title: Integration of arterial spin labeling into stereotactic radiosurgery planning of cerebral arteriovenous malformations.
abstract: To test whether the combined use of 4D arterial spin labeling angiography (4D ASL) and contrast-enhanced magnetic resonance angiography (4D CE-MRA) can work as a prospective alternative to digital subtraction angiography (DSA) for the delineation of the arteriovenous malformation (AVM) nidus in stereotactic radiosurgery (SRS) planning.
  
  
  
  A custom 4D ASL sequence and a proof-of-concept software tool to integrate 4D ASL data to SRS planning were implemented. Ten AVM patients were scanned at 3T. Two observers independently contoured niduses in two separate sessions. Reference niduses were contoured using DSA, 4D ASL, and 4D CE-MRA. Test niduses were contoured using 4D ASL and 4D CE-MRA only. Reference and test niduses from both observers were compared in terms of volume, distance between centers of volumes (dCOV), and the Jaccard index (JI).
  
  
  
  In volume comparisons, excellent intraobserver and interobserver agreements were obtained (intraclass correlation coefficients: 0.99 and 0.98, respectively). Median dCOV, JIs between reference and test niduses were 0.55 mm, 0.78 for Observer 1 and were 0.6 mm, 0.78 for Observer 2. None of the dCOV and JI parameters varied significantly among the delineation methods or the observers (P = 0.84, P = 0.39).
  
  
  
  Our preliminary results indicate that reproducibility of the target volumes with high agreement levels is achievable without using DSA. The combined use of high temporal resolution 4D ASL and high spatial resolution and vessel-to-background contrast 4D CE-MRA provided sufficient spatiotemporal angiographic information for the delineation of AVM niduses.
  
  
  
  2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1718-1727.
authors.affiliation: Bogazici University, Institute of Biomedical Engineering, Istanbul, Turkey.|Acibadem University, Neuroradiology Research Center, Istanbul, Turkey.
authors.forename: Onur
authors.identifier: 0000-0001-9479-6190
authors.initials: O
authors.lastname: Ozyurt
authors.affiliation: Acibadem University, Neuroradiology Research Center, Istanbul, Turkey.|Acibadem University, Department of Radiology, School of Medicine, Istanbul, Turkey.
authors.forename: Alp
authors.initials: A
authors.lastname: Dincer
authors.affiliation: Acibadem University, Neuroradiology Research Center, Istanbul, Turkey.|Acibadem University, Department of Radiology, School of Medicine, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Erdem Yildiz
authors.affiliation: Acibadem University, Department of Neurosurgery, School of Medicine, Istanbul, Turkey.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Peker
authors.affiliation: Acibadem Kozyatagi Hospital, Department of Radiation Oncology, School of Medicine, Istanbul, Turkey.
authors.forename: Meltem
authors.initials: M
authors.lastname: Yilmaz
authors.affiliation: Acibadem Kozyatagi Hospital, Department of Radiation Oncology, School of Medicine, Istanbul, Turkey.
authors.forename: Meric
authors.initials: M
authors.lastname: Sengoz
authors.affiliation: Bogazici University, Institute of Biomedical Engineering, Istanbul, Turkey.|Bogazici University, Center for Life Sciences and Technologies, Istanbul, Turkey.
authors.forename: Cengizhan
authors.initials: C
authors.lastname: Ozturk
mesh_terms: D000293:Adolescent; D000328:Adult; D015901:Angiography, Digital Subtraction / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000601:surgery*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D015203:Reproducibility of Results; D013113:Spin Labels; D055815:Young Adult
chemical_list: D013113:Spin Labels
keywords: arterial spin labeling; arteriovenous malformation; contrast-enhanced MR angiography; digital subtraction angiography; nidus delineation; stereotactic radiosurgery planning