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Published on: July 28, 2018
Concordance of Time-of-Flight MRA and Digital Subtraction Angiography in Adult Primary Central Nervous System
H de Boysson1, G Boulouis2, J-J Parienti3
1From the Departments of Internal Medicine (H.d.B., B.B., A.A.) deboysson-h@chu-caen.fr.
Insights
Three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) closely matches digital subtraction angiography (DSA) for diagnosing primary central nervous system vasculitis. Negative 3T 3D-TOF-MRA results suggest DSA may offer limited additional diagnostic value.
Area of Science:
- Neurology
- Radiology
- Vascular Imaging
Background:
- Primary central nervous system vasculitis (PCNSV) diagnosis relies on demonstrating neurovascular involvement.
- Both 3D-TOF-MRA and DSA are utilized for visualizing cerebral vasculature in PCNSV.
- Comparing the diagnostic accuracy of these imaging modalities is crucial.
Purpose of the Study:
- To compare the diagnostic concordance between 3D-TOF-MRA and DSA.
- To evaluate the effectiveness of 3D-TOF-MRA in detecting neurovascular abnormalities in PCNSV patients.
Main Methods:
- Retrospective analysis of 31 PCNSV patients who underwent both 3D-TOF-MRA and DSA within two weeks before treatment.
- Independent review of intracranial imaging by two neuroradiologists.
- Assessment of vessel stenosis concordance using Cohen κ Index across 25 arterial segments.
Main Results:
- High concordance was observed between 3D-TOF-MRA and DSA.
- Concordance rates were 0.82 for 1.5T 3D-TOF-MRA and 0.87 for 3T 3D-TOF-MRA.
- 81% of patients showed abnormal DSA findings, with 24 also having abnormal 3D-TOF-MRA.
Conclusions:
- 3D-TOF-MRA demonstrates high diagnostic performance comparable to DSA for PCNSV.
- For patients with negative 3T 3D-TOF-MRA results, the additional diagnostic utility of DSA appears limited.
Background And Purpose:
3D-TOF-MRA and DSA are 2 available tools to demonstrate neurovascular involvement in primary central nervous system vasculitis. We aimed to compare the diagnostic concordance of vessel imaging using 3D-TOF-MRA and DSA in patients with primary central nervous system vasculitis.
Materials And Methods:
We retrospectively identified all patients included in the French primary central nervous system vasculitis cohort of 85 patients who underwent, at baseline, both intracranial 3D-TOF-MRA and DSA in an interval of no more than 2 weeks and before treatment initiation. Two neuroradiologists independently reviewed all 3D-TOF-MRA and DSA imaging. Brain vasculature was divided into 25 arterial segments. Concordance between 3D-TOF-MRA and DSA for the identification of arterial stenosis was assessed by the Cohen κ Index.
Results:
Thirty-one patients met the inclusion criteria, including 20 imaged with a 1.5T MR unit and 11 with a 3T MR unit. Among the 25 patients (81%) with abnormal DSA findings, 24 demonstrated abnormal 3D-TOF-MRA findings, whereas all 6 remaining patients with normal DSA findings had normal 3D-TOF-MRA findings. In the per-segment analysis, concordance between 1.5T 3D-TOF-MRA and DSA was 0.82 (95% CI, 0.75-0.93), and between 3T 3D-TOF-MRA and DSA, it was 0.87 (95% CI, 0.78-0.91).
Conclusions:
3D-TOF-MRA shows a high concordance with DSA in diagnostic performance when analyzing brain vasculature in patients with primary central nervous system vasculitis. In patients with negative 3T 3D-TOF-MRA findings, the added diagnostic value of DSA is limited.
