title: Four-dimensional computed tomography angiographic evaluation of cranial dural arteriovenous fistula before and after embolization.
abstract: OBJECTIVE
  This study aimed to evaluate the usefulness of four-dimensional CTA before and after embolization treatment with ONYX-18 in eleven patients with cranial dural arteriovenous fistulas, and to compare the results with those of the reference standard DSA.
  
  
  METHODS
  Eleven patients with cranial dural arteriovenous fistulas detected on DSA underwent transarterial embolization with ONYX-18. Four-dimensional CTA was performed an average of 2 days before and 4 days after DSA. Four-dimensional CTA and DSA images were reviewed by two neuroradiologists for identification of feeding arteries and drainage veins and for determining treatment effects. Interobserver and intermodality agreement between four-dimensional CTA and DSA were assessed.
  
  
  RESULTS
  Forty-two feeding arteries were identified for 14 fistulas in the 11 patients. Of these, 36 (85.71%) were detected on four-dimensional CTA. After transarterial embolization, one patient got partly embolized, and the fistulas in the remaining 10 patients were completely occluded. The interobserver agreement for four-dimensional CTA and intermodality agreement between four-dimensional CTA and DSA were excellent (κ=1) for shunt location, identification of drainage veins, and fistula occlusion after treatment.
  
  
  CONCLUSIONS
  Four-dimensional CTA images are highly accurate when compared with DSA images both before and after transarterial embolization treatment. Four-dimensional CTA can be used for diagnosis as well as follow-up of cranial dural arteriovenous fistulas in clinical settings.
authors.affiliation: Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Road, Shanghai, China. Electronic address: bing.tian@hotmail.com.
authors.forename: Bing
authors.initials: B
authors.lastname: Tian
authors.affiliation: Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Road, Shanghai, China. Electronic address: aishanli0102@126.com.
authors.forename: Bing
authors.initials: B
authors.lastname: Xu
authors.affiliation: Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Road, Shanghai, China. Electronic address: tianbing2003@163.com.
authors.forename: Jianping
authors.initials: J
authors.lastname: Lu
authors.affiliation: Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Road, Shanghai, China. Electronic address: liuqimd@126.com.
authors.forename: Qi
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Road, Shanghai, China. Electronic address: wangli_changhai@163.com.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Road, Shanghai, China. Electronic address: cjr.wangminjie@vip.163.com.
authors.forename: Minjie
authors.initials: M
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000628:therapy*; D003287:Contrast Media; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D056973:Four-Dimensional Computed Tomography / Q000379:methods*; D006801:Humans; D007479:Iopamidol; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D015588:Observer Variation; D011145:Polyvinyls / Q000627:therapeutic use; D011856:Radiographic Image Enhancement; D015203:Reproducibility of Results; D013635:Tantalum / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003287:Contrast Media; D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum; D007479:Iopamidol
keywords: DSA; Dural arteriovenous fistulas; Embolization; Four-dimensional CTA