Cerebral arteriovenous malformations at 3.0 T: intraindividual comparative study of 4D-MRA in combination with selective arterial spin labeling and digital subtraction angiography.
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.
Kukuk
Guido M
GM
Department of Radiology, University of Bonn, Bonn, Germany. Guido.Kukuk@ukb.uni-bonn.de
Hadizadeh
Dariusch R
DR
Boström
Azize
A
Gieseke
Jürgen
J
Bergener
Julia
J
Nelles
Michael
M
Mürtz
Petra
P
Urbach
Horst
H
Schild
Hans H
HH
Willinek
Winfried A
WA
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
D003287:Contrast Media; D009942:Organometallic Compounds; D013113:Spin Labels; C090600:gadobutrol