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Predictive Value of MRI in Diagnosing Brain AVM Recurrence after Angiographically Documented Exclusion in Children
A Jhaveri1, A Amirabadi1, P Dirks2
1From Pediatric Neuroradiology and Image Guided Therapy (A.J., A.A., M.M.S., N.S., V.R., P.M.), Diagnostic Imaging.
Background And Purpose:
MRI is routinely performed following brain AVM after treatment in children. Our aim was to determine the predictive values of contrast-enhanced MR imaging and TOF-MRA for brain AVM recurrence in children, compared with conventional angiography and the role of 3D rotational angiography-MR imaging fusion in these cases.
Materials And Methods:
We included all pediatric patients with brain AVMs during an 18-year period with angiographically documented obliteration after treatment. Patients underwent 3T MR imaging, including contrast-enhanced MR imaging, TOF-MRA, and conventional angiography, with a subset undergoing 3D rotational angiography. The predictive values of contrast-enhanced MR imaging and TOF-MRA for brain AVM recurrence were determined. CTA sections reconstructed from 3D rotational angiography were coregistered with and fused to 3D-T1WI for analysis.
Results:
Thirty-nine children (10.8 ± 3.9 years of age; range, 2-17 years; male/female ratio, 19:20; mean Spetzler-Martin grade, 1.9 ± 0.6) met the inclusion criteria. Of these, 13 had angiographically confirmed brain AVM recurrence, 8 following surgery and 5 following embolization. Sensitivity, specificity, and positive and negative predictive values for recurrence were the following: contrast-enhanced MR imaging: 84.6%, 38.5%, 40.7%, 81.8%; TOF-MRA: 50.0%, 96.1%, 85.7%, 79.3%; both: 75.0%, 90.9%, 85.7%, 83.3%. 3D rotational angiography-MR imaging fused images confirmed or excluded recurrence in all available cases (13/13). Embolization-only treatment was a significant predictor of recurrence (OR = 32.4, P = .006). MR imaging features predictive of recurrence included a tuft of vessels on TOF-MRA and nodular juxtamural/linear enhancement with a draining vein on contrast-enhanced MR imaging.
Conclusions:
MR imaging is useful for surveillance after brain AVM treatment in children, but conventional angiography is required for definitive diagnosis of recurrence. TOF-MRA and contrast-enhanced MR imaging provide complementary information for determining brain AVM recurrence and should be interpreted in conjunction. 3D rotational angiography-MR imaging fusion increases the diagnostic confidence regarding brain AVM recurrence and is therefore suited for intraoperative neuronavigation.
Insights
Magnetic resonance imaging (MRI) is valuable for monitoring pediatric brain arteriovenous malformations (AVMs) after treatment. While time-of-flight MRA and contrast-enhanced MRI offer complementary data, conventional angiography remains definitive for diagnosing AVM recurrence.
Area of Science:
- Neuroradiology
- Pediatric Neurology
- Vascular Imaging
Background:
- Routine surveillance MRI is standard after pediatric brain arteriovenous malformation (AVM) treatment.
- Accurate detection of AVM recurrence is crucial for patient management.
Purpose of the Study:
- To evaluate the predictive values of contrast-enhanced MR imaging and time-of-flight MRA for detecting pediatric brain AVM recurrence.
- To compare these MRI techniques with conventional angiography.
- To assess the utility of 3D rotational angiography-MR imaging fusion in diagnosing recurrence.
Main Methods:
- Retrospective analysis of 39 pediatric patients with treated brain AVMs over 18 years.
- All patients underwent 3T MRI, including contrast-enhanced sequences and TOF-MRA.
- Conventional angiography was performed, with a subset receiving 3D rotational angiography for fusion with MRI.
Main Results:
- Thirteen of 39 patients (33%) experienced AVM recurrence, predominantly after embolization.
- Contrast-enhanced MRI showed 84.6% sensitivity and 38.5% specificity; TOF-MRA demonstrated 50.0% sensitivity and 96.1% specificity for recurrence.
- Combined MRI techniques yielded 75.0% sensitivity and 90.9% specificity.
- 3D rotational angiography-MR imaging fusion confirmed or excluded recurrence in all cases.
- Embolization-only treatment was a significant predictor of recurrence (OR = 32.4, P = .006).
Conclusions:
- MRI, particularly TOF-MRA and contrast-enhanced sequences, is useful for surveillance of pediatric brain AVMs post-treatment.
- Conventional angiography is necessary for definitive diagnosis of recurrence.
- 3D rotational angiography-MR imaging fusion enhances diagnostic confidence and aids intraoperative navigation.
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