title: The use of 4D-CTA in the diagnostic work-up of brain arteriovenous malformations.
abstract: BACKGROUND
  We aimed to evaluate the use of time-resolved whole-head CT angiography (4D-CTA) in patients with an untreated arteriovenous malformation of the brain (bAVM), as demonstrated by catheter angiography (DSA).
  
  
  METHODS
  Seventeen patients with a DSA-proven bAVM were enrolled. These were subjected to 4D-CTA imaging using a 320 detector row CT scanner. Using a standardized scoring sheet, all studies were analyzed by a panel of three readers. This panel was blind to the DSA results at the time of reading the 4D-CTA.
  
  
  RESULTS
  4D-CTA detected all bAVMs. With regard to the Spetzler-Martin grade, 4D-CTA disagreed with DSA in only one case, where deep venous drainage was missed. Further discrepancies between 4D-CTA and DSA analyses included underestimation of the nidus size in small lesions (four cases), misinterpretation of a feeding vessel (one case), misinterpretation of indirect feeding through pial collaterals (three cases) and oversight of mild arterial enlargement (two cases). 4D-CTA correctly distinguished low-flow from high-flow lesions and detected dural/transosseous feeding (one case), venous narrowing (one case) and venous pouches (nine cases).
  
  
  CONCLUSIONS
  In this series, 4D-CTA was able to detect all bAVMs. Although some angioarchitectural details were missed or misinterpreted when compared to DSA, 4D-CTA evaluation was sufficiently accurate to diagnose the shunt and classify it. Moreover, 4D-CTA adds cross-sectional imaging and perfusion maps, helpful in treatment planning. 4D-CTA appears to be a valuable new adjunct in the non-invasive diagnostic work-up of bAVMs and their follow-up when managed conservatively.
authors.affiliation: Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, UHN, 399 Bathurst St., 3MCL-429, Toronto, Ontario, M5T 2S8, Canada.
authors.forename: Peter W A
authors.initials: PW
authors.lastname: Willems
authors.forename: Patamintita
authors.initials: P
authors.lastname: Taeshineetanakul
authors.forename: Barry
authors.initials: B
authors.lastname: Schenk
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Brouwer
authors.forename: Karel G
authors.initials: KG
authors.lastname: Terbrugge
authors.forename: Timo
authors.initials: T
authors.lastname: Krings
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography / Q000379:methods*; D003287:Contrast Media; D005260:Female; D056973:Four-Dimensional Computed Tomography / Q000379:methods*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging*; D008297:Male
chemical_list: D003287:Contrast Media