title: Value of 4D MR angiography at 3T compared with DSA for the follow-up of treated brain arteriovenous malformation.
abstract: OBJECTIVE
  Four-dimensional, contrast-enhanced MRA is a useful technique for the diagnosis and classification of brain AVM. The purpose of this study was to evaluate its usefulness in the follow-up of treated brain AVM.
  
  
  METHODS
  Patients with treated brain AVM (embolization, radiosurgery, and/or surgery) were investigated with both DSA (the "gold standard") and 4D MRA. Four-dimensional MRA was performed at 3T using a 4D sequence, combining contrast-enhanced timing-robust angiography, keyhole, and sensitivity encoding techniques. Examinations were evaluated by 2 independent readers and disagreements were resolved by a third reader. Interobserver and intermodality agreement with respect to residual nidus, residual venous drainage, and brain AVM patency were determined.
  
  
  RESULTS
  Between May 2008 and February 2013, 37 patients with a median age of 45 years (interquartile range = 26-55) were prospectively included. Examinations were acquired 36 months (IQR = 10-45.5) after the last treatment. Interobserver agreement for brain AVM patency was very good for both 4D MRA (κ 0.82, 95% CI .67-.98) and DSA (κ 0.84, 95% CI .69-.98). After consensus reading, intermodality agreement for the evaluation of brain AVM patency was good (κ 0.73, 95% CI .55-.90). Diagnostic accuracy of 4D MRA for residual brain AVM compared with DSA, reached a sensitivity of 73.7%, specificity 100%, positive predictive value 100%, and negative predictive value 78.3%. Agreements by technique of treatment are also detailed.
  
  
  CONCLUSIONS
  Four-dimensional MRA is a useful radiation-free technique for the follow-up of patients with treated brain AVM, especially patients treated by radiosurgery. However, given its actual limitations it is not sufficient to assert the cure; DSA remains mandatory for this purpose.
authors.affiliation: From the Department of Radiology, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France.
authors.forename: S
authors.initials: S
authors.lastname: Soize
authors.affiliation: From the Department of Radiology, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France.
authors.forename: F
authors.initials: F
authors.lastname: Bouquigny
authors.affiliation: From the Department of Radiology, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France.
authors.forename: K
authors.initials: K
authors.lastname: Kadziolka
authors.affiliation: From the Department of Radiology, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France.
authors.forename: C
authors.initials: C
authors.lastname: Portefaix
authors.affiliation: From the Department of Radiology, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France. lpierot@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Pierot
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction / Q000379:methods*; D001921:Brain / Q000000981:diagnostic imaging; D003287:Contrast Media; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000628:therapy; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D016634:Radiosurgery; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media