????The diagnostic performance of the combination of ASL and TOF MRA for the cerebral arteriovenous shunt

Abstract

Objective: To evaluate the diagnostic performance of the combination of arterial spin labeling (ASL) and time of flight MR angiography (TOF MRA) for intracranial arteriovenous shunt (AVS) detection. Methods: A total of 39 patients with known or suspected with cerebrovascular malformations underwent digital subtraction angiography (DSA) and ASL/TOF MRA imaging in Department of neurosurgery and radiology and nuclear medicine, Xuanwu Hospital from May 1, 2020 to October 31, 2020 were retrospectively analyzed. Patients were divided into either acute cerebral hemorrhage group (n=13) or non-acute cerebral hemorrhage group (n=26) based on the signs of bleeding on imaging findings. According to history of treatment, those patients were divided into treated (n=11) and untreated (n=28) subgroups. The determination of the presence of AVS on images was judged by two radiologists in a blinded and randomized order fashion. The diagnostic performance of ASL or TOF MRA for AVS were evaluated in overall, acute cerebral hemorrhage subgroup and treated subgroup by using the area under receiver operating curve (AUC) with DSA as the reference standard, respectively. The κ coefficients were calculated to determine the interobserver agreement. Results: Among 39 patients, 29 patients were confirmed with AVS by DSA while 10 patients with no AVS. Interobserver agreement was good-excellent (κ=0.83-1.00). In patients with AVM, the detection rates for AVS of ASL or TOF MRA were 93.1% and 86.2% respectively, while the detection rates of the combination of ASL and TOF MRA were 100%. The AUC of ASL, TOF MRA and their combination for diagnosis of AVS in overall were 0.966 (95%CI: 0.909-1.00), 0.914 (95%CI: 0.825-1.00) and 0.983 (95%CI:0.943-1.00), respectively. The AUC of ASL, TOF MRA and their combination for AVS in acute cerebral hemorrhage subgroup were 1(95%CI:1.00-1.00), 0.833(95%CI:0.611-1.00), 1(95%CI:1.00-1.00), respectively. Conclusion: Combination of ASL and TOF MRA can be a non-invasive thchnique for the detection of AVS.