title: Detection of residual brain arteriovenous malformations after radiosurgery: diagnostic accuracy of contrast-enhanced three-dimensional time of flight MR angiography at 3.0 Tesla.
abstract: OBJECTIVE
  Although three-dimensional time-of-flight magnetic resonance angiography (3D TOF-MRA) is used frequently as a follow-up tool to assess the response of arteriovenous malformations (AVMs) after radiosurgery, the diagnostic accuracy of 3D TOF-MRA is not well known. We evaluated the diagnostic accuracy of contrast-enhanced 3D TOF-MRA at 3.0 Tesla for the detection of residual AVMs.
  
  
  METHODS
  This study included 32 AVMs from 32 patients who had been treated with radiosurgery (males/females: 21/11; average patient age, 33.1 years). The time interval between radiosurgery and MRA was an average of 35.3 months (range, 12-88 months). Three-dimensional TOF-MRA was obtained at a magnetic field strength of 3.0 Tesla after infusion of contrast media, with a measured voxel size of 0.40 x 0.80 x 1.4 (0.45) mm(3) and a reconstructed voxel size of 0.27 x 0.27 x 0.70 (0.05) mm(3) after zero-filling. X-ray angiography was performed as the reference of standard within six months after MRA (an average of two months). To determine the presence of a residual AVM, the source images of 3D TOF-MRA were independently reviewed, focusing on the presence of abnormally hyperintense fine tangled or tubular structures with continuity as seen on consecutive slices by two observers blinded to the X-ray angiography results.
  
  
  RESULTS
  A residual AVM was identified in 10 patients (10 of 32, 31%) on X-ray angiography. The inter-observer agreement for MRA was excellent (kappa= 0.813). For the detection of a residual AVM after radiosurgery as determined by observer 1 and observer 2, the source images of MRA had an overall sensitivity of 100%/90% (10 of 10, 9 of 10), specificity of 68%/68% (15 of 22, 15 of 22), positive predictive value of 59%/56% (10 of 17, 9 of 16), negative predictive value of 100%/94% (15 of 15, 15 of 16) and diagnostic accuracy of 78%/75% (25 of 32, 24 of 32), respectively.
  
  
  CONCLUSIONS
  The sensitivity of contrast-enhanced 3D TOF-MRA at 3.0 Tesla is high but the specificity is not sufficient for the detection of a residual AVM after radiosurgery.
authors: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Kyoung Eun
authors: KE
authors: Lee
authors: Choong Gon
authors: CG
authors: Choi
authors: Jin Woo
authors: JW
authors: Choi
authors: Byung Se
authors: BS
authors: Choi
authors: Deok Hee
authors: DH
authors: Lee
authors: Sang Joon
authors: SJ
authors: Kim
authors: Do Hoon
authors: DH
authors: Kwon
mesh_terms: D000328:Adult; D003287:Contrast Media; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis* / Q000601:surgery*; D018810:Magnetic Resonance Angiography / Q000379:methods / Q000592:standards*; D008297:Male; D016634:Radiosurgery; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media