Assessment and treatment planning of lateral intracranial dural arteriovenous fistulas in 3 T MRI and DSA: A detailed analysis under consideration of time-resolved imaging of contrast kinetics (TRICKS) and ce-MRA sequences.
OBJECTIVE
The current gold standard in the assessment of lateral intracranial dural arteriovenous fistulas (LDAVF) is digital subtraction angiography (DSA). However, magnetic resonance imaging (MRI) is a non-invasive emerging tool for the evaluation of such lesions. The aim of our study was to compare the DSA to our 3 T MR-imaging protocol including a highly spatial resolved (ce-MRA) and a temporal resolved ("time-resolved imaging of contrast kinetics", TRICKS) contrast-enhanced MR angiography to evaluate if solely DSA can remain the gold-standard imaging modality for the treatment planning of LDAVF.


METHODS
We retrospectively reviewed matched pairs of DSA and 3 T MRI examinations of 24 patients with LDAVF (03/2008-04/2014) by the same list of relevant criteria for an endovascular LDAVF treatment planning. In particular, we determined intermodality agreement for the Cognard classification, the identifeication of arterial feeders, and the detailed assessment of each venous drainage pattern.


RESULTS
Intermodality agreement for the Cognard classification was excellent (ĸ = 1.0). Whereas MRI failed in identifying small arterial feeders, it was superior to the DSA in the assessment of the sinus and the venous drainage pattern.


CONCLUSIONS
The combination of MRI and DSA is the new gold standard in LDAVF treatment planning.


CONCLUSIONS
• DSA is superior to the MRI in detecting LDAVF arterial feeders. • MRI excellently evaluates the venous side of an LDAVF. • MRI can replace DSA in initial diagnosis and monitoring of LDAVF. • MRI and DSA combined are the new gold standard in LDAVF treatment planning.
Department of Neuroradiology, Institute of Clinical Radiology, Ludwig-Maximilians-University, Grosshadern Campus, Marchioninistr. 15, D-81377, Munich, Germany. lorenz.ertl@med.uni-muenchen.de.
L
L
Ertl
Department of Neuroradiology, Institute of Clinical Radiology, Ludwig-Maximilians-University, Grosshadern Campus, Marchioninistr. 15, D-81377, Munich, Germany.
H
H
Brückmann
Department of Neurosurgery, Ludwig-Maximilians-University, Grosshadern Campus, Marchioninistr. 15, Munich, D-81377, Germany.
M
M
Kunz
Department of Neuroradiology, Institute of Clinical Radiology, Ludwig-Maximilians-University, Grosshadern Campus, Marchioninistr. 15, D-81377, Munich, Germany.
M
M
Patzig
Department of Neuroradiology, Institute of Clinical Radiology, Ludwig-Maximilians-University, Grosshadern Campus, Marchioninistr. 15, D-81377, Munich, Germany.
C
C
Brem
Department of Neuroradiology, Institute of Clinical Radiology, Ludwig-Maximilians-University, Grosshadern Campus, Marchioninistr. 15, D-81377, Munich, Germany.
R
R
Forbrig
Department of Neuroradiology, Institute of Clinical Radiology, Ludwig-Maximilians-University, Grosshadern Campus, Marchioninistr. 15, D-81377, Munich, Germany.
G
G
Fesl
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007479:Iopamidol / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D007700:Kinetics; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D015203:Reproducibility of Results; D012189:Retrospective Studies
D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol
CNS; Digital subtraction angiography; Intracranial arteriovenous fistula; MR-angiography; Technology assessment