical outcomes. In this review, three educational cases with demonstrating figures are provided to elaborate TMR DAVFs.
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Affiliation(s)
- Dan Tong
- Department of Radiology, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Xuan Chen
- Department of Neurosurgery, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Litanglu 168#, Beijing, 102218, China
| | - Kailing Li
- Department of Neurosurgery, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China.
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22
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Amukotuwa SA, Marks MP, Zaharchuk G, Calamante F, Bammer R, Fischbein N. Arterial Spin-Labeling Improves Detection of Intracranial Dural Arteriovenous Fistulas with MRI. AJNR Am J Neuroradiol 2018; 39:669-677. [PMID: 29545245 DOI: 10.3174/ajnr.a5570] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 12/26/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial dural arteriovenous fistulas carry a risk of substantial neurologic complications but can be difficult to detect on structural MR imaging and TOF-MRA. The purpose of this study was to assess the accuracy and added value of 3D pseudocontinuous arterial spin-labeling MR imaging for the detection of these lesions. MATERIALS AND METHODS This retrospective study included 39 patients with a dural arteriovenous fistula and 117 controls who had undergone both DSA and MR imaging with pseudocontinuous arterial spin-labeling. Two neuroradiologists blinded to the DSA results independently assessed MR imaging with and without pseudocontinuous arterial spin-labeling. They recorded specific signs, including venous arterial spin-labeling signal, and the likelihood of a dural arteriovenous fistula using a 5-point Likert scale. Logistic regression and receiver operating characteristic analyses were performed to determine the accuracy of specific signs and the added value of pseudocontinuous arterial spin-labeling. Interobserver agreement was determined by using κ statistics. RESULTS Identification of the venous arterial spin-labeling signal had a high sensitivity (94%) and specificity (88%) for the presence a dural arteriovenous fistula. Receiver operating characteristic analysis showed significant improvement in diagnostic performance with the addition of pseudocontinuous arterial spin-labeling in comparison with structural MR imaging (Δarea under the receiver operating characteristic curve = 0.179) and a trend toward significant improvement in comparison with structural MR imaging with time-of-flight MRA (Δarea under the receiver operating characteristic curve = 0.043). Interobserver agreement for the presence of a dural arteriovenous fistula improved substantially and was almost perfect with the addition of pseudocontinuous arterial spin-labeling (κ = 0.92). CONCLUSIONS Venous arterial spin-labeling signal has high sensitivity and specificity for the presence of a dural arteriovenous fistula, and the addition of pseudocontinuous arterial spin-labeling increases confidence in the diagnosis of this entity on MR imaging.
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Affiliation(s)
- S A Amukotuwa
- From the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California
- Florey Department of Neuroscience and Mental Health (S.A.A., F.C.), University of Melbourne, Melbourne, Victoria, Australia
| | - M P Marks
- From the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California
| | - G Zaharchuk
- From the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California
| | - F Calamante
- Florey Department of Neuroscience and Mental Health (S.A.A., F.C.), University of Melbourne, Melbourne, Victoria, Australia
| | - R Bammer
- From the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California
| | - N Fischbein
- From the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California
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ACR Appropriateness Criteria ® Cerebrovascular Disease. J Am Coll Radiol 2018; 14:S34-S61. [PMID: 28473091 DOI: 10.1016/j.jacr.2017.01.051] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 11/23/2022]
Abstract
Diseases of the cerebral vasculature represent a heterogeneous group of ischemic and hemorrhagic etiologies, which often manifest clinically as an acute neurologic deficit also known as stroke or less commonly with symptoms such as headache or seizures. Stroke is the fourth leading cause of death and is a leading cause of serious long-term disability in the United States. Eighty-seven percent of strokes are ischemic, 10% are due to intracerebral hemorrhage, and 3% are secondary to subarachnoid hemorrhage. The past two decades have seen significant developments in the screening, diagnosis, and treatment of ischemic and hemorrhagic causes of stroke with advancements in CT and MRI technology and novel treatment devices and techniques. Multiple different imaging modalities can be used in the evaluation of cerebrovascular disease. The different imaging modalities all have their own niches and their own advantages and disadvantages in the evaluation of cerebrovascular disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Accelerated Time-Resolved Contrast-Enhanced Magnetic Resonance Angiography of Dural Arteriovenous Fistulas Using Highly Constrained Reconstruction of Sparse Cerebrovascular Data Sets. Invest Radiol 2017; 51:365-71. [PMID: 26488372 DOI: 10.1097/rli.0000000000000212] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Time-resolved contrast-enhanced magnetic resonance angiography (MRA) is commonly used to noninvasively characterize vascular malformations. However, the spatial and temporal resolution of current methods often compromises the clinical value of the examinations. Constrained reconstruction is a temporal spatial correlation strategy that exploits the relative sparsity of vessels in space to dramatically reduce the amount of data required to generate fast high-resolution time-resolved contrast-enhanced MRA studies. In this report, we use a novel temporal spatial acceleration method termed HYPRFlow to diagnose and classify dural arteriovenous fistulas (DAVFs). Our hypothesis is that HYPRFlow images are of adequate diagnostic image quality to delineate the arterial and venous components of DAVFs and allow correct classification using the Cognard system. SUBJECTS AND METHODS Eight patients with known DAVFs underwent HYPRFlow imaging with isotropic resolution of 0.68 mm and temporal resolution of 0.75 second and 3-dimensional time-of-flight (3DTOF) MRA. The 3DTOF images and HYPRFlow images were evaluated by 2 readers and scored for arterial anatomic image quality. Digital subtraction angiography (DSA) was available for comparison in 7 subjects, and for these patients, each DAVF was classified according to the Cognard system using HYPRFlow and DSA examinations. Digital subtraction angiography was considered the reference examination or criterion standard. RESULTS HYPRFlow imaging classification was concordant with DSA in all but 1 case. There was no difference in the arterial image quality scores between HYPRFlow and 3DTOF MRA (95% confidence interval). Arterial-to-venous separation was rated excellent (n = 3), good (n = 4), or poor (n = 1), and arteriovenous shunting was easily appreciated. Undersampling artifacts were reduced by using a low pass filter and did not interfere with the diagnostic quality of the examinations. CONCLUSIONS HYPRFlow is a novel acquisition and reconstruction technique that exploits the relative sparsity of intracranial vessels in space to increase temporal and spatial resolution and provides accurate delineation of DAVF vasculature.
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Lang S, Gölitz P, Struffert T, Rösch J, Rössler K, Kowarschik M, Strother C, Doerfler A. 4D DSA for Dynamic Visualization of Cerebral Vasculature: A Single-Center Experience in 26 Cases. AJNR Am J Neuroradiol 2017; 38:1169-1176. [PMID: 28408632 DOI: 10.3174/ajnr.a5161] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/23/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE 4D DSA allows acquisition of time-resolved 3D reconstructions of cerebral vessels by using C-arm conebeam CT systems. The aim of our study was to evaluate this new method by qualitative and quantitative means. MATERIALS AND METHODS 2D and 4D DSA datasets were acquired in patients presenting with AVMs, dural arteriovenous fistulas, and cerebral aneurysms. 4D DSA was compared with 2D DSA in a consensus reading of qualitative and quantitative parameters of AVMs (eg, location, feeder, associated aneurysms, nidus size, drainage, Martin-Spetzler Score), dural arteriovenous fistulas (eg, fistulous point, main feeder, diameter of the main feeder, drainage), and cerebral aneurysms (location, neck configuration, aneurysmal size). Identifiability of perforators and diameters of the injection vessel (ICA, vertebral artery) were analyzed in 2D and 4D DSA. Correlation coefficients and a paired t test were calculated for quantitative parameters. The effective patient dose of the 4D DSA protocol was evaluated with an anthropomorphic phantom. RESULTS In 26 patients, datasets were acquired successfully (AVM = 10, cerebral aneurysm = 10, dural arteriovenous fistula = 6). Qualitative and quantitative evaluations of 4D DSA in AVMs (nidus size: r = 0.99, P = .001), dural arteriovenous fistulas (diameter of the main feeder: r = 0.954, P = .03), and cerebral aneurysms (aneurysmal size: r = 1, P = .001) revealed nearly complete accordance with 2D DSA. Perforators were comparably visualized with 4D DSA. Measurement of the diameter of the injection vessel in 4D DSA was equivalent to that in 2D DSA (P = .039). The effective patient dose of 4D DSA was 1.2 mSv. CONCLUSIONS 4D DSA is feasible for imaging of AVMs, dural arteriovenous fistulas, and cerebral aneurysms. 4D DSA offers reliable visualization of the cerebral vasculature and may improve the understanding and treatment of AVMs and dural arteriovenous fistulas. The number of 2D DSA acquisitions required for an examination may be reduced through 4D DSA.
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Affiliation(s)
- S Lang
- From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.)
| | - P Gölitz
- From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.)
| | - T Struffert
- From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.)
| | - J Rösch
- From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.)
| | - K Rössler
- Neurosurgery (K.R.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - M Kowarschik
- Angiography & Interventional X-Ray Systems (M.K.), Siemens Healthcare GmbH, Forchheim, Germany
| | - C Strother
- Department of Radiology (C.S.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - A Doerfler
- From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.)
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Abdel Razek AAK, Albair GA, Samir S. Clinical value of classification of venous malformations with contrast-enhanced MR Angiography. Phlebology 2016; 32:628-633. [DOI: 10.1177/0268355516682861] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Aim To classify venous malformations based on contrast-enhanced MR angiography that may serve as a basis for treatment plan. Patients and methods A retrospective analysis was performed in 58 patients with venous malformations who underwent contrast-enhanced MR angiography. Venous malformations were classified according to their venous drainage into: type I, isolated malformation without peripheral drainage; type II, malformation that drains into normal veins; type III, malformation that drains into dilated veins; and type IV, malformation that represents dysplastic venous ectasia. Image analysis was done by two reviewers. Intra and inter-observer agreement of both reviewers and intra-class correlation was done. Results The intra-observer agreement of contrast-enhanced MR angiography classification of venous malformations was excellent for the first reviewer ( k = 0.83, 95% CI = 0.724–0.951, P = 0.001) and substantial for the second reviewer ( K = 0.79, 95% CI = 0.656-0.931, P = 0.001). The inter-observer agreement of contrast-enhanced MR angiography classification of venous malformations was excellent for both reviewers at the first time ( K = 0.96, 95% CI = 0.933–1.000, P = 0.001) and second time ( k = 0.81, 95% CI = 0.678–0.942, P = 0.001). There was high intra-class correlation of both reviewers for single measure ( ICC = 0.85, 95% CI = 0.776–0.918, P = 0.001) and for average measures ( ICC = 0.96, 95% CI = 0.933–0.978, P = 0.001). Conclusion Contrast-enhanced MR angiography classification of venous malformations may be a useful, simple and reliable tool to accurately classify venous malformation and this topographic classification helps for better management strategy.
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Affiliation(s)
| | - Germeen Ashmalla Albair
- Faculty of medicine, Department of diagnostic Radiology, Mansoura University, Mansoura, Egypt
| | - Sieza Samir
- Faculty of medicine, Department of diagnostic Radiology, Mansoura University, Mansoura, Egypt
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Hodel J, Leclerc X, Kalsoum E, Zuber M, Tamazyan R, Benadjaoud MA, Pruvo JP, Piotin M, Baharvahdat H, Zins M, Blanc R. Intracranial Arteriovenous Shunting: Detection with Arterial Spin-Labeling and Susceptibility-Weighted Imaging Combined. AJNR Am J Neuroradiol 2016; 38:71-76. [PMID: 27789452 DOI: 10.3174/ajnr.a4961] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/16/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Arterial spin-labeling and susceptibility-weighted imaging are 2 MR imaging techniques that do not require gadolinium. The study aimed to assess the accuracy of arterial spin-labeling and SWI combined for detecting intracranial arteriovenous shunting in comparison with conventional MR imaging. MATERIALS AND METHODS Ninety-two consecutive patients with a known (n = 24) or suspected arteriovenous shunting (n = 68) underwent digital subtraction angiography and brain MR imaging, including arterial spin-labeling/SWI and conventional angiographic MR imaging (3D TOF, 4D time-resolved, and 3D contrast-enhanced MRA). Arterial spin-labeling/SWI and conventional MR imaging were reviewed separately in a randomized order by 2 blinded radiologists who judged the presence or absence of arteriovenous shunting. The accuracy of arterial spin-labeling/SWI for the detection of arteriovenous shunting was calculated by using the area under receiver operating curve with DSA as reference standard. κ coefficients were computed to determine interobserver and intermodality agreement. RESULTS Of the 92 patients, DSA showed arteriovenous shunting in 63 (arteriovenous malformation in 53 and dural arteriovenous fistula in 10). Interobserver agreement was excellent (κ =0.83-0.95). In 5 patients, arterial spin-labeling/SWI correctly detected arteriovenous shunting, while the conventional angiographic MR imaging did not. Compared with conventional MR imaging, arterial spin-labeling/SWI was significantly more sensitive (0.98 versus 0.90, P = .04) and equally specific (0.97) and showed significantly higher agreement with DSA (κ = 0.95 versus 0.84, P = .01) and higher area under the receiver operating curve (0.97 versus 0.93, P = .02). CONCLUSIONS Our study showed that the combined use of arterial spin-labeling and SWI may be an alternative to contrast-enhanced MRA for the detection of intracranial arteriovenous shunting.
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Affiliation(s)
- J Hodel
- From the Departments of Radiology (J.H., M.Z.) .,Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - X Leclerc
- Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France
| | - E Kalsoum
- Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - M Zuber
- From the Departments of Radiology (J.H., M.Z.).,Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France
| | - R Tamazyan
- Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France
| | - M A Benadjaoud
- Department of Radiobiology and Epidemiology (M.A.B.), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France
| | - J-P Pruvo
- Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France
| | - M Piotin
- Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France
| | - H Baharvahdat
- Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France
| | - M Zins
- From the Departments of Radiology (J.H., M.Z.)
| | - R Blanc
- Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France
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Hage ZA, Alaraj A, Arnone GD, Charbel FT. Novel imaging approaches to cerebrovascular disease. Transl Res 2016; 175:54-75. [PMID: 27094991 DOI: 10.1016/j.trsl.2016.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 11/19/2022]
Abstract
Imaging techniques available to the physician treating neurovascular disease have substantially grown over the past several decades. New techniques as well as advances in imaging modalities continuously develop and provide an extensive array of modalities to diagnose, characterize, and understand neurovascular pathology. Modern noninvasive neurovascular imaging is generally based on computed tomography (CT), magnetic resonance (MR) imaging, or nuclear imaging and includes CT angiography, CT perfusion, xenon-enhanced CT, single-photon emission CT, positron emission tomography, magnetic resonance angiography, MR perfusion, functional magnetic resonance imaging with global and regional blood oxygen level dependent imaging, and magnetic resonance angiography with the use of the noninvasive optional vessel analysis software (River Forest, Ill). In addition to a brief overview of the technique, this review article discusses the clinical indications, advantages, and disadvantages of each of those modalities.
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Affiliation(s)
- Ziad A Hage
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill, USA
| | - Gregory D Arnone
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill, USA.
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Assessment and treatment planning of lateral intracranial dural arteriovenous fistulas in 3 T MRI and DSA: A detailed analysis under consideration of time-resolved imaging of contrast kinetics (TRICKS) and ce-MRA sequences. Eur Radiol 2016; 26:4284-4292. [PMID: 27121930 DOI: 10.1007/s00330-016-4335-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/05/2016] [Accepted: 03/14/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The current gold standard in the assessment of lateral intracranial dural arteriovenous fistulas (LDAVF) is digital subtraction angiography (DSA). However, magnetic resonance imaging (MRI) is a non-invasive emerging tool for the evaluation of such lesions. The aim of our study was to compare the DSA to our 3 T MR-imaging protocol including a highly spatial resolved (ce-MRA) and a temporal resolved ("time-resolved imaging of contrast kinetics", TRICKS) contrast-enhanced MR angiography to evaluate if solely DSA can remain the gold-standard imaging modality for the treatment planning of LDAVF. METHODS We retrospectively reviewed matched pairs of DSA and 3 T MRI examinations of 24 patients with LDAVF (03/2008-04/2014) by the same list of relevant criteria for an endovascular LDAVF treatment planning. In particular, we determined intermodality agreement for the Cognard classification, the identifeication of arterial feeders, and the detailed assessment of each venous drainage pattern. RESULTS Intermodality agreement for the Cognard classification was excellent (ĸ = 1.0). Whereas MRI failed in identifying small arterial feeders, it was superior to the DSA in the assessment of the sinus and the venous drainage pattern. CONCLUSIONS The combination of MRI and DSA is the new gold standard in LDAVF treatment planning. KEY POINTS • DSA is superior to the MRI in detecting LDAVF arterial feeders. • MRI excellently evaluates the venous side of an LDAVF. • MRI can replace DSA in initial diagnosis and monitoring of LDAVF. • MRI and DSA combined are the new gold standard in LDAVF treatment planning.
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Detection of Cortical Venous Drainage and Determination of the Borden Type of Dural Arteriovenous Fistula by Means of 3D Pseudocontinuous Arterial Spin-Labeling MRI. AJR Am J Roentgenol 2016; 207:163-9. [PMID: 27082987 DOI: 10.2214/ajr.15.15171] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The risk of intracranial dural arteriovenous fistula is linked to its pattern of venous drainage (Borden type), in particular the presence of cortical venous drainage. The purpose of this study was to assetss the accuracy of 3D pseudocontinuous arterial spin-labeling (ASL) MRI for noninvasive delineation of venous drainage. MATERIALS AND METHODS This retrospective study included 34 patients with a dural arteriovenous fistula who had undergone both digital subtraction angiography (DSA) and 3D pseudocontinuous ASL MRI. Two neuroradiologists blinded to the DSA results independently assessed ASL images for the presence of cortical vein hyperintensity (cortical venous drainage) and the distribution of venous hyperintensity (Borden type). DSA was used as the reference standard. The sensitivity and specificity of 3D pseudocontinuous ASL MRI for the detection of cortical venous drainage were determined. Intermodality and interobserver agreement for Borden type was determined by use of the weighted kappa statistic. RESULTS Three-dimensional pseudocontinuous ASL MRI had high sensitivity (91%) and specificity (96%) for the detection of cortical venous drainage. Borden type was correctly identified with very good intermodality (weighted κ = 0.82) and interobserver (weighted κ = 0.85) agreement in 88% of patients. CONCLUSION Three-dimensional pseudocontinuous ASL MRI is highly accurate for the detection of cortical venous drainage and determination of Borden type. With this technique, high-risk fistulas requiring treatment can be reliably differentiated from low-risk lesions. Although it cannot replace DSA, incorporating 3D pseudocontinuous ASL into an MRI protocol for assessment of dural arteriovenous fistula can facilitate treatment planning.
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Cheng YC, Chen HC, Wu CH, Wu YY, Sun MH, Chen WH, Chai JW, Chi-Chang Chen C. 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. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e19814. [PMID: 27679690 PMCID: PMC5036458 DOI: 10.5812/iranjradiol.19814] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 09/28/2014] [Accepted: 10/18/2014] [Indexed: 11/20/2022]
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.
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Affiliation(s)
- Yu-Ching Cheng
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hung-Chieh Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chen-Hao Wu
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung, Taiwan
- Corresponding author: Chen-Hao Wu, Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan. Fax: +886-423595046, E-mail:
| | - Yi-Ying Wu
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-His Sun
- Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Hsien Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jyh-Wen Chai
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
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Tsai LK, Liu HM, Jeng JS. Diagnosis and management of intracranial dural arteriovenous fistulas. Expert Rev Neurother 2016; 16:307-18. [PMID: 26832225 DOI: 10.1586/14737175.2016.1149063] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dural arteriovenous fistula (DAVF) is a rare type of acquired intracranial vascular malformation. Recent progress in neuroimaging technology, such as advanced MRI and CT, provides non-invasive methods to accurately diagnose DAVF, including evaluation of the hemodynamics of the drainage veins. The clinical manifestations of DAVFs vary widely and depend on the location and venous drainage pattern of arteriovenous shunting. Patients with high grade DAVFs having cortical venous reflux should receive aggressive treatment to prevent the occurrence of intracranial hemorrhage and other neurological deficits related to venous congestion. Intra-arterial or intravenous endovascular embolization remains the primary therapy for high grade DAVF, while open surgery and stereotactic radiosurgery can serve as alternative treatment options. Early and accurate diagnosis with appropriate treatment is the goal for clinical management of DAVFs to reduce symptoms and prevent the development of venous congestion and stroke.
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Affiliation(s)
- Li-Kai Tsai
- a Department of Neurology and Stroke Center , National Taiwan University Hospital , Taipei , Taiwan
| | - Hon-Man Liu
- b Department of Medical Imaging , National Taiwan University Hospital , Taipei , Taiwan
| | - Jiann-Shing Jeng
- a Department of Neurology and Stroke Center , National Taiwan University Hospital , Taipei , Taiwan
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Iryo Y, Hirai T, Nakamura M, Tateishi M, Hayashida E, Azuma M, Nishimura S, Kitajima M, Yamashita Y. Evaluation of Intracranial Vasculatures in Healthy Subjects with Arterial-Spin-Labeling-Based 4D-MR Angiography at 3T. Magn Reson Med Sci 2015; 15:335-9. [PMID: 26701696 PMCID: PMC5608130 DOI: 10.2463/mrms.tn.2015-0081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Contrast inherent inflow-enhanced multi-phase angiography combining multiple-phase flow-alternating inversion-recovery (CINEMA-FAIR) is an arterial-spin-labeling-based four-dimensional magnetic resonance angiography (4D-MRA) technique. Two neuroradiologists independently evaluated the depiction of the intracranial vasculatures in healthy subjects with 3T 4D-MRA using CINEMA-FAIR. Our results indicated that this technique can provide good visualization of the cerebral arteries with a high spatial and temporal resolution. It appears to have sufficient resolution for identifying flow difference in the anterior and posterior circulation in healthy subjects.
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Affiliation(s)
- Yasuhiko Iryo
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical Sciences
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Time-Resolved Magnetic Resonance Angiography in the Evaluation of Intracranial Vascular Lesions and Tumors: A Pictorial Essay of Our Experience. Can Assoc Radiol J 2015; 66:385-92. [DOI: 10.1016/j.carj.2015.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 04/13/2015] [Accepted: 05/13/2015] [Indexed: 11/19/2022] Open
Abstract
Time-resolved magnetic resonance angiography (TR MRA) is a promising less invasive technique for the diagnosis of intracranial vascular lesions and hypervascular tumors. Similar to 4-dimensional computed tomographic angiography obtaining high frame rate images, TR MRA utilizes acceleration techniques to acquire sequential arterial and venous phase images for identifying, localizing, and classifying vascular lesions. Because of the good agreement with digital subtraction angiography for grading brain arteriovenous malformations with the Spetzler–Martin classification and the good sensitivity for visualizing arteriovenous fistulas, studies have suggested that TR MRA could serve as a screening or routine follow-up tool for diagnosing intracranial vascular disorders. In this pictorial essay, we report on the use of TR MRA at 3.0 T to diagnose intracranial vascular lesions and hypervascular tumors, employing DSA as the reference technique.
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Ye X, Wang H, Huang Q, Jiang M, Gao X, Zhang J, Zhou S, Lin Z. Four-dimensional computed tomography angiography is valuable in intracranial dural arteriovenous fistula diagnosis and fistula evaluation. Acta Neurol Belg 2015; 115:303-9. [PMID: 25354667 DOI: 10.1007/s13760-014-0387-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 10/23/2014] [Indexed: 11/25/2022]
Abstract
This study was to evaluate the value of four-dimensional computed tomography angiography (4D-CTA) in the diagnosis of intracranial dural arteriovenous fistula (DAVF). This study included 16 patients who were diagnosed to have intracranial DAVF by digital subtraction angiography (DSA). The 4D-CTA was performed by Aquilion ONE multi-detector CT scanner (Toshiba Medical Systems, Japan) equipped with 320 × 0.5 mm detector rows. Standard biplane fluoroscopy equipments (Infinix, Toshiba Medical Systems, Japan and ADVANTX LC/LP, GE Medical Systems, Milwaukee, WI, USA) were applied in the diagnosis of intra-arterial DSA. Examinations were performed to evaluate the findings of DSA and 4D-CTA in each patient. The examination results were read by two independent readers in a blind manner. All results were documented on standardized scoring sheets. In all 16 cases, the same diagnosis results of intracranial DAVF were obtained from DSA and 4D-CTA. The results of subtype (Borden and Cognard classification), venous reflux and fistula sites were also accurately exhibited in 4D-CTA. In addition, there was a little discrepancy in identifying smaller and specific arterial branches and in distinguishing fistula type (focal or diffuse) using 4D-CTA. Good-to-excellent agreements were made between 4D-CTA and DSA. Therefore, 4D-CTA could be a feasible tool for the characterization of intracranial DAVF, with respect to determining fistula site and venous drainage.
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Affiliation(s)
- Xianwang Ye
- Department of Radiology, No. 1 Hospital of Ningbo, No. 59 Liuting Road, Haishu District, Ningbo, 315010, Zhejiang, People's Republic of China
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Azuma M, Hirai T, Shigematsu Y, Kitajima M, Kai Y, Yano S, Nakamura H, Makino K, Iryo Y, Yamashita Y. Evaluation of Intracranial Dural Arteriovenous Fistulas: Comparison of Unenhanced 3T 3D Time-of-flight MR Angiography with Digital Subtraction Angiography. Magn Reson Med Sci 2015; 14:285-93. [PMID: 25994036 DOI: 10.2463/mrms.2014-0120] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We compared gross characterization of intracranial dural arteriovenous fistulas (DAVFs) between unenhanced 3-tesla 3-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) and digital subtraction angiography (DSA). METHODS We subjected 26 consecutive patients with intracranial DAVF to unenhanced 3T 3D TOF MRA and to DSA. Two independent sets of observers inspected the main arterial feeders, fistula site, and venous drainage pattern on MRA and DSA images. Interobserver and intermodality agreements were assessed by k statistics. RESULTS Interobserver agreement was excellent for fistula site (κ = 0.919; 95% confidence interval [CI], 0.805 to 1.000), good for main arterial feeders (κ = 0.711; 95% CI, 0.483 to 0.984), and very good for venous drainage (κ = 0.900; 95% CI, 0.766 to 1.000). Intermodality agreement was excellent for fistula site (κ = 0.968; 95% CI, 0.906 to 1.000) and good for main arterial feeder (κ = 0.809; 95% CI, 0.598 to 1.000) and venous drainage (κ = 0.837; 95% CI, 0.660 to 1.000). CONCLUSION Gross characterization of intracranial DAVF was similar for both imaging modalities, but unenhanced 3T 3D TOF MRA cannot replace DSA.
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Affiliation(s)
- Minako Azuma
- Department of Diagnostic Radiology,Graduate School of Medical Sciences, Kumamoto University
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Flat Detector Computed Tomography-Based "Dual Vessel Fusion" Technique for Diagnosis and Surgical Planning in the Management of Dural Arteriovenous Fistula. World Neurosurg 2015; 84:520-7. [PMID: 25900791 DOI: 10.1016/j.wneu.2015.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 04/09/2015] [Accepted: 04/11/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore the value of flat detector computed tomography-based vessel fusion technique for visualizing and evaluating anatomic structures and hemodynamic features of patients diagnosed with dural arteriovenous fistulas (DAVF). METHODS Eleven patients with DAVF were investigated. The 3-dimensional structure of the DAVF fistula point, feeding arteries, and draining veins were reconstructed from separately acquired rotational angiographic images and then displayed as a single image in a fused manner. RESULTS In the vessel fusion image, the tangled cluster of vessels of the DAVF could be clearly visualized from selected optimal viewing angles in the 3-dimensional space. Each component of the DAVF fistula point with its specific artery feedings and venous drainage could be identified accurately. CONCLUSIONS The vessel fusion technique gave detailed anatomic information that enabled better understanding of the DAVF structure, and facilitated an accurate interventional or surgical planning.
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Spittau B, Millán DS, El-Sherifi S, Hader C, Singh TP, Motschall E, Vach W, Urbach H, Meckel S. Dural arteriovenous fistulas of the hypoglossal canal: systematic review on imaging anatomy, clinical findings, and endovascular management. J Neurosurg 2015; 122:883-903. [DOI: 10.3171/2014.10.jns14377] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dural arteriovenous fistulas (DAVFs) of the hypoglossal canal (HCDAVFs) are rare and display a complex angiographic anatomy. Hitherto, they have been referred to as various entities (for example, “marginal sinus DAVFs”) solely described in case reports or small series. In this in-depth review of HCDAVF, the authors describe clinical and imaging findings, as well as treatment strategies and subsequent outcomes, based on a systematic literature review supplemented by their own cases (120 cases total). Further, the involved craniocervical venous anatomy with variable venous anastomoses is summarized. Hypoglossal canal DAVFs consist of a fistulous pouch involving the anterior condylar confluence and/or anterior condylar vein with a variable intraosseous component. Three major types of venous drainage are associated with distinct clinical patterns: Type 1, with anterograde drainage (62.5%), mostly presents with pulsatile tinnitus; Type 2, with retrograde drainage to the cavernous sinus and/or orbital veins (23.3%), is associated with ocular symptoms and may mimic cavernous sinus DAVF; and Type 3, with cortical and/or perimedullary drainage (14.2%), presents with either hemorrhage or cervical myelopathy. For Types 1 and 2 HCDAVF, transvenous embolization demonstrates high safety and efficacy (2.9% morbidity, 92.7% total occlusion). Understanding the complex venous anatomy is crucial for planning alternative approaches if standard transjugular access is impossible. Transarterial embolization or surgical disconnection (morbidity 13.3%–16.7%) should be reserved for Type 3 HCDAVFs or lesions with poor venous access. A conservative strategy could be appropriate in Type 1 HCDAVF for which spontaneous regression (5.8%) may be observed.
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Affiliation(s)
- Björn Spittau
- 1Institute for Anatomy and Cell Biology, Department of Molecular Embryology, Albert-Ludwigs-University Freiburg
| | - Diego San Millán
- 2Neuroradiology Unit, Department of Diagnostic and Interventional Radiology, Centre Hospitalier du Centre du Valais, Hôpital de Sion
| | | | - Claudia Hader
- 3Department of Neuroradiology, University Hospital Freiburg
- 4Neuroradiology Unit, Institute of Radiology, Kantonsspital St. Gallen, Switzerland; and
| | - Tejinder Pal Singh
- 5Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner & Royal Perth Hospitals, Nedlands, Western Australia, Australia
| | - Edith Motschall
- 6Center for Medical Biometry and Medical Informatics, Medical Center–University of Freiburg, Germany
| | - Werner Vach
- 6Center for Medical Biometry and Medical Informatics, Medical Center–University of Freiburg, Germany
| | - Horst Urbach
- 3Department of Neuroradiology, University Hospital Freiburg
| | - Stephan Meckel
- 3Department of Neuroradiology, University Hospital Freiburg
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Kiyosue H, Tanoue S, Hori Y, Hongo N, Mori H. Shunted pouches of cavernous sinus dural AVFs: evaluation by 3D rotational angiography. Neuroradiology 2014; 57:283-90. [PMID: 25471664 DOI: 10.1007/s00234-014-1474-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/25/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The aims of this study were to evaluate the angioarchitecture of cavernous sinus dural arteriovenous fistulas (CSdAVFs), including the number and location of shunted pouches (SPs), and to evaluate whether the location and number of the SPs affect the outcomes of transvenous embolization of CSdAVFs. METHODS Nineteen consecutive cases of CSdAVFs that underwent rotational angiography and transvenous embolization were reviewed. Multiplanar reconstruction images of rotational angiography and selective angiography were reviewed with particular interest in the SPs. Relationships of the locations and number of SPs with the results of transvenous embolization were statistically analyzed. RESULTS All cases showed SPs, with numbers ranging from 1 to 4 (mean, 2.2). The location of the SPs was "posteromedial" in 16, "posterolateral" in 13, "lateral" in 6, and "medial" in 3 patients. Six cases showed posteromedial SPs alone, and three cases showed posterolateral SPs alone. The other 10 cases showed multiple locations of SPs. All cases were treated by transvenous embolization with sinus packing (n = 11) or selective embolization of the SP (n = 8). Complete occlusion of dAVF was obtained in 16 cases immediately after embolization. Locations of SPs and drainage types were significantly associated with the immediate angiographic results (p < 0.01). CONCLUSION The SP of CSdAVFs is often multiple and is located posteriorly to the CS. The number and location of SPs affect immediate angiographic results of transvenous embolization.
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Affiliation(s)
- Hiro Kiyosue
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Yufu City, Oita, Japan, 879-5593,
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Natural history, current concepts, classification, factors impacting endovascular therapy, and pathophysiology of cerebral and spinal dural arteriovenous fistulas. Clin Neurol Neurosurg 2014; 121:64-75. [DOI: 10.1016/j.clineuro.2014.01.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/12/2014] [Accepted: 01/19/2014] [Indexed: 11/24/2022]
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MRI and MR angiography findings to differentiate jugular venous reflux from cavernous dural arteriovenous fistula. AJR Am J Roentgenol 2014; 202:839-46. [PMID: 24660714 DOI: 10.2214/ajr.13.11048] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Both jugular venous reflux (JVR) and cavernous dural arteriovenous fistula (DAVF) manifest as abnormal venous signal intensities on time-of-flight (TOF) MR angiography (MRA). We investigated brain MRI and MRA findings that might differentiate JVR from cavernous DAVF. MATERIALS AND METHODS Forty-one patients with abnormal venous signal intensities on TOF MRA in the cavernous sinus and its vicinity were selected from 1508 patients who had undergone TOF MRA over the previous 6 months. For comparison, the examinations of 26 patients with cavernous DAVF who had undergone imaging over the previous 8 years were collected. The following findings were assessed: the side and location of abnormal venous signal intensities on intracranial TOF MRA; the signal intensity of the proximal jugular vein on T2-weighted imaging; whether there was early opacification of the cavernous sinus in the arterial phase of contrast-enhanced MRA (CE-MRA); the side of jugular venous drainage in the arteriovenous phase of CE-MRA; and whether retrograde jugular venous flow was seen on neck TOF MRA. RESULTS Abnormal venous signal intensities were seen on the left side in 73% of patients with JVR and 58% of patients with cavernous DAVF; involvement of the cavernous sinus was found in 12% of patients with JVR and 100% of patients with cavernous DAVF. Increased signal intensity in the ipsilateral jugular vein on T2-weighted imaging was found in 73% of JVR patients and 4% of cavernous DAVF patients. Early opacification of the cavernous sinus in the arterial phase of CE-MRA, ipsilateral jugular venous drainage in the arteriovenous phase of CE-MRA, and ipsilateral retrograde jugular venous flow on neck TOF MRA were found in 0%, 0%, and 63%, respectively, of JVR patients and in 100%, 100%, and 0%, respectively, of cavernous DAVF patients. CONCLUSION JVR and cavernous DAVF can be differentiated from one another using MRI and MRA.
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Honarmand AR, Gemmete JJ, Hurley MC, Shaibani A, Chaudhary N, Pandey AS, Bendok BR, Ansari SA. Adjunctive value of intra-arterial cone beam CT angiography relative to DSA in the evaluation of cranial and spinal arteriovenous fistulas. J Neurointerv Surg 2014; 7:517-23. [DOI: 10.1136/neurintsurg-2014-011139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 04/22/2014] [Indexed: 11/03/2022]
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Jang J, Schmitt P, Kim BY, Choi HS, Jung SL, Ahn KJ, Kim I, Paek M, Kim BS. Non-contrast-enhanced 4D MR angiography with STAR spin labeling and variable flip angle sampling: a feasibility study for the assessment of Dural Arteriovenous Fistula. Neuroradiology 2014; 56:305-14. [PMID: 24526141 DOI: 10.1007/s00234-014-1336-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION This study aimed to evaluate the feasibility of non-contrast-enhanced 4D magnetic resonance angiography (NCE 4D MRA) with signal targeting with alternative radiofrequency (STAR) spin labeling and variable flip angle (VFA) sampling in the assessment of dural arteriovenous fistula (DAVF) in the transverse sinus. METHODS Nine patients underwent NCE 4D MRA for the evaluation of DAVF in the transverse sinus at 3 T. One patient was examined twice, once before and once after the interventional treatment. All patients also underwent digital subtraction angiography (DSA) and/or contrast-enhanced magnetic resonance angiography (CEMRA). For the acquisition of NCE 4D MRA, a STAR spin tagging method was used, and a VFA sampling was applied in the data readout module instead of a constant flip angle. Two readers evaluated the NCE 4D MRA data for the diagnosis of DAVF and its type with consensus. The results were compared with those from DSA and/or CEMRA. RESULTS All patients underwent NCE 4D MRA without any difficulty. Among seven patients with patent DAVFs, all cases showed an early visualization of the transverse sinus on NCE 4D MRA. Except for one case, the type of DAVF of NCE 4D MRA was agreed with that of reference standard study. Cortical venous reflux (CVR) was demonstrated in two cases out of three patients with CVR. CONCLUSION NCE 4D MRA with STAR tagging and VFA sampling is technically and clinically feasible and represents a promising technique for assessment of DAVF in the transverse sinus. Further technical developments should aim at improvements of spatial and temporal coverage.
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Affiliation(s)
- Jinhee Jang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea
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Iryo Y, Hirai T, Kai Y, Nakamura M, Shigematsu Y, Kitajima M, Azuma M, Komi M, Morita K, Yamashita Y. Intracranial dural arteriovenous fistulas: evaluation with 3-T four-dimensional MR angiography using arterial spin labeling. Radiology 2013; 271:193-9. [PMID: 24475797 DOI: 10.1148/radiol.13122670] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate whether 3-T four-dimensional (4D) arterial spin-labeling (ASL)-based magnetic resonance (MR) angiography is useful for the evaluation of shunt lesions in patients with intracranial dural arteriovenous fistulas (AVFs). MATERIALS AND METHODS Institutional review board approval and prior written informed consent from all patients were obtained. Nine patients with intracranial dural AVF (seven men, two women; age range, 52-77 years; mean age, 63 years) underwent 4D ASL MR angiography at 3 T and digital subtraction angiography (DSA). Spin tagging was with flow-sensitive alternating inversion recovery with Look-Locker sampling. At 300-millisecond intervals, seven dynamic images with a spatial resolution of 0.5 × 0.5 × 0.6 mm(3) were obtained. The 4D ASL MR angiographic and DSA images were read by two sets of two independent readers each. Interobserver and intermodality agreement was assessed with the κ statistic. RESULTS On all 4D ASL MR angiographic images, the major intracranial arteries were demonstrated at a temporal resolution of 300 milliseconds. Interobserver agreement was excellent for the fistula site (κ = 1.00; 95% confidence interval [CI]: 1.00, 1.00), moderate for the main arterial feeders (κ = 0.53; 95% CI: 0.08, 0.98), and good for venous drainage (κ = 0.77; 95% CI: 0.35, 1.00). Intermodality agreement was excellent for the fistula site and venous drainage (κ = 1.00; 95% CI: 1.00, 1.00) and good for the main arterial feeders (κ = 0.80; 95% CI: 0.58, 1.00). CONCLUSION The good-to-excellent agreement between 3-T 4D ASL MR angiographic and DSA findings suggests that 3-T 4D ASL MR angiography is a useful tool for the evaluation of intracranial dural AVFs.
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Affiliation(s)
- Yasuhiko Iryo
- From the Departments of Diagnostic Radiology (Y.I., T.H., Y.S., M. Kitajima, M.A., Y.Y.), and Neurosurgery (Y.K.), Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556 Japan; Medical Satellite Yaesu Clinic, Tokyo, Japan (M.N.); and Kumamoto University Hospital, Kumamoto, Japan (M. Komi, K.M.)
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Sheng L, Li J, Li H, Li G, Chen G, Xiang W, Wang Q, Gan Z, Sun Q, Yan B, Beilner J, Ma LT. Evaluation of cerebral arteriovenous malformation using ‘dual vessel fusion’ technology. J Neurointerv Surg 2013; 6:667-71. [DOI: 10.1136/neurintsurg-2013-010980] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Edjlali M, Roca P, Rabrait C, Trystram D, Rodriguez-Régent C, Johnson KM, Wieben O, Turski P, Meder JF, Naggara O, Oppenheim C. MR selective flow-tracking cartography: a postprocessing procedure applied to four-dimensional flow MR imaging for complete characterization of cranial dural arteriovenous fistulas. Radiology 2013; 270:261-8. [PMID: 24029646 DOI: 10.1148/radiol.13130507] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the feasibility of a selective flow-tracking cartographic procedure applied to four-dimensional (4D) flow imaging and to demonstrate its usefulness in the characterization of dural arteriovenous fistulas (DAVFs). MATERIALS AND METHODS Institutional review board approval was obtained, and all patients provided written informed consent. Eight patients (nine DAVFs) underwent 3.0-T magnetic resonance (MR) imaging and digital subtraction angiography (DSA). Imaging examinations were performed within 24 hours of each other. 4D flow MR imaging was performed by using a 4D radial phase-contrast vastly undersampled isotropic projection reconstruction pulse sequence with an isotropic spatial resolution of 0.86 mm (5 minutes 35 seconds). Two radiologists independently reviewed images from MR flow-tracking cartography and reported the location of arterial feeder vessels and the venous drainage type and classified DAVFs according to the risk of rupture (Cognard classification). These results were compared with those at DSA. Quadratic weighted κ statistics with their 95% confidence intervals (CIs) were used to test intermodality agreement in the identification of arterial feeder vessels, draining veins, and Cognard classification. RESULTS Interreader agreement for shunt location on MR images was perfect (κ = 1), with good-to-excellent interreader agreement for arterial feeder vessel identification (κ = 0.97; 95% CI = 0.92, 1.0), and matched in all cases with shunt location defined at DSA. There was good-to-excellent agreement between MR cartography and DSA in the definition of the main feeding arteries (κ = 0.92; 95% CI = 0.83, 1.0), presence of retrograde flow in dural sinuses (κ = 1), presence of retrograde cortical venous drainage (κ = 1), presence of venous ectasia (κ = 1), and final Cognard classification of DAVFs (κ = 1, standard error = 0.35). CONCLUSION MR selective flow-tracking cartography enabled the noninvasive characterization of cranial DAVFs.
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Affiliation(s)
- Myriam Edjlali
- From the Department of Morphologic and Functional Imaging, Université Paris Descartes, INSERM UMR 894, Hôpital Sainte Anne, 1 rue Cabanis, 75014 Paris, France (M.E., P.R., D.T., C. Rodriguez-Régent, J.F.M., O.N., C.O.), Clinical Science Development Group, GE Healthcare, Buc, France (C. Rabrait); and Departments of Medical Physics (K.M.J., O.W., P.T.) and Radiology (P.T.), University of Wisconsin, Madison, Wis
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Endovascular treatment of 170 consecutive cranial dural arteriovenous fistulae: results and complications. Neurosurg Rev 2013; 37:63-71. [DOI: 10.1007/s10143-013-0498-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 06/12/2013] [Accepted: 07/27/2013] [Indexed: 10/26/2022]
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Razek AAKA, Gaballa G, Megahed AS, Elmogy E. Time resolved imaging of contrast kinetics (TRICKS) MR angiography of arteriovenous malformations of head and neck. Eur J Radiol 2013; 82:1885-91. [PMID: 23928233 DOI: 10.1016/j.ejrad.2013.07.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/11/2013] [Accepted: 07/04/2013] [Indexed: 01/12/2023]
Abstract
PURPOSE To evaluate vasculature of arteriovenous malformations (AVMs) of head and neck with time resolved imaging of contrast kinetics (TRICKS) MR angiography (MRA). MATERIAL AND METHODS Prospective study was conducted upon 19 patients (age range, 12-29 years; mean age 18 years; 10 males and 9 females) with AVM of head and neck. TRICKS-MRA of head and neck was performed during injection of contrast medium. Post processing with reconstruction of the images was done. Two independent readers assessed the overall TRICKS-MRA image quality score using a 5-point scale and depiction of the main arterial feeders, nidus, and venous drainage using 3 points scale. The Kappa test for interobserver agreement was done. The AVMs were evaluated morphologically in terms of number and origin of the main arterial feeders, the location and size of nidus either small (>2 cm) or large (>2 cm) and the draining veins into the superficial or deep venous drainage. RESULTS The average TRICKS-MRA image quality score as judged by reader 1 was 3.89 ± 1.15 and that as judged by reader 2 was 3.89 ± 0.10, which yielded excellent interobserver agreement (k=0.77, 95% CI=0.53-0.98, r=0.78, P=0.001). The interobserver agreement of both readers was excellent for the arterial feeders (k=0.81, 95% CI=0.57-1.00, r=0.83, P=0.001), excellent for the nidus (k=0.91, 95% CI=0.75-1.00, r=0.92, P=0.001), and good for the venous drainage (k=0.77, 95% CI=0.53-0.98, r=0.78, P=0.001). The arterial feeders were single (n=14) or multiple (n=5), the nidus was large (n=16) or small (n=3) and the venous drainage was into the internal jugular (n=17) or the external jugular (n=2) veins. Three patients with small nidus and single arterial feeder were treated with sclerotherapy. Eleven patients with large nidus and single arterial feeder were referred for embolization. Combined embolization and surgery were done for five patients with large nidus and multiple arterial feeders. CONCLUSION We concluded that TRICKS-MRA is a reliable non invasive tool for evaluation of the feeding arteries, the nidus and the draining veins of AVMs of head and neck. TRICKS-MRA can be used for evaluation and treatment planning of AVMs of head and neck.
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