title: Cerebral arteriovenous malformations at 3.0 T: intraindividual comparative study of 4D-MRA in combination with selective arterial spin labeling and digital subtraction angiography.
abstract: OBJECTIVE
  Prospective intraindividual comparison of 4-dimensional contrast-enhanced MR angiography (4D-MRA) in combination with selective arterial spin labeling (ASL) at 3.0 Tesla and digital subtraction angiography (DSA) for anatomic and functional characterization of cerebral arteriovenous malformations (AVMs).
  
  
  METHODS
  In a prospective intraindividual comparative study, 16 patients diagnosed with symptomatic cerebral AVMs underwent 4D-MRA at an isotropic spatial resolution of 1.1 x 1.1 x 1.1 mm and a temporal resolution of 572 milliseconds, regional brain perfusion imaging using selective ASL and DSA. Selective ASL was performed for selective labeling of both carotid arteries and the vertebrobasilar complex. In a stepwise approach, all images were evaluated by 2 radiologists according to technical success rate, Spetzler-Martin classification, identification of arterial feeders, and existence of anatomic variants or functional cross-filling.
  
  
  RESULTS
  4D-MRA allowed for the same Spetzler-Martin classification as DSA in all patients. Of 28, 26 (93%) feeding arteries were correctly identified by both readers using 4D-MRA alone. Selective ASL provided additional functional or anatomic information in 4 of 16 cases (25%), enabling the detection of a cross-filling feeding artery that was not identified by 4D-MRA without selective ASL, thus improving the sensitivity of MRI in identification of arterial feeders from 26/28 (93%) to 27/28 (96%). The additional functional information regarding anatomic variants and cross-filling provided by selective ASL was confirmed by DSA in all cases.
  
  
  CONCLUSIONS
  4D-MRA in combination with selective arterial spin labeling is a promising tool for the noninvasive assessment of cerebral AVMs providing functional information that so far has been gained only with DSA.
authors.affiliation: Department of Radiology, University of Bonn, Bonn, Germany. Guido.Kukuk@ukb.uni-bonn.de
authors.forename: Guido M
authors.initials: GM
authors.lastname: Kukuk
authors.forename: Dariusch R
authors.initials: DR
authors.lastname: Hadizadeh
authors.forename: Azize
authors.initials: A
authors.lastname: Boström
authors.forename: Jürgen
authors.initials: J
authors.lastname: Gieseke
authors.forename: Julia
authors.initials: J
authors.lastname: Bergener
authors.forename: Michael
authors.initials: M
authors.lastname: Nelles
authors.forename: Petra
authors.initials: P
authors.lastname: Mürtz
authors.forename: Horst
authors.initials: H
authors.lastname: Urbach
authors.forename: Hans H
authors.initials: HH
authors.lastname: Schild
authors.forename: Winfried A
authors.initials: WA
authors.lastname: Willinek
mesh_terms: D000293:Adolescent; D000328:Adult; D015901:Angiography, Digital Subtraction / Q000379:methods*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis* / Q000000981:diagnostic imaging; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D011446:Prospective Studies; D013113:Spin Labels
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D013113:Spin Labels; C090600:gadobutrol