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Boisseau W, Benaissa A, Fahed R, Amegnizin JL, Smajda S, Benadjaoud S, Benadjaoud AM, Saint-Val L, Alias Q, Iorio P, Yang S, Zuber K, Kalsoum E, Hodel J. Delayed Contrast-Enhanced MR Angiography for the Assessment of Internal Carotid Bulb Patency in the Context of Acute Ischemic Stroke: An Accuracy, Interrater, and Intrarater Agreement Study. AJNR Am J Neuroradiol 2021; 42:1116-1122. [PMID: 33707285 DOI: 10.3174/ajnr.a7054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/21/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE CTA has shown limited accuracy and reliability in distinguishing tandem occlusions and pseudo-occlusions on initial acute stroke imaging. The utility of early and delayed contrast-enhanced MRA in this setting is unknown. We aimed to assess the accuracy and reliability of early and delayed contrast-enhanced MRA for carotid bulb patency in patients with acute ischemic stroke. MATERIALS AND METHODS We retrospectively reviewed patients who had ICA occlusion and underwent thrombectomy with preprocedural early and delayed contrast-enhanced MRA in a single comprehensive stroke center. During 2 sessions, 10 raters independently assessed 32 cases with early contrast-enhanced MRA (with an additional delayed contrast-enhanced MRA sequence during the second reading session). Their judgments were compared with DSA as a reference standard. Accuracy and interrater agreement were measured. Five raters undertook a third reading session to assess intrarater agreement. RESULTS Accuracy for the assessment of carotid bulb patency with early contrast-enhanced MRA was limited (69%; 95% CI, 59%-79%), with moderate interrater agreement (κ = 0.42; 95% CI, 0.27-0.55). The second reading with an additional delayed contrast-enhanced MRA sequence improved both accuracy (82%; 95% CI, 73%-91%; P < .001) (raters corrected 43%-77% of incorrect diagnoses with early contrast-enhanced MRA alone; mean = 59%) and interrater agreement (κ = 0.56; 95% CI, 0.41-0.73; P = .07). Intrarater agreement was almost perfect, substantial, and moderate for 3, 1, and 1 raters. CONCLUSIONS Early contrast-enhanced MRA has limited accuracy and repeatability for the evaluation of carotid bulb patency in acute ischemic stroke. The additional delayed contrast-enhanced MRA sequence may improve accuracy and reliability.
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Affiliation(s)
- W Boisseau
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - A Benaissa
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - R Fahed
- Department of Interventional Neuroradiology (R.F., S.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J-L Amegnizin
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - S Smajda
- Department of Interventional Neuroradiology (R.F., S.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Benadjaoud
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - A M Benadjaoud
- Department of Radiobiology and Epidemiology (A.M.B.), Institute for Radiological Protection and Nuclear Safety, Fontenay-Aux-Roses, France
| | - L Saint-Val
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - Q Alias
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - P Iorio
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - S Yang
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - K Zuber
- Clinical Research Unit (K.Z.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - E Kalsoum
- From the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - J Hodel
- Department of Radiology, (J.H.), Groupe-Hospitalier-Paris-Saint-Joseph, Paris, France
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Garzelli L, Shotar E, Blauwblomme T, Sourour N, Alias Q, Stricker S, Mathon B, Kossorotoff M, Gariel F, Boddaert N, Brunelle F, Meyer P, Naggara O, Clarençon F, Boulouis G. Risk Factors for Early Brain AVM Rupture: Cohort Study of Pediatric and Adult Patients. AJNR Am J Neuroradiol 2020; 41:2358-2363. [PMID: 33122204 DOI: 10.3174/ajnr.a6824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/06/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Whether architectural characteristics of ruptured brain AVMs vary across the life span is unknown. We aimed to identify angioarchitectural features associated with brain AVMs ruptured early in life. MATERIALS AND METHODS Patients with ruptured brain AVMs referred to 2 distinct academic centers between 2000 and 2018 were pooled and retrospectively analyzed. Imaging was retrospectively reviewed for angioarchitectural characteristics, including nidus size, location, Spetzler-Martin grade, venous drainage, and arterial or nidal aneurysm. Angioarchitecture variations across age groups were analyzed using uni- and multivariable models; then cohorts were pooled and analyzed using Kaplan-Meier and Cox models to determine factors associated with earlier rupture. RESULTS Among 320 included patients, 122 children (mean age, 9.8 ± 3.8 years) and 198 adults (mean age, 43.3 ± 15.7 years) were analyzed. Pediatric brain AVMs were more frequently deeply located (56.3% versus 21.2%, P < .001), with a larger nidus (24.2 versus 18.9 mm, P = .002), were less frequently nidal (15.9% versus 23.5%, P = .03) and arterial aneurysms (2.7% versus 17.9%, P < .001), and had similar drainage patterns or Spetzler-Martin grades. In the fully adjusted Cox model, supratentorial, deep brain AVM locations (adjusted relative risk, 1.19; 95% CI, 1.01-1.41; P = .03 and adjusted relative risk, 1.43; 95% CI, 1.22-1.67; P < .001, respectively) and exclusively deep venous drainage (adjusted relative risk, 1.46, 95% CI, 1.21-1.76; P < .001) were associated with earlier rupture, whereas arterial or nidal aneurysms were associated with rupture later in life. CONCLUSIONS The angioarchitecture of ruptured brain AVMs significantly varies across the life span. These distinct features may help to guide treatment decisions for patients with unruptured AVMs.
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Affiliation(s)
- L Garzelli
- From the Department of Neuroradiology (L.G., O.N., G.B.), Sainte-Anne University Hospital, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1266, Paris, France.,Departments of Neuroradiology (L.G., F.C.)
| | - E Shotar
- Department of Neuroradiology (E.S., N.S., F.C.)
| | - T Blauwblomme
- Department of Pediatric Neurosurgery (T.B., S.S.), French Center for Pediatric Stroke.,Université de Paris (T.B., N.B., F.B., O.N., G.B.), Paris, France
| | - N Sourour
- Department of Neuroradiology (E.S., N.S., F.C.)
| | - Q Alias
- Department of Pediatric Imaging (Q.A., N.B., F.B., O.N., G.B.)
| | - S Stricker
- Department of Pediatric Neurosurgery (T.B., S.S.), French Center for Pediatric Stroke
| | - B Mathon
- Neurosurgery (B.M.), Sorbonne University, Paris, France.,Neurosurgery (B.M.), Pitié-Salpêtrière University Hospital, Public Assistance-Paris Hospitals, Paris, France.,Brain and Spine Institute (B.M.), Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1127; Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
| | - M Kossorotoff
- Department of Pediatric Neurology (M.K.), French Center for Pediatric Stroke
| | - F Gariel
- Department of Neuroimaging (F.G.), Pellegrin Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - N Boddaert
- Department of Pediatric Imaging (Q.A., N.B., F.B., O.N., G.B.).,Université de Paris (T.B., N.B., F.B., O.N., G.B.), Paris, France
| | - F Brunelle
- Department of Pediatric Imaging (Q.A., N.B., F.B., O.N., G.B.).,Université de Paris (T.B., N.B., F.B., O.N., G.B.), Paris, France
| | - P Meyer
- Department of Anesthesiology (P.M.), Necker-Enfants Malades University Hospital, Public Assistance-Paris Hospitals, Paris, France
| | - O Naggara
- From the Department of Neuroradiology (L.G., O.N., G.B.), Sainte-Anne University Hospital, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1266, Paris, France.,Department of Pediatric Imaging (Q.A., N.B., F.B., O.N., G.B.).,Université de Paris (T.B., N.B., F.B., O.N., G.B.), Paris, France
| | - F Clarençon
- Departments of Neuroradiology (L.G., F.C.).,Department of Neuroradiology (E.S., N.S., F.C.)
| | - G Boulouis
- From the Department of Neuroradiology (L.G., O.N., G.B.), Sainte-Anne University Hospital, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1266, Paris, France .,Department of Pediatric Imaging (Q.A., N.B., F.B., O.N., G.B.).,Université de Paris (T.B., N.B., F.B., O.N., G.B.), Paris, France
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