Abstract
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. 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. 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). 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.
Highlights
BACKGROUND AND PURPOSEArterial spin-labeling and susceptibility-weighted imaging are 2 MR imaging techniques that do not require gadolinium
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
Intracranial arteriovenous shunting (AVS) related to dural arteriovenous fistulas (DAVFs) or AVMs may lead to several neurologic complications, including acute intracranial hemorrhage (ICH).[1,2,3]
Summary
Ninety-two consecutive patients with a known (n ϭ 24) or suspected arteriovenous shunting (n ϭ 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). Known AVS included brain AVM previously treated by embolization and/or radiosurgery In this patient group, DSA was performed to evaluate nidus reduction or detect a potential residual shunting. DAVF or brain AVM was suspected in patients with brain hematoma (according to clinical status, patient age, medical history, and location of hemorrhage), pulsatile tinnitus, and suggestive findings on brain MR imaging/CT. In these patients, DSA was performed to confirm AVS and to analyze its location and angioarchitecture
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