title: Delineation of brain AVMs on MR-Angiography for the purpose of stereotactic radiosurgery.
abstract: OBJECTIVE
  To assess the dosimetric consequences of brain arteriovenous malformation (bAVM) delineation on magnetic resonance angiography (MRA) for the purpose of stereotactic radiosurgery.
  
  
  METHODS
  Three observers contoured a bAVM in 20 patients, using digital subtraction angiography (V(DSA)) and three-dimensional time-of-flight MRA (V(MRA)). Displacement between contours was calculated. Agreement and differences between observers and imaging modalities were assessed. A standardized treatment plan with dynamic conformal arcs was generated and dosimetric coverage of all contours and the volume of normal brain tissue within the high dose region was determined.
  
  
  RESULTS
  The generalized reliability coefficient was "fair" for target volume (0.79), but "poor" for displacement (0.35). V(MRA) was larger than V(DSA) (5.0 vs. 4.0 mL, p = 0.001). No difference in displacement was found (2.8 vs. 2.5 mm, p = 0.156). Dosimetric coverage of V(MRA) was 62.9% (95% CI, 56.9-68.8) when V(DSA) was used as planning target volume, and coverage of V(DSA) was 83.5% (95% CI, 78.1-88.8) when V(MRA) was used for planning (p < 0.001). The mean volume of normal brain within the 80% isodose was larger when the bAVM was delineated on MRA (0.7 vs. 1.0 mL (p = 0.02) for targets < or =3 mL and 3.7 vs. 7.0 mL (p = 0.01) for targets >3 mL).
  
  
  CONCLUSIONS
  Brain arteriovenous malformations delineated on MRA are larger and more randomly displaced. However, for bAVMs < or =3 mL, the difference in volume of normal brain tissue within the high-dose region does not seem to be clinically relevant. Therefore, MRA-images might be used as the sole imaging modality for the radiosurgical treatment of bAVMs < or =3 mL when the bAVM is located in a noneloquent position.
authors.affiliation: Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands. dr.buis@vumc.nl
authors.forename: Dennis R
authors.initials: DR
authors.lastname: Buis
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Lagerwaard
authors.forename: Clemens M F
authors.initials: CM
authors.lastname: Dirven
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Knol
authors.forename: René
authors.initials: R
authors.lastname: van den Berg
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Slotman
authors.forename: W Peter
authors.initials: WP
authors.lastname: Vandertop
mesh_terms: D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D018810:Magnetic Resonance Angiography / Q000379:methods*; D015588:Observer Variation; D016634:Radiosurgery; D013382:Subtraction Technique