Magnetic Resonance Angiography in the Diagnosis of Cerebral Arteriovenous Malformation and Dural Arteriovenous Fistulas: Comparison of Time-Resolved Magnetic Resonance Angiography and Three Dimensional Time-of-Flight Magnetic Resonance Angiography.
BACKGROUND
Traditional digital subtraction angiography (DSA) is currently the gold standard diagnostic method for the diagnosis and evaluation of cerebral arteriovenous malformation (AVM) and dural arteriovenous fistulas (dAVF).


OBJECTIVE
The aim of this study was to analyze different less invasive magnetic resonance angiography (MRA) images, time-resolved MRA (TR-MRA) and three-dimensional time-of-flight MRA (3D TOF MRA) to identify their diagnostic accuracy and to determine which approach is most similar to DSA.


METHODS
A total of 41 patients with AVM and dAVF at their initial evaluation or follow-up after treatment were recruited in this study. We applied time-resolved angiography using keyhole (4D-TRAK) MRA to perform TR-MRA and 3D TOF MRA examinations simultaneously followed by DSA, which was considered as a standard reference. Two experienced neuroradiologists reviewed the images to compare the diagnostic accuracy, arterial feeder and venous drainage between these two MRA images. Inter-observer agreement for different MRA images was assessed by Kappa coefficient and the differences of diagnostic accuracy between MRA images were evaluated by the Wilcoxon rank sum test.


RESULTS
Almost all vascular lesions (92.68%) were correctly diagnosed using 4D-TRAK MRA. However, 3D TOF MRA only diagnosed 26 patients (63.41%) accurately. There were statistically significant differences regarding lesion diagnostic accuracy (P = 0.008) and venous drainage identification (P < 0.0001) between 4D-TRAK MRA and 3D TOF MRA. The results indicate that 4D-TRAK MRA is superior to 3D TOF MRA in the assessment of lesions.


CONCLUSIONS
Compared with 3D TOF MRA, 4D-TRAK MRA proved to be a more reliable screening modality and follow-up method for the diagnosis of cerebral AVM and dAVF.
Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.
Yu-Ching
YC
Cheng
Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.
Hung-Chieh
HC
Chen
Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung, Taiwan.
Chen-Hao
CH
Wu
Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.
Yi-Ying
YY
Wu
Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan.
Ming-His
MH
Sun
Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.
Wen-Hsien
WH
Chen
Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.
Jyh-Wen
JW
Chai
Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.
Clayton
C
Chi-Chang Chen
3D TOF MRA; 4D-TRAK MRA; Cerebral Arteriovenous Malformation; Cerebral Dural Arteriovenous Fistulas
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