Intracranial dural arteriovenous fistulas: evaluation with 3-T four-dimensional MR angiography using arterial spin labeling.
OBJECTIVE
To evaluate whether 3-T four-dimensional (4D) arterial spin-labeling (ASL)-based magnetic resonance (MR) angiography is useful for the evaluation of shunt lesions in patients with intracranial dural arteriovenous fistulas (AVFs).


METHODS
Institutional review board approval and prior written informed consent from all patients were obtained. Nine patients with intracranial dural AVF (seven men, two women; age range, 52-77 years; mean age, 63 years) underwent 4D ASL MR angiography at 3 T and digital subtraction angiography (DSA). Spin tagging was with flow-sensitive alternating inversion recovery with Look-Locker sampling. At 300-millisecond intervals, seven dynamic images with a spatial resolution of 0.5 × 0.5 × 0.6 mm(3) were obtained. The 4D ASL MR angiographic and DSA images were read by two sets of two independent readers each. Interobserver and intermodality agreement was assessed with the κ statistic.


RESULTS
On all 4D ASL MR angiographic images, the major intracranial arteries were demonstrated at a temporal resolution of 300 milliseconds. Interobserver agreement was excellent for the fistula site (κ = 1.00; 95% confidence interval [CI]: 1.00, 1.00), moderate for the main arterial feeders (κ = 0.53; 95% CI: 0.08, 0.98), and good for venous drainage (κ = 0.77; 95% CI: 0.35, 1.00). Intermodality agreement was excellent for the fistula site and venous drainage (κ = 1.00; 95% CI: 1.00, 1.00) and good for the main arterial feeders (κ = 0.80; 95% CI: 0.58, 1.00).


CONCLUSIONS
The good-to-excellent agreement between 3-T 4D ASL MR angiographic and DSA findings suggests that 3-T 4D ASL MR angiography is a useful tool for the evaluation of intracranial dural AVFs.
From the Departments of Diagnostic Radiology (Y.I., T.H., Y.S., M. Kitajima, M.A., Y.Y.), and Neurosurgery (Y.K.), Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556 Japan; Medical Satellite Yaesu Clinic, Tokyo, Japan (M.N.); and Kumamoto University Hospital, Kumamoto, Japan (M. Komi, K.M.).
Yasuhiko
Y
Iryo
Toshinori
T
Hirai
Yutaka
Y
Kai
Masanobu
M
Nakamura
Yoshinori
Y
Shigematsu
Mika
M
Kitajima
Minako
M
Azuma
Masanori
M
Komi
Kosuke
K
Morita
Yasuyuki
Y
Yamashita
D000368:Aged; D015901:Angiography, Digital Subtraction; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007479:Iopamidol; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013113:Spin Labels
D003287:Contrast Media; D013113:Spin Labels; D007479:Iopamidol