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Zhuo Y, Chang J, Chen Y, Wen C, Chen F, Li W, Gao M, Luo W, Wan S, Song L, Zhu L. Value of contrast-enhanced MR angiography for the follow-up of treated brain arteriovenous malformations: systematic review and meta-analysis. Eur Radiol 2023; 33:7139-7148. [PMID: 37148354 DOI: 10.1007/s00330-023-09714-w] [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: 10/06/2022] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To estimate the diagnostic value of contrast-enhanced MR angiography (CE-MRA) in identifying residual brain arteriovenous malformations (AVMs) after treatment. METHODS We retrieved appropriate references from the electronic databases of PubMed, Web of Science, Embase, and Cochrane Library, and then evaluated the methodology quality of included references using the QUADAS-2 tool. We calculated the pooled sensitivity and specificity by applying a bivariate mixed-effects model and detected the publication bias using Deeks' funnel plot. The values of I2 were used to test heterogeneity and meta-regression analyses were performed to search for the causes of heterogeneity. RESULTS We included 7 eligible studies containing 223 participants. Compared with a gold standard, the overall sensitivity and specificity of CE-MRA in detecting residual brain AVMs were 0.77 (95% CI 0.65-0.86) and 0.97 (95% CI 0.82-1.00), respectively. Based on the summary ROC curve, the AUC was 0.89 (95% CI 0.86-0.92). Heterogeneity could be observed in our study, especially for the specificity (I2 = 74.23%). Furthermore, there was no evidence of publication bias. CONCLUSIONS Our study provides evidence that CE-MRA has good diagnostic value and specificity for the follow-up of treated brain AVMs. Nevertheless, considering the small sample size, heterogeneity, and many factors that may affect the diagnostic accuracy, future large-sample, prospective studies are necessary to validate the results. KEY POINTS • The pooled sensitivity and specificity of contrast-enhanced MR angiography (CE-MRA) in detecting residual arteriovenous malformations (AVMs) were 0.77 (95% CI 0.65-0.86) and 0.97 (95% CI 0.82-1.00). • The four-dimensional CE-MRA showed less sensitivity than the three-dimensional CE-MRA for treated AVMs. • CE-MRA is helpful to identify residual AVMs and reduce excessive DSA during follow-up.
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Affiliation(s)
- Yudi Zhuo
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Jingling Chang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Yi Chen
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Chunli Wen
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Fei Chen
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Wenhui Li
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Mengxia Gao
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Weibo Luo
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Shurun Wan
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Lianying Song
- Department of Radiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
| | - Lingqun Zhu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
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Desai VR, Lee JJ, Britz GW. In Reply: Clinical Outcomes of Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations in Pediatric Patients: Systematic Review and Meta-Analysis. Neurosurgery 2020; 85:E1131-E1132. [PMID: 31559429 DOI: 10.1093/neuros/nyz375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Virendra R Desai
- Department of Neurosurgery Houston Methodist Hospital Houston, Texas
| | - Jonathan J Lee
- Department of Neurosurgery Houston Methodist Hospital Houston, Texas
| | - Gavin W Britz
- Department of Neurosurgery Houston Methodist Hospital Houston, Texas
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Finitsis S, Anxionnat R, Gory B, Planel S, Liao L, Bracard S. Susceptibility-Weighted Angiography for the Follow-Up of Brain Arteriovenous Malformations Treated with Stereotactic Radiosurgery. AJNR Am J Neuroradiol 2019; 40:792-797. [PMID: 31023658 DOI: 10.3174/ajnr.a6053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/10/2019] [Indexed: 11/07/2022]
Abstract
The criterion standard for assessing brain AVM obliteration postradiosurgery is DSA. To explore the value of susceptibility-weighted angiography, we followed 26 patients with brain AVMs treated by radiosurgery using susceptibility-weighted angiography and DSA. Studies were evaluated by 2 independent readers for residual nidi. Susceptibility-weighted angiography demonstrated good intermodality (κ = 0.71) and interobserver (κ = 0.64) agreement, and good sensitivity (85.7%) and specificity (85.7%). Susceptibility-weighted angiography is a useful radiation- and contrast material-free technique to follow-up brain AVM obliteration postradiosurgery.
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Affiliation(s)
- S Finitsis
- AHEPA Hospital (S.F.), Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - R Anxionnat
- From the Department of Neuroradiology (R.A., B.G., S.P., L.L., S.B.), Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - B Gory
- From the Department of Neuroradiology (R.A., B.G., S.P., L.L., S.B.), Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - S Planel
- From the Department of Neuroradiology (R.A., B.G., S.P., L.L., S.B.), Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - L Liao
- From the Department of Neuroradiology (R.A., B.G., S.P., L.L., S.B.), Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - S Bracard
- From the Department of Neuroradiology (R.A., B.G., S.P., L.L., S.B.), Centre Hospitalier Universitaire de Nancy, Nancy, France
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Iv M, Choudhri O, Dodd RL, Vasanawala SS, Alley MT, Moseley M, Holdsworth SJ, Grant G, Cheshier S, Yeom KW. High-resolution 3D volumetric contrast-enhanced MR angiography with a blood pool agent (ferumoxytol) for diagnostic evaluation of pediatric brain arteriovenous malformations. J Neurosurg Pediatr 2018; 22:251-260. [PMID: 29882734 DOI: 10.3171/2018.3.peds17723] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with brain arteriovenous malformations (AVMs) often require repeat imaging with MRI or MR angiography (MRA), CT angiography (CTA), and digital subtraction angiography (DSA). The ideal imaging modality provides excellent vascular visualization without incurring added risks, such as radiation exposure. The purpose of this study is to evaluate the performance of ferumoxytol-enhanced MRA using a high-resolution 3D volumetric sequence (fe-SPGR) for visualizing and grading pediatric brain AVMs in comparison with CTA and DSA, which is the current imaging gold standard. METHODS In this retrospective cohort study, 21 patients with AVMs evaluated by fe-SPGR, CTA, and DSA between April 2014 and August 2017 were included. Two experienced raters graded AVMs using Spetzler-Martin criteria on all imaging studies. Lesion conspicuity (LC) and diagnostic confidence (DC) were assessed using a 5-point Likert scale, and interrater agreement was determined. The Kruskal-Wallis test was performed to assess the raters' grades and scores of LC and DC, with subsequent post hoc pairwise comparisons to assess for statistically significant differences between pairs of groups at p < 0.05. RESULTS Assigned Spetzler-Martin grades for AVMs on DSA, fe-SPGR, and CTA were not significantly different (p = 0.991). LC and DC scores were higher with fe-SPGR than with CTA (p < 0.05). A significant difference in LC scores was found between CTA and fe-SPGR (p < 0.001) and CTA and DSA (p < 0.001) but not between fe-SPGR and DSA (p = 0.146). A significant difference in DC scores was found among DSA, fe-SPGR, and CTA (p < 0.001) and between all pairs of the groups (p < 0.05). Interrater agreement was good to very good for all image groups (κ = 0.77-1.0, p < 0.001). CONCLUSIONS Fe-SPGR performed robustly in the diagnostic evaluation of brain AVMs, with improved visual depiction of AVMs compared with CTA and comparable Spetzler-Martin grading relative to CTA and DSA.
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Affiliation(s)
- Michael Iv
- 1Department of Radiology, Stanford University Medical Center, Stanford
| | - Omar Choudhri
- 1Department of Radiology, Stanford University Medical Center, Stanford
| | - Robert L Dodd
- 1Department of Radiology, Stanford University Medical Center, Stanford
| | - Shreyas S Vasanawala
- 1Department of Radiology, Stanford University Medical Center, Stanford.,2Department of Radiology, Lucile Packard Children's Hospital, Palo Alto
| | - Marcus T Alley
- 3Richard M. Lucas Center for Imaging, Stanford University, Stanford; and
| | - Michael Moseley
- 3Richard M. Lucas Center for Imaging, Stanford University, Stanford; and
| | | | - Gerald Grant
- 4Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Palo Alto, California
| | - Samuel Cheshier
- 4Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Palo Alto, California
| | - Kristen W Yeom
- 2Department of Radiology, Lucile Packard Children's Hospital, Palo Alto
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Harada Y, Hirata K, Nakayama N, Yamaguchi S, Yoshida M, Onodera S, Manabe O, Shiga T, Terae S, Shirato H, Tamaki N. Improvement of cerebral hypometabolism after resection of radiation-induced necrotic lesion in a patient with cerebral arteriovenous malformation. Acta Radiol Open 2015; 4:2058460115584112. [PMID: 26331089 PMCID: PMC4548730 DOI: 10.1177/2058460115584112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 04/05/2015] [Indexed: 11/16/2022] Open
Abstract
A 55-year-old woman underwent radiosurgery for a left cerebral hemisphere arteriovenous malformation (AVM) and developed radiation-induced necrosis causing a massive edema in the surrounding brain tissues. Despite various therapies, the edema expanded to the ipsilateral hemisphere and induced neurological symptoms. The radiation-induced necrotic lesion was surgically removed 4 years after radiosurgery. While the preoperative FDG PET revealed severe hypometabolism in the left cerebrum, the necrotomy significantly ameliorated the brain edema, glucose metabolism (postoperative FDG PET), and symptoms. This case indicates that radiation necrosis-induced neurological deficits may be associated with brain edema and hypometabolism, which could be reversed by appropriate necrotomy.
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Affiliation(s)
- Yae Harada
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kenji Hirata
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoki Nakayama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shigeru Yamaguchi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Michiharu Yoshida
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shunsuke Onodera
- Department of Radiation Oncology, Hokkaido Cancer Center, Sapporo, Japan
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tohru Shiga
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Terae
- Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan
| | - Hiroki Shirato
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Soize S, Bouquigny F, Kadziolka K, Portefaix C, Pierot L. Value of 4D MR angiography at 3T compared with DSA for the follow-up of treated brain arteriovenous malformation. AJNR Am J Neuroradiol 2014; 35:1903-9. [PMID: 24904052 DOI: 10.3174/ajnr.a3982] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Four-dimensional, contrast-enhanced MRA is a useful technique for the diagnosis and classification of brain AVM. The purpose of this study was to evaluate its usefulness in the follow-up of treated brain AVM. MATERIALS AND METHODS Patients with treated brain AVM (embolization, radiosurgery, and/or surgery) were investigated with both DSA (the "gold standard") and 4D MRA. Four-dimensional MRA was performed at 3T using a 4D sequence, combining contrast-enhanced timing-robust angiography, keyhole, and sensitivity encoding techniques. Examinations were evaluated by 2 independent readers and disagreements were resolved by a third reader. Interobserver and intermodality agreement with respect to residual nidus, residual venous drainage, and brain AVM patency were determined. RESULTS Between May 2008 and February 2013, 37 patients with a median age of 45 years (interquartile range = 26-55) were prospectively included. Examinations were acquired 36 months (IQR = 10-45.5) after the last treatment. Interobserver agreement for brain AVM patency was very good for both 4D MRA (κ 0.82, 95% CI .67-.98) and DSA (κ 0.84, 95% CI .69-.98). After consensus reading, intermodality agreement for the evaluation of brain AVM patency was good (κ 0.73, 95% CI .55-.90). Diagnostic accuracy of 4D MRA for residual brain AVM compared with DSA, reached a sensitivity of 73.7%, specificity 100%, positive predictive value 100%, and negative predictive value 78.3%. Agreements by technique of treatment are also detailed. CONCLUSIONS Four-dimensional MRA is a useful radiation-free technique for the follow-up of patients with treated brain AVM, especially patients treated by radiosurgery. However, given its actual limitations it is not sufficient to assert the cure; DSA remains mandatory for this purpose.
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Affiliation(s)
- S Soize
- From the Department of Radiology, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
| | - F Bouquigny
- From the Department of Radiology, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
| | - K Kadziolka
- From the Department of Radiology, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
| | - C Portefaix
- From the Department of Radiology, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
| | - L Pierot
- From the Department of Radiology, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France.
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7
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O'Connor TE, Friedman WA. Magnetic Resonance Imaging Assessment of Cerebral Arteriovenous Malformation Obliteration After Stereotactic Radiosurgery. Neurosurgery 2013; 73:761-6. [DOI: 10.1227/neu.0000000000000086] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Stereotactic radiosurgery is ideal for treating small cerebral arteriovenous malformations (AVMs) that are surgically inaccessible. However, given the inherent delay of AVM obliteration and the potential for radiosurgical failure, detailed evaluation of the neurovascular architecture is necessary to monitor persistence of residual flow. Modern imaging systems such as magnetic resonance imaging (MRI) and angiography allow clinicians to assess transnidus flow after radiosurgical intervention.
OBJECTIVE:
To determine the accuracy of an MRI diagnosis of complete thrombosis and to identify variables that affect the precision of MRI assessment.
METHODS:
One hundred twenty patients were reviewed after receiving radiosurgery at the University of Florida from 1990 to 2010. Each patient had an MRI demonstrating AVM obliteration and an angiogram either confirming or denying AVM thrombosis.
RESULTS:
MRI correctly predicted complete AVM obliteration in 82% of patients. There was a significant correlation between AVM volume and MRI accuracy in 2 separate models. In the first model, logistic regression analysis revealed a significant linear relationship between the natural log of AVM volume and MRI accuracy. The second model showed significant evidence of a cutoff point in MRI accuracy near an AVM volume of 2.80 cm3, above which MRI agreement with angiography is 90% and below which MRI agreement falls off sharply to remain constant at 70%.
CONCLUSION:
MRI is a useful diagnostic system for assessing AVM obliteration, but its accuracy is inherently linked to the nidus volume it is measuring. These results suggest that MRI may be able to take on an increasingly independent role in the evaluation of AVM regression.
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8
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Raza SM, Papadimitriou K, Gandhi D, Radvany M, Olivi A, Huang J. Intra-arterial intraoperative computed tomography angiography guided navigation: a new technique for localization of vascular pathology. Neurosurgery 2013; 71:ons240-52; discussion ons252. [PMID: 22858682 DOI: 10.1227/neu.0b013e3182647a73] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Precise intraoperative surgical localization of small distal aneurysms, arteriovenous malformations (AVMs), and cranial base dural arteriovenous fistulae may be challenging. Current neuronavigational techniques are based on imaging techniques with limited sensitivity to detect vascular lesions that are small. We introduce the technique of intraoperative computed tomography angiography (iCTA) with an intra-arterial injection for surgical navigation. OBJECTIVE To determine whether iCTA integrated with a navigation platform is accurate and useful for precise localization of small vascular lesions that are challenging to treat. METHODS This study included 8 patients: 2 with aneurysms, 3 with small cortical AVMs, and 3 with cranial base dural arteriovenous fistulae. iCTA with intra-arterial contrast injection was performed in all patients for precise localization of the small vascular lesion to facilitate craniotomy planning and microsurgical approach. All operative reports, inpatient and outpatient records, and radiographic studies available were reviewed retrospectively. RESULTS : The iCTA was used to target 2 aneurysms, 3 small subcortical AVMs, and 3 dural arteriovenous fistulae. This technique was most helpful to localize the 3 AVMs and the distal M4 aneurysm precisely. Craniotomy planning was accurate in all instances; no complications related to the technique were noted, and all patients had uneventful postoperative recoveries. CONCLUSION iCTA is an effective and accurate novel technique that can enhance the safety of surgical treatment for small intra-axial vascular pathology. ABBREVIATIONS AVM, arteriovenous malformationCTA, computed tomography angiographyDAVF, dural arteriovenous fistulaDSA, digital subtraction angiographyiCTA, intraoperative computed tomography angiographyMCA, middle cerebral arteryMSCT, multislice computed tomographyMRA, magnetic resonance angiography.
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Affiliation(s)
- Shaan M Raza
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Khandanpour N, Griffiths P, Warren D, Hoggard N. Prospective comparison of late 3T MRI with conventional angiography in evaluating the patency of cerebral arteriovenous malformations treated with stereotactic radiosurgery. Neuroradiology 2013; 55:683-7. [DOI: 10.1007/s00234-013-1153-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 01/30/2013] [Indexed: 11/25/2022]
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10
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Fukaya C, Shimoda K, Watanabe M, Morishita T, Sumi K, Otaka T, Obuchi T, Toshikazu K, Kobayashi K, Oshima H, Yamamoto T, Katayama Y. Fatal Hemorrhage From AVM After DBS Surgery: Case Report. Neuromodulation 2012; 16:414-7; discussion 417. [DOI: 10.1111/j.1525-1403.2012.00516.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 07/25/2012] [Accepted: 08/14/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Chikashi Fukaya
- Nihon University Hospital; Neuromodulation Center; Department of Neurological Surgery; Division of Applied System Neuroscience; Nihon University School of Medicine; Itabashi-ku Tokyo Japan
| | - Kentaro Shimoda
- Nihon University Hospital; Neuromodulation Center; Department of Neurological Surgery; Division of Applied System Neuroscience; Nihon University School of Medicine; Itabashi-ku Tokyo Japan
| | - Mitsuru Watanabe
- Nihon University Hospital; Neuromodulation Center; Department of Neurological Surgery; Division of Applied System Neuroscience; Nihon University School of Medicine; Itabashi-ku Tokyo Japan
| | - Takashi Morishita
- Nihon University Hospital; Neuromodulation Center; Department of Neurological Surgery; Division of Applied System Neuroscience; Nihon University School of Medicine; Itabashi-ku Tokyo Japan
| | - Koichiro Sumi
- Nihon University Hospital; Neuromodulation Center; Department of Neurological Surgery; Division of Applied System Neuroscience; Nihon University School of Medicine; Itabashi-ku Tokyo Japan
| | - Toshiharu Otaka
- Nihon University Hospital; Neuromodulation Center; Department of Neurological Surgery; Division of Applied System Neuroscience; Nihon University School of Medicine; Itabashi-ku Tokyo Japan
| | - Toshiki Obuchi
- Nihon University Hospital; Neuromodulation Center; Department of Neurological Surgery; Division of Applied System Neuroscience; Nihon University School of Medicine; Itabashi-ku Tokyo Japan
| | - Kano Toshikazu
- Nihon University Hospital; Neuromodulation Center; Department of Neurological Surgery; Division of Applied System Neuroscience; Nihon University School of Medicine; Itabashi-ku Tokyo Japan
| | - Kazutaka Kobayashi
- Nihon University Hospital; Neuromodulation Center; Department of Neurological Surgery; Division of Applied System Neuroscience; Nihon University School of Medicine; Itabashi-ku Tokyo Japan
| | - Hideki Oshima
- Nihon University Hospital; Neuromodulation Center; Department of Neurological Surgery; Division of Applied System Neuroscience; Nihon University School of Medicine; Itabashi-ku Tokyo Japan
| | - Takamitsu Yamamoto
- Nihon University Hospital; Neuromodulation Center; Department of Neurological Surgery; Division of Applied System Neuroscience; Nihon University School of Medicine; Itabashi-ku Tokyo Japan
| | - Yoichi Katayama
- Nihon University Hospital; Neuromodulation Center; Department of Neurological Surgery; Division of Applied System Neuroscience; Nihon University School of Medicine; Itabashi-ku Tokyo Japan
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11
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Mossa-Basha M, Chen J, Gandhi D. Imaging of cerebral arteriovenous malformations and dural arteriovenous fistulas. Neurosurg Clin N Am 2012; 23:27-42. [PMID: 22107856 DOI: 10.1016/j.nec.2011.09.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Imaging plays a major role in the identification, grading, and treatment of cerebral arteriovenous malformations and cerebral dural arteriovenous fistulas. Digital subtraction angiography is the gold standard in the diagnosis and characterization of these vascular malformations, but advances in both magnetic resonance imaging and computed tomography, including advanced imaging techniques, have provided new tools for further characterizing these lesions as well as the surrounding brain structures that may be affected. This article discusses the role of conventional as well as advanced imaging modalities that are providing novel ways to characterize these vascular malformations.
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Affiliation(s)
- Mahmud Mossa-Basha
- Division of Neuroradiology, Russell H. Morgan Department of Radiology, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, USA
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12
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Hadizadeh DR, Kukuk GM, Steck DT, Gieseke J, Urbach H, Tschampa HJ, Greschus S, Kovàcs A, Möhlenbruch M, Bostroem A, Schild HH, Willinek WA. Noninvasive evaluation of cerebral arteriovenous malformations by 4D-MRA for preoperative planning and postoperative follow-up in 56 patients: comparison with DSA and intraoperative findings. AJNR Am J Neuroradiol 2012; 33:1095-101. [PMID: 22300925 DOI: 10.3174/ajnr.a2921] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE 4D-MRA is a promising technique in the diagnosis and follow-up of cAVMs. The purpose of this study was to compare 4D-MRA in the pre- and postoperative evaluation of cAVMs with DSA or intraoperative findings as the standards of reference regarding qualitative and quantitative parameters. MATERIALS AND METHODS Fifty-six consecutive patients with cAVMs (30 women) underwent both 4D-MRA and DSA. Preoperative 4D-MRA was excluded from analysis in 1 patient (movement artifacts). Twenty-five patients underwent surgery on cAVMs and underwent both imaging modalities pre- and postoperatively. 4D-MRA was performed with either 0.5-mol/L gadolinium-diethylene-triamine pentaacetic acid (group 1: voxel size, 1.1 × 1.1 × 1.4 mm(3); 608 ms/dynamic frame; 19 patients) or 1.0-mol/L gadobutrol (group 2: voxel size, 1.1 × 1.1 × 1.1 mm(3); 572 ms/dynamic frame; additional alternating view sharing; 37 patients). Two readers independently reviewed 4D-MRA and DSA regarding the Spetzler-Martin classification, arterial feeders, and postoperative residual filling. Vessel sharpness, vessel diameter, and VBC of 4D-MRA were quantified. RESULTS Preoperative Spetzler-Martin classification 4D-MRA and DSA ratings matched in 55/55 patients (Spetzler-Martin grades: I, 12; II, 22; III, 15; IV, 5; V, 1), and 93/100 arterial feeders were correctly identified by preoperative 4D-MRA (7 additional arterial feeders identified by DSA only: group 1, 3/19; group 2, 4/36). Postoperative 4D-MRA and DSA matched in 25/25 patients (residual filling, 1/25). Vessel sharpness and diameters did not differ substantially between the 2 groups. VBC was significantly higher in group 2 (P < .005). CONCLUSIONS 4D-MRA is a reliable tool that allows predicting Spetzler-Martin classification and postoperative residual filling; it hence allows substituting DSA in the pre- and postoperative evaluation of patients with cerebral AVMs.
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Affiliation(s)
- D R Hadizadeh
- Departments of Radiology and Neurosurgery, University of Bonn, Bonn, Germany; and Philips Healthcare, Best, the Netherlands
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13
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Buis DR, Bot JCJ, Barkhof F, Knol DL, Lagerwaard FJ, Slotman BJ, Vandertop WP, van den Berg R. The predictive value of 3D time-of-flight MR angiography in assessment of brain arteriovenous malformation obliteration after radiosurgery. AJNR Am J Neuroradiol 2011; 33:232-8. [PMID: 22095967 DOI: 10.3174/ajnr.a2744] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of radiosurgery of bAVMs is complete angiographic obliteration of its nidus. We assessed the diagnostic accuracy of 1.5T T2-weighted MR imaging and TOF-MRA images for detecting nidus obliteration after radiosurgery. MATERIALS AND METHODS The pre- and postradiosurgery MR images and DSA images from 120 patients who were radiosurgically treated for a bAVM were re-evaluated by 2 observers for patency of the nidus (preradiosurgery) and obliteration (postradiosurgery: final follow-up MR imaging), by using a 3-point scale of confidence. Consensus reading of the DSA after radiosurgery was considered the criterion standard for obliteration. Sensitivity, specificity, PPVs, and NPVs, and overall diagnostic performance by using ROC were determined. RESULTS Mean bAVM volume during radiosurgery was 3.4 mL (95% CI, 2.6-4.3 mL). Sixty-six patients (55%) had undergone previous endovascular embolization. The mean intervals between radiosurgery and follow-up MR imaging and for DSA, respectively, were 35.6 months (95% CI, 32.3-38.9 months) and 42.1 months (95% CI, 40.3-44.0 months). With ROC, an area under curve of 0.81-0.83 was found. PPVs of final follow-up MR-imaging for definitive obliteration varied between 0.89 [corrected] and 0.95. NPV was 0.52 [corrected] . An average false-positive rate, meaning overestimation of nidus obliteration of 0.10 [corrected] and an average false-negative rate, meaning underestimation of nidus obliteration of 0.42 [corrected] were found. CONCLUSIONS MRA is insufficient to diagnose obliteration in the follow-up of bAVMs after radiosurgery. A remaining nidus diameter <10 mm seems to be the major limiting factor for reliable assessment of obliteration. We highly recommend follow-up DSA for definitive diagnosis of complete obliteration.
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Affiliation(s)
- D R Buis
- Department of Neurosurgery, Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
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Use of three-dimensional MRI-angiography in preoperative evaluation and postoperative management of hemangiomas of head and neck region. J Craniofac Surg 2011; 22:1814-8. [PMID: 21959441 DOI: 10.1097/scs.0b013e31822f3b05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Hemangiomas (proliferating endothelial tumors) are the most common benign tumors of infancy. Most often hemangiomas are self-regressing lesions without any treatment. Approximately 10% of hemangiomas cause complications such as major ulceration/destruction, distortion of involved tissues, and obstruction of a vital structure. When the situation becomes complicated, there are different treatment alternatives, ranging from systemic or local corticosteroid use to surgery. Sclerotherapy using intralesional polidocanol (Aethoxysklerol) injection may be used before surgery to decrease blood loss or when a vital structure of the face is in danger because of sudden increase in size of a surrounding hemangioma. Before any kind of treatment for both hemangiomas and vascular malformations, preoperative diagnosis and anatomic position of the lesion must be documented thoroughly. With the help of magnetic resonance imaging, tridimensional vascular pattern of such lesions can be shown successfully. We used three-dimensional contrast-enhanced time-resolved magnetic resonance angiography to detect the changes of lesions for 2 children who have large hemangiomas on their faces, before and after sclerotherapy with polidocanol injection. The findings of three-dimensional magnetic resonance imaging studies help to better assess the success rate of treatment not only for us as the physicians but also for the parents of these children who cannot understand anything with standard two-dimensional radiologic imaging.
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Jagadeesan BD, Delgado Almandoz JE, Benzinger TLS, Moran CJ. Postcontrast susceptibility-weighted imaging: a novel technique for the detection of arteriovenous shunting in vascular malformations of the brain. Stroke 2011; 42:3127-31. [PMID: 21940964 DOI: 10.1161/strokeaha.111.623587] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to determine the utility of postcontrast susceptibility-weighted MRI (PCSWI) in the evaluation of vascular malformations of the brain (BVM). METHODS We retrospectively evaluated PCSWI and digital subtraction angiography data from 16 consecutive patients with known or suspected BVM, which had been entered into a prospectively maintained database during a 1-year period. There had been no intervening treatment or change in patients' symptoms between the PCSWI and digital subtraction angiography studies. The use of PCSWI in the detection of arteriovenous shunting was compared with that of routine noncontrast susceptibility-weighted imaging, time-of-flight MR angiography, and contrast-enhanced MR angiography using digital subtraction angiography results as the reference standard. The presence of arteriovenous shunting in PCSWI or susceptibility-weighted imaging sequences was defined by the presence of abnormal signal hyperintensity in the venous structures adjacent to the BVM. RESULTS A total of 17 BVMs were identified by digital subtraction angiography (9 newly diagnosed arteriovenous malformations, 3 dural arteriovenous fistulas, 4 treated arteriovenous malformations with residual arteriovenous shunting, and 1 complex developmental venous anomaly). PCSWI was 100% sensitive and 100% specific with 100% positive predictive value and 100% negative predictive value for the detection of arteriovenous shunting in these BVMs. The PCSWI/susceptibility-weighted imaging signal intensity ratio in the most prominent early draining venous structure was 1.2±0.32. CONCLUSIONS PCSWI appears to be superior to susceptibility-weighted imaging, time-of-flight MR angiography, and contrast-enhanced MR angiography in detecting arteriovenous shunting in BVMs and may be useful in the initial diagnosis and follow-up of patients with BVMs.
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Jagadeesan BD, Delgado Almandoz JE, Moran CJ, Benzinger TLS. Accuracy of susceptibility-weighted imaging for the detection of arteriovenous shunting in vascular malformations of the brain. Stroke 2010; 42:87-92. [PMID: 21088245 DOI: 10.1161/strokeaha.110.584862] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE to determine the accuracy of susceptibility-weighted MRI (SWI) for the detection of arteriovenous shunting (AVS) in vascular malformations of the brain (BVM). METHODS we retrospectively identified 60 patients who had been evaluated for known or suspected BVM by both SWI and digital subtraction angiography, without intervening treatment, during a 3-year period. SWI images were retrospectively assessed by 2 independent reviewers for the presence of AVS as determined by the presence of signal hyperintensity within a venous structure in the vicinity of the BVM. Discrepancies were resolved by consensus among a panel of 3 neuroradiologists. Accuracy parameters of SWI for the detection of AVS were calculated using digital subtraction angiography as the reference standard. RESULTS a total of 80 BVM were identified in the 60 patients included in our study. Of the 29 BVM with AVS on digital subtraction angiography, 14 were untreated arteriovenous malformations, 10 were previously treated arteriovenous malformations, and 5 were untreated dural arteriovenous fistulas. Overall, SWI was 93% sensitive and 98% specific for the detection of AVS in BVM, with excellent interobserver agreement (κ=0.94). In the 14 previously treated arteriovenous malformations, SWI was 100% sensitive and specific for the detection of AVS. In the 28 BVM associated with intracerebral hemorrhage, SWI was 100% sensitive and 96% specific for the detection of AVS. CONCLUSIONS SWI is accurate for the detection of arteriovenous shunting in vascular malformations of the brain and, for some patients, SWI may offer a noninvasive alternative to angiography in screening for or follow-up of treated BVM.
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Affiliation(s)
- Bharathi D Jagadeesan
- Division of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University Campus, Saint Louis, MO 63110, USA.
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