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Rojas-Villabona A, Pizzini FB, Solbach T, Sokolska M, Ricciardi G, Lemonis C, DeVita E, Suzuki Y, van Osch MJP, Foroni RI, Longhi M, Montemezzi S, Atkinson D, Kitchen N, Nicolato A, Golay X, Jäger HR. Are Dynamic Arterial Spin-Labeling MRA and Time-Resolved Contrast-Enhanced MRA Suited for Confirmation of Obliteration following Gamma Knife Radiosurgery of Brain Arteriovenous Malformations? AJNR Am J Neuroradiol 2021; 42:671-678. [PMID: 33541896 DOI: 10.3174/ajnr.a6990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 10/21/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intra-arterial DSA has been traditionally used for confirmation of cure following gamma knife radiosurgery for AVMs. Our aim was to evaluate whether 4D arterial spin-labeling MRA and contrast-enhanced time-resolved MRA in combination can be an alternative to DSA for confirmation of AVM obliteration following gamma knife radiosurgery. MATERIALS AND METHODS In this prospective study, 30 patients undergoing DSA for confirmation of obliteration following gamma knife radiosurgery for AVMs (criterion standard) also underwent MRA, including arterial spin-labeling MRA and contrast-enhanced time-resolved MRA. One dataset was technically unsatisfactory, and the case was excluded. The DSA and MRA datasets of 29 patients were independently and blindly evaluated by 2 observers regarding the presence/absence of residual AVMs. RESULTS The mean time between gamma knife radiosurgery and follow-up DSA/MRA was 53 months (95% CI, 42-64 months; range, 22-168 months). MRA total scanning time was 9 minutes and 17 seconds. Residual AVMs were detected on DSA in 9 subjects (obliteration rate = 69%). All residual AVMs were detected on at least 1 MRA sequence. Arterial spin-labeling MRA and contrast-enhanced time-resolved MRA showed excellent specificity and positive predictive values individually (100%). However, their sensitivity and negative predictive values were suboptimal due to 1 false-negative with arterial spin-labeling MRA and 2 with contrast-enhanced time-resolved MRA (sensitivity = 88% and 77%, negative predictive values = 95% and 90%, respectively). Both sensitivity and negative predictive values increased to 100% if a composite assessment of both MRA sequences was performed. Diagnostic accuracy (receiver operating characteristic) and agreement (κ) are maximized using arterial spin-labeling MRA and contrast-enhanced time-resolved MRA in combination (area under receiver operating characteristic curve = 1, P < .001; κ = 1, P < .001, respectively). CONCLUSIONS Combining arterial spin-labeling MRA with contrast-enhanced time-resolved MRA holds promise as an alternative to DSA for confirmation of obliteration following gamma knife radiosurgery for brain AVMs, having provided 100% sensitivity and specificity in the study. Their combined use also enables reliable characterization of residual lesions.
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Affiliation(s)
- A Rojas-Villabona
- From The Gamma Knife Centre at Queen Square (A.R.-V.) .,Department of Neurosurgery (A.R.-V.), Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - F B Pizzini
- Department of Radiology (F.B.P., R.I.F.), Department of Diagnostic and Public Health, Verona University, Verona, Italy
| | - T Solbach
- The Lysholm Department of Neuroradiology (T.S., H.R.J.)
| | - M Sokolska
- Department of Medical Physics and Bioengineering (M.S.).,Neuroradiological Academic Unit (M.S., X.G., H.R.J.)
| | - G Ricciardi
- Neuroradiology Unit (G.R., C.L.), Department of Diagnostic and Pathology, University Hospital of Verona, Verona, Italy
| | - C Lemonis
- Neuroradiology Unit (G.R., C.L.), Department of Diagnostic and Pathology, University Hospital of Verona, Verona, Italy
| | - E DeVita
- School of Biomedical Engineering and Imaging Sciences (E.D.V.), King's College London, London, UK
| | - Y Suzuki
- Wellcome Centre for Integrative Neuroimaging (Y.S.), FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - M J P van Osch
- C.J. Gorter Center for High Field MRI (M.J.P.v.O.), Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - R I Foroni
- Department of Radiology (F.B.P., R.I.F.), Department of Diagnostic and Public Health, Verona University, Verona, Italy
| | - M Longhi
- Department of Neuroscience (M.L., A.N.)
| | | | - D Atkinson
- Department of Brain Repair and Rehabilitation, Institute of Neurology and Centre for Medical Imaging (D.A.), University College London, London, UK
| | - N Kitchen
- Department of Neurosurgery (N.K.), National Hospital for Neurology and Neurosurgery, London, UK
| | | | - X Golay
- Neuroradiological Academic Unit (M.S., X.G., H.R.J.)
| | - H R Jäger
- The Lysholm Department of Neuroradiology (T.S., H.R.J.).,Neuroradiological Academic Unit (M.S., X.G., H.R.J.)
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