Time resolved imaging of contrast kinetics (TRICKS) MR angiography of arteriovenous malformations of head and neck.
OBJECTIVE
To evaluate vasculature of arteriovenous malformations (AVMs) of head and neck with time resolved imaging of contrast kinetics (TRICKS) MR angiography (MRA).


METHODS
Prospective study was conducted upon 19 patients (age range, 12-29 years; mean age 18 years; 10 males and 9 females) with AVM of head and neck. TRICKS-MRA of head and neck was performed during injection of contrast medium. Post processing with reconstruction of the images was done. Two independent readers assessed the overall TRICKS-MRA image quality score using a 5-point scale and depiction of the main arterial feeders, nidus, and venous drainage using 3 points scale. The Kappa test for interobserver agreement was done. The AVMs were evaluated morphologically in terms of number and origin of the main arterial feeders, the location and size of nidus either small (>2 cm) or large (>2 cm) and the draining veins into the superficial or deep venous drainage.


RESULTS
The average TRICKS-MRA image quality score as judged by reader 1 was 3.89 ± 1.15 and that as judged by reader 2 was 3.89 ± 0.10, which yielded excellent interobserver agreement (k=0.77, 95% CI=0.53-0.98, r=0.78, P=0.001). The interobserver agreement of both readers was excellent for the arterial feeders (k=0.81, 95% CI=0.57-1.00, r=0.83, P=0.001), excellent for the nidus (k=0.91, 95% CI=0.75-1.00, r=0.92, P=0.001), and good for the venous drainage (k=0.77, 95% CI=0.53-0.98, r=0.78, P=0.001). The arterial feeders were single (n=14) or multiple (n=5), the nidus was large (n=16) or small (n=3) and the venous drainage was into the internal jugular (n=17) or the external jugular (n=2) veins. Three patients with small nidus and single arterial feeder were treated with sclerotherapy. Eleven patients with large nidus and single arterial feeder were referred for embolization. Combined embolization and surgery were done for five patients with large nidus and multiple arterial feeders.


CONCLUSIONS
We concluded that TRICKS-MRA is a reliable non invasive tool for evaluation of the feeding arteries, the nidus and the draining veins of AVMs of head and neck. TRICKS-MRA can be used for evaluation and treatment planning of AVMs of head and neck.
Diagnostic Radiology Department, Mansoura Faculty of Medicine, Mansoura 13551, Egypt. Electronic address: arazek@mans.edu.eg.
Ahmed Abdel Khalek Abdel
AA
Razek
Gada
G
Gaballa
Abdel Salam
AS
Megahed
Ebrahiem
E
Elmogy
D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000378:metabolism* / Q000473:pathology*; D002648:Child; D003198:Computer Simulation; D003287:Contrast Media / Q000493:pharmacokinetics; D005260:Female; D019786:Gadolinium DTPA / Q000493:pharmacokinetics*; D006257:Head / Q000002:abnormalities / Q000098:blood supply* / Q000473:pathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008657:Metabolic Clearance Rate; D008955:Models, Cardiovascular; D009333:Neck / Q000002:abnormalities / Q000098:blood supply* / Q000473:pathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014018:Tissue Distribution; D055815:Young Adult
D003287:Contrast Media; D019786:Gadolinium DTPA
Arteriovenous; Head and neck; MR angiography; Malformations