title: Intracranial Arteriovenous Shunting: Detection with Arterial Spin-Labeling and Susceptibility-Weighted Imaging Combined.
abstract: Arterial spin-labeling and susceptibility-weighted imaging are 2 MR imaging techniques that do not require gadolinium. The study aimed to assess the accuracy of arterial spin-labeling and SWI combined for detecting intracranial arteriovenous shunting in comparison with conventional MR imaging.
  
  
  
  Ninety-two consecutive patients with a known (n = 24) or suspected arteriovenous shunting (n = 68) underwent digital subtraction angiography and brain MR imaging, including arterial spin-labeling/SWI and conventional angiographic MR imaging (3D TOF, 4D time-resolved, and 3D contrast-enhanced MRA). Arterial spin-labeling/SWI and conventional MR imaging were reviewed separately in a randomized order by 2 blinded radiologists who judged the presence or absence of arteriovenous shunting. The accuracy of arterial spin-labeling/SWI for the detection of arteriovenous shunting was calculated by using the area under receiver operating curve with DSA as reference standard. κ coefficients were computed to determine interobserver and intermodality agreement.
  
  
  
  Of the 92 patients, DSA showed arteriovenous shunting in 63 (arteriovenous malformation in 53 and dural arteriovenous fistula in 10). Interobserver agreement was excellent (κ =0.83-0.95). In 5 patients, arterial spin-labeling/SWI correctly detected arteriovenous shunting, while the conventional angiographic MR imaging did not. Compared with conventional MR imaging, arterial spin-labeling/SWI was significantly more sensitive (0.98 versus 0.90, P = .04) and equally specific (0.97) and showed significantly higher agreement with DSA (κ = 0.95 versus 0.84, P = .01) and higher area under the receiver operating curve (0.97 versus 0.93, P = .02).
  
  
  
  Our study showed that the combined use of arterial spin-labeling and SWI may be an alternative to contrast-enhanced MRA for the detection of intracranial arteriovenous shunting.
authors: From the Departments of Radiology (J.H., M.Z.) jerome.hodel@gmail.com.|Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France.
authors: J
authors: 0000-0002-9029-6890
authors: J
authors: Hodel
authors: Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France.
authors: X
authors: 0000-0002-0922-7661
authors: X
authors: Leclerc
authors: Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France.
authors: E
authors: 0000-0002-7030-0514
authors: E
authors: Kalsoum
authors: From the Departments of Radiology (J.H., M.Z.).|Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France.
authors: M
authors: 0000-0002-4049-2746
authors: M
authors: Zuber
authors: Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France.
authors: R
authors: 0000-0002-9878-2818
authors: R
authors: Tamazyan
authors: Department of Radiobiology and Epidemiology (M.A.B.), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France.
authors: M A
authors: 0000-0002-9895-6654
authors: MA
authors: Benadjaoud
authors: Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France.
authors: J-P
authors: 0000-0001-8335-4872
authors: JP
authors: Pruvo
authors: Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France.
authors: M
authors: 0000-0002-1354-4328
authors: M
authors: Piotin
authors: Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France.
authors: H
authors: 0000-0002-1154-8843
authors: H
authors: Baharvahdat
authors: From the Departments of Radiology (J.H., M.Z.).
authors: M
authors: 0000-0001-5694-1238
authors: M
authors: Zins
authors: Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France.
authors: R
authors: 0000-0002-0086-8614
authors: R
authors: Blanc
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods*; D013113:Spin Labels
chemical_list: D013113:Spin Labels