Abstract
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. 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. 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. 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.
Highlights
BACKGROUND AND PURPOSEFour-dimensional, contrast-enhanced MRA is a useful technique for the diagnosis and classification of brain AVM
Interobserver agreement for brain AVM patency was very good for both 4D MRA ( 0.82, 95% CI .67–.98) and DSA ( 0.84, 95% CI .69 –.98)
For the purpose of the present study, patients imaged between May 2008 and February 2013 were included if they met the following criteria: 1) they had a Brain AVMs (bAVMs) treated at least by 1 of the following modalities, 2) they were imaged during the follow-up with both 4D-MRA at 3T and DSA, 3) both examinations were performed at least 1 month after the last treatment, 4) both examinations were performed in a time interval less than 1 month and without treatment in between, and 5) image datasets were of sufficient quality
Summary
The purpose of this study was to evaluate the performance of 4D-MRA at 3T for the follow-up of patients with a treated bAVM
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