Can magnetic resonance imaging alone accurately define the arteriovenous nidus for gamma knife radiosurgery?
OBJECTIVE
Current radiosurgical treatment of arteriovenous malformations (AVMs) relies on planning protocols that integrate data from both magnetic resonance (MR) imaging and stereotactic angiography studies. Angiography, however, is invasive and associated with a small but well-defined risk of neurological and systemic complications. Magnetic resonance imaging, on the other hand, is noninvasive with multiplanar capability, demonstrates good anatomical detail, and has been shown to be superior to angiography in the delineation of selected AVMs.


METHODS
In this study, MR imaging-related accuracy of defining the AVM nidus in gamma knife radiosurgery is investigated using only T1- and T2-weighted sequences.


CONCLUSIONS
Little interobserver variability was observed and AVM nidi, as demonstrated on T1- and T2-weighted MR images, were well correlated in terms of size. The displacement of the new target, however, from the original nidus, was not predictable and occasionally was significant, thus precluding safe radiosurgical planning.
St George
E J
EJ
Department of Neurosurgery, Barts, London NHS Trust, and The London Radiosurgical Centre, London, England. edward.st.george@lineone.net
Butler
P
P
Plowman
P N
PN
D002533:Cerebral Angiography; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000592:standards* / Q000706:statistics & numerical data; D015588:Observer Variation; D011237:Predictive Value of Tests; D016634:Radiosurgery; D015203:Reproducibility of Results