Stereotactic magnetic resonance angiography for targeting in arteriovenous malformation radiosurgery

Because conventional stereotactic angiography provides only two-dimensional information for dose planning, we studied the accuracy and usefulness of stereotactic magnetic resonance angiography (sMRA) for arteriovenous malformation (AVM) radiosurgery in 28 consecutive patients. We hypothesized that the multidimensional data set provided by sMRA and the opportunity to image both blood vessels and brain parenchyma would improve the accuracy of AVM irradiation and improve the safety of radiosurgery. Twenty-eight patients with AVMs in different brain locations and with a variety of AVM sizes (range, 15-31 mm mean diameter) had sMRA followed by stereotactic angiography. The sMRA images only were used to construct an initial radiosurgical plan. This plan was then used to outline the AVM volume defined by conventional angiography. In 24 patients, sMRA information equaled that of conventional angiography. In 3 patients, sMRA was better, because conventional angiography overestimated the size of the AVM nidus. In one patient, the conventional angiogram showed a second separate nidus (10-mm diameter) that was not as well defined on MRA. There were no complications with any procedure. In 16 patients (57%), sMRA provided critical information on AVM shape that was not provided by conventional angiography alone. Stereotactic MRA is a fast, noninvasive, inexpensive, multidimensional imaging method for AVM radiosurgery that provides information on vascular and parenchymal brain anatomy important for optimal dose planning. We believe that it can be used with confidence as the sole imaging method for medium-size, compact-nidus AVMs.