Abstract
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. 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. 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). 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.
Highlights
BACKGROUND AND PURPOSE4D contrast-enhanced MRA in the follow-up of treated dural arteriovenous fistulas has rarely been evaluated
The sensitivity and specificity of 4D contrast-enhanced MRA for the detection of residual/recurrent dural arteriovenous fistula was 63.6% and 96.6%, respectively
The positive and negative predictive values of 4D contrast-enhanced MRA were 93.3% and 77.8%
Summary
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. With DSA images as the standard of reference, the purpose of this study was to evaluate the performance of 4D-MRA at 3T in the follow-up of patients with treated DAVFs
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