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Follow-Up MRI for Small Brain AVMs Treated by Radiosurgery: Is Gadolinium Really Necessary?
X Leclerc1,2, O Guillaud3, N Reyns3,4
1From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France xavier.leclerc@chru-lille.fr.
Background And Purpose:
Follow-up MR imaging of brain AVMs currently relies on contrast-enhanced sequences. Noncontrast techniques, including arterial spin-labeling and TOF, may have value in detecting a residual nidus after radiosurgery. The aim of this study was to compare noncontrast with contrast-enhanced MR imaging for the differentiation of residual-versus-obliterated brain AVMs in radiosurgically treated patients.
Materials And Methods:
Twenty-eight consecutive patients with small brain AVMs (<20 mm) treated by radiosurgery were followed with the same MR imaging protocol. Three neuroradiologists, blinded to the results, independently reviewed the following: 1) postcontrast images alone (4D contrast-enhanced MRA and postcontrast 3D T1 gradient recalled-echo), 2) arterial spin-labeling and TOF images alone, and 3) all MR images combined. The primary end point was the detection of residual brain AVMs using a 5-point scale, with DSA as the reference standard.
Results:
The highest interobserver agreement was for arterial spin-labeling/TOF (κ = 0.81; 95% confidence interval, 0.66-0.93). Regarding brain AVM detection, arterial spin-labeling/TOF had higher sensitivity (sensitivity, 85%; specificity, 100%; 95% CI, 62-97) than contrast-enhanced MR imaging (sensitivity, 55%; specificity, 100%; 95% CI, 27-73) and all MR images combined (sensitivity, 75%; specificity, 100%; 95% CI, 51-91) (P = .008). All nidus obliterations on DSA were detected on MR imaging. In 6 patients, a residual brain AVM present on DSA was only detected with arterial spin-labeling/TOF, including 3 based solely on arterial spin-labeling images.
Conclusions:
In this study of radiosurgically treated patients with small brain AVMs, arterial spin-labeling/TOF was found to be superior to gadolinium-enhanced MR imaging in detecting residual AVMs.
Insights
Noncontrast arterial spin-labeling/TOF MR imaging is superior to contrast-enhanced techniques for detecting residual brain arteriovenous malformations (AVMs) after radiosurgery. This noncontrast approach offers higher sensitivity in identifying AVM remnants, improving follow-up care.
Area of Science:
- Neuroradiology
- Medical Imaging
- Neurosurgery
Background:
- Current follow-up for brain arteriovenous malformations (AVMs) after radiosurgery primarily uses contrast-enhanced Magnetic Resonance (MR) imaging.
- Noncontrast MR techniques, specifically arterial spin-labeling (ASL) and Time-of-Flight (TOF), show potential for detecting residual AVM nidus post-treatment.
Purpose of the Study:
- To compare the efficacy of noncontrast (ASL/TOF) versus contrast-enhanced MR imaging in differentiating residual from obliterated brain AVMs.
- To evaluate the diagnostic performance of different MR imaging sequences in patients who have undergone radiosurgery for brain AVMs.
Main Methods:
- Twenty-eight patients with small brain AVMs (<20 mm) treated with radiosurgery were included.
- MR imaging protocols included postcontrast sequences, ASL/TOF sequences, and combined sequences.
- Three neuroradiologists independently assessed images for residual AVMs, with Digital Subtraction Angiography (DSA) as the reference standard.
Main Results:
- Arterial spin-labeling/TOF demonstrated the highest interobserver agreement (κ = 0.81).
- ASL/TOF showed significantly higher sensitivity (85%) compared to contrast-enhanced MR imaging (55%) for detecting residual AVMs (P = .008).
- Six residual AVMs identified on DSA were detected only with ASL/TOF, with three detected solely on ASL images.
Conclusions:
- Noncontrast arterial spin-labeling/TOF MR imaging is superior to gadolinium-enhanced MR imaging for detecting residual brain AVMs after radiosurgery.
- ASL/TOF offers improved sensitivity for identifying residual AVM nidus, potentially enhancing patient management and follow-up strategies.
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