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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Three-dimensional dynamic magnetic resonance angiography for the evaluation of radiosurgically treated cerebral
Jean-Yves Gauvrit1, Catherine Oppenheim, Francois Nataf
1Department of Neuroradiology, EA 2691, Roger Salengro Hospital, rue du Pr. E Laine, 59037, Lille, France. jygauvrit@chru-lille.fr
Abstract:
We assessed the value of three-dimensional (3D) dynamic magnetic resonance angiography (MRA) for the follow-up of patients with radiosurgically treated cerebral arteriovenous malformations (AVMs). Fifty-four patients with cerebral AVMs treated by radiosurgery (RS) were monitored using conventional catheter angiography (CCA) and 3D dynamic MRA with sensitivity encoding based on the parallel imaging. Cerebral AVM was qualitatively classified by two radiologists into one of five categories in terms of residual nidus size and persistence of early draining vein (I, >6 cm; II, 3-6 cm; III, <3 cm; IV, isolated early draining vein; V, complete obliteration). 3D MRA findings showed a good agreement with CCA in 40 cases (kappa=0.62). Of 23 nidus detected on CCA, 3D dynamic MRA showed 14 residual nidus. Of 28 occluded nidus on 3D dynamic MRA, 22 nidus were occluded on CCA. The sensitivity and specificity of 3D dynamic MRA for the detection of residual AVM were 81% and 100%. 3D dynamic MRA after RS may therefore be useful in association with MRI and can be repeated as long as opacification of the nidus or early venous drainage persists, one CCA remaining indispensable to affirm the complete occlusion at the end of follow-up.
Insights
Three-dimensional dynamic magnetic resonance angiography (3D dynamic MRA) shows good agreement with conventional catheter angiography for monitoring cerebral arteriovenous malformations (AVMs) after radiosurgery. This imaging technique is valuable for follow-up, though catheter angiography remains essential for final occlusion confirmation.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Cerebral arteriovenous malformations (AVMs) require diligent follow-up after radiosurgery (RS) to assess treatment efficacy.
- Conventional catheter angiography (CCA) is the gold standard but is invasive.
- Non-invasive imaging modalities are sought for AVM follow-up.
Purpose of the Study:
- To evaluate the diagnostic value of three-dimensional (3D) dynamic magnetic resonance angiography (MRA) for follow-up of radiosurgically treated cerebral AVMs.
- To compare the accuracy of 3D dynamic MRA with conventional catheter angiography (CCA).
Main Methods:
- Fifty-four patients with cerebral AVMs treated with RS were monitored.
- Conventional catheter angiography (CCA) and 3D dynamic MRA were utilized for follow-up assessments.
- Radiologists classified AVMs into five categories based on residual nidus size and early draining vein status.
Main Results:
- 3D dynamic MRA demonstrated good agreement with CCA (kappa=0.62).
- The sensitivity and specificity of 3D dynamic MRA for detecting residual AVM were 81% and 100%, respectively.
- 3D dynamic MRA identified 14 residual nidus among 23 detected by CCA.
Conclusions:
- 3D dynamic MRA is a valuable, non-invasive tool for monitoring cerebral AVMs post-radiosurgery.
- It can be repeated as needed, complementing MRI.
- CCA remains indispensable for confirming complete AVM occlusion at the conclusion of follow-up.
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