Detection of residual brain arteriovenous malformations after radiosurgery: diagnostic accuracy of contrast-enhanced four-dimensional MR angiography at 3.0 T

• Published in: British journal of radiology Vol. 85; no. 1016; pp. 1064 - 1069
• Main Authors: LIM, H. K, CHOI, C. G, KIM, S. M, KIM, J. L, LEE, D. H, KIM, S. J, SUH, D. C
• Format: Journal Article
• Language: English
• Published: London British Institute of Radiology 01-08-2012; The British Institute of Radiology
• Subjects: Adolescent; Adult; Biological and medical sciences; Cardiovascular system; Child; Contrast Media; Female; Humans; Intracranial Arteriovenous Malformations - diagnosis; Intracranial Arteriovenous Malformations - surgery; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Angiography - methods; Male; Medical sciences; Middle Aged; Neurology; Observer Variation; Postoperative Period; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiosurgery - methods; Retrospective Studies; Sensitivity and Specificity; Vascular diseases and vascular malformations of the nervous system; Young Adult; Nuclear medicine; Treatment; Radiosurgery; Radiology; Medical imagery; Intracranial arteriovenous malformation; Diagnosis; Radiotherapy; NMR angiography; Nuclear magnetic resonance imaging
• ISSN: 0007-1285; 1748-880X
• DOI: 10.1259/bjr/30618275

To evaluate the diagnostic accuracy of four-dimensional MR angiography (4D-MRA) at 3.0 T for detecting residual arteriovenous malformations (AVMs) after Gamma Knife (Elekta Instrument AB, Stockholm, Sweden) radiosurgery (GKRS).
We assessed 36 angiographically confirmed AVMs in 36 patients who had been treated with GKRS. 4D-MRA was performed after GKRS and the time intervals were 39.4 ± 26.0 months [mean ± standard deviation (SD)]. 4D-MRA was obtained at 3.0 T after contrast injection, with a measured voxel size of 1 × 1 × 1 mm and a temporal resolution of 1.1 s (13 patients) or a voxel size of 1 × 1 × 2 mm and a temporal resolution of 0.98 s (23 patients). X-ray angiography was performed as the standard reference within 53 ± 47 days (mean ± SD) after MRA. To determine a residual AVM, the 4D-MRA results were independently reviewed by two readers blinded to the X-ray angiography results. We evaluated diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 4D-MRA for detection of a residual AVM.
A residual AVM was identified in 13 patients (13/36, 36%) on X-ray angiography. According to Readers 1 and 2, 4D-MRA had a sensitivity of 79.6% and 64.3%, a specificity of 90.9% and 100%, a PPV of 84.6% and 100% and an NPV of 90% and 81.5%, respectively, and a diagnostic accuracy of 86.1% for Readers 1 and 2, for detecting residual AVMs after GKRS.
The diagnostic accuracy of 4D-MRA at 3.0 T seems high, but there is still the possibility of further improving the spatiotemporal resolution of this technique.