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Arterial Spin-Labeling Improves Detection of Intracranial Dural Arteriovenous Fistulas with MRI
S A Amukotuwa1,2, M P Marks3, G Zaharchuk3
1From the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California samukotuwa@gmail.com.
Background And Purpose:
Intracranial dural arteriovenous fistulas carry a risk of substantial neurologic complications but can be difficult to detect on structural MR imaging and TOF-MRA. The purpose of this study was to assess the accuracy and added value of 3D pseudocontinuous arterial spin-labeling MR imaging for the detection of these lesions.
Materials And Methods:
This retrospective study included 39 patients with a dural arteriovenous fistula and 117 controls who had undergone both DSA and MR imaging with pseudocontinuous arterial spin-labeling. Two neuroradiologists blinded to the DSA results independently assessed MR imaging with and without pseudocontinuous arterial spin-labeling. They recorded specific signs, including venous arterial spin-labeling signal, and the likelihood of a dural arteriovenous fistula using a 5-point Likert scale. Logistic regression and receiver operating characteristic analyses were performed to determine the accuracy of specific signs and the added value of pseudocontinuous arterial spin-labeling. Interobserver agreement was determined by using κ statistics.
Results:
Identification of the venous arterial spin-labeling signal had a high sensitivity (94%) and specificity (88%) for the presence a dural arteriovenous fistula. Receiver operating characteristic analysis showed significant improvement in diagnostic performance with the addition of pseudocontinuous arterial spin-labeling in comparison with structural MR imaging (Δarea under the receiver operating characteristic curve = 0.179) and a trend toward significant improvement in comparison with structural MR imaging with time-of-flight MRA (Δarea under the receiver operating characteristic curve = 0.043). Interobserver agreement for the presence of a dural arteriovenous fistula improved substantially and was almost perfect with the addition of pseudocontinuous arterial spin-labeling (κ = 0.92).
Conclusions:
Venous arterial spin-labeling signal has high sensitivity and specificity for the presence of a dural arteriovenous fistula, and the addition of pseudocontinuous arterial spin-labeling increases confidence in the diagnosis of this entity on MR imaging.
Insights
3D pseudocontinuous arterial spin-labeling (PCASL) MR imaging accurately detects intracranial dural arteriovenous fistulas. Adding PCASL to MR imaging significantly improves diagnostic performance and confidence in identifying these challenging lesions.
Area of Science:
- Neuroradiology
- Medical Imaging
- Neurology
Background:
- Intracranial dural arteriovenous fistulas (dAVFs) pose a risk of serious neurologic complications.
- Detection of dAVFs can be challenging with conventional structural MR imaging and time-of-flight MRA.
Purpose of the Study:
- To evaluate the diagnostic accuracy and added value of 3D pseudocontinuous arterial spin-labeling (PCASL) MR imaging for detecting intracranial dAVFs.
Main Methods:
- Retrospective analysis of 39 dAVF patients and 117 controls who underwent DSA and MR imaging with PCASL.
- Two blinded neuroradiologists assessed MR images with and without PCASL, evaluating specific signs like venous ASL signal and dAVF likelihood.
- Statistical analyses included logistic regression, ROC analysis, and interobserver agreement (κ statistics).
Main Results:
- The venous arterial spin-labeling (ASL) signal demonstrated high sensitivity (94%) and specificity (88%) for dAVF detection.
- PCASL significantly improved diagnostic performance compared to structural MR imaging (ΔAUC = 0.179) and showed a trend versus TOF-MRA (ΔAUC = 0.043).
- Interobserver agreement for dAVF presence improved to nearly perfect (κ = 0.92) with the addition of PCASL.
Conclusions:
- Venous ASL signal is a sensitive and specific indicator for dAVFs.
- Incorporating PCASL into MR imaging protocols enhances diagnostic confidence for dAVF detection.
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