4D radial acquisition contrast-enhanced MR angiography and intracranial arteriovenous malformations

Quickly approaching digital subtraction angiography

Christopher S. Eddleman, Hyun J. Jeong, Michael C. Hurley, Sven Zuehlsdorff, Guilherme Dabus, Christopher G. Getch, H. Hunt Batjer, Bernard R. Bendok, Timothy J. Carroll

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE-: The current gold standard for imaging intracranial AVMs involves catheter-based techniques, namely cerebral digital subtraction angiography (DSA). However, DSA presents some procedural risks to the patient. Unfortunately, AVM patients usually undergo multiple DSA exams throughout their diagnostic and therapeutic course, significantly increasing their procedural risk exposure. As such, high-quality noninvasive imaging is desired. We hypothesize that 4D radial acquisition contrast-enhanced MRA approximates the vascular architecture and hemodynamics of AVMs compared to conventional angiography. METHODS-: Thirteen consecutive AVM patients were assessed by 4D radial acquisition contrast-enhanced MRA and DSA. The 4D rCE-MRA images were independently assessed regarding the location, nidal size, Spetzler-Martin grade, and identification of arterial feeders, drainage pattern, and any other vascular anomalies. RESULTS-: 4D rCE-MRA correctly depicted the size, venous drainage pattern, and prominent arterial feeders in all cases. Spetzler-Martin grade was correctly determined between reviewers and between the different imaging modalities in all cases except 1. The nidus size was in good correlation between the reviewers, where r=0.99, P<0.000001. There was very good agreement between reviewers regarding the individual scans (κ=0.63 to 1), whereas the agreement between the DSA and 4D rCE-MRA images was also good (κ=0.61 to 0.85). CONCLUSIONS-: We have developed a 4D radial acquisition contrast-enhanced MRA sequence capable of imaging intracranial AVMs approximating that of DSA. Image analysis demonstrates equivalency in terms of grading AVMs using the Spetzler-Martin grading scale. This 4D rCE-MRA sequence has the potential to avoid some applications of DSA, thus saving patients from potential procedural risks.

Original languageEnglish (US)
Pages (from-to)2749-2753
Number of pages5
JournalStroke
Volume40
Issue number8
DOIs
StatePublished - Aug 2009

Fingerprint

Intracranial Arteriovenous Malformations
Digital Subtraction Angiography
Angiography
Blood Vessels
Drainage
Cerebral Angiography
Catheters
Hemodynamics

Keywords

  • Angiography
  • Arteriovenous malformation
  • DSA
  • Imaging
  • MRA
  • Vascular

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Eddleman, C. S., Jeong, H. J., Hurley, M. C., Zuehlsdorff, S., Dabus, G., Getch, C. G., ... Carroll, T. J. (2009). 4D radial acquisition contrast-enhanced MR angiography and intracranial arteriovenous malformations: Quickly approaching digital subtraction angiography. Stroke, 40(8), 2749-2753. https://doi.org/10.1161/STROKEAHA.108.546663

4D radial acquisition contrast-enhanced MR angiography and intracranial arteriovenous malformations : Quickly approaching digital subtraction angiography. / Eddleman, Christopher S.; Jeong, Hyun J.; Hurley, Michael C.; Zuehlsdorff, Sven; Dabus, Guilherme; Getch, Christopher G.; Batjer, H. Hunt; Bendok, Bernard R.; Carroll, Timothy J.

In: Stroke, Vol. 40, No. 8, 08.2009, p. 2749-2753.

Research output: Contribution to journalArticle

Eddleman, Christopher S. ; Jeong, Hyun J. ; Hurley, Michael C. ; Zuehlsdorff, Sven ; Dabus, Guilherme ; Getch, Christopher G. ; Batjer, H. Hunt ; Bendok, Bernard R. ; Carroll, Timothy J. / 4D radial acquisition contrast-enhanced MR angiography and intracranial arteriovenous malformations : Quickly approaching digital subtraction angiography. In: Stroke. 2009 ; Vol. 40, No. 8. pp. 2749-2753.
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AU - Jeong, Hyun J.

AU - Hurley, Michael C.

AU - Zuehlsdorff, Sven

AU - Dabus, Guilherme

AU - Getch, Christopher G.

AU - Batjer, H. Hunt

AU - Bendok, Bernard R.

AU - Carroll, Timothy J.

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AB - BACKGROUND AND PURPOSE-: The current gold standard for imaging intracranial AVMs involves catheter-based techniques, namely cerebral digital subtraction angiography (DSA). However, DSA presents some procedural risks to the patient. Unfortunately, AVM patients usually undergo multiple DSA exams throughout their diagnostic and therapeutic course, significantly increasing their procedural risk exposure. As such, high-quality noninvasive imaging is desired. We hypothesize that 4D radial acquisition contrast-enhanced MRA approximates the vascular architecture and hemodynamics of AVMs compared to conventional angiography. METHODS-: Thirteen consecutive AVM patients were assessed by 4D radial acquisition contrast-enhanced MRA and DSA. The 4D rCE-MRA images were independently assessed regarding the location, nidal size, Spetzler-Martin grade, and identification of arterial feeders, drainage pattern, and any other vascular anomalies. RESULTS-: 4D rCE-MRA correctly depicted the size, venous drainage pattern, and prominent arterial feeders in all cases. Spetzler-Martin grade was correctly determined between reviewers and between the different imaging modalities in all cases except 1. The nidus size was in good correlation between the reviewers, where r=0.99, P<0.000001. There was very good agreement between reviewers regarding the individual scans (κ=0.63 to 1), whereas the agreement between the DSA and 4D rCE-MRA images was also good (κ=0.61 to 0.85). CONCLUSIONS-: We have developed a 4D radial acquisition contrast-enhanced MRA sequence capable of imaging intracranial AVMs approximating that of DSA. Image analysis demonstrates equivalency in terms of grading AVMs using the Spetzler-Martin grading scale. This 4D rCE-MRA sequence has the potential to avoid some applications of DSA, thus saving patients from potential procedural risks.

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