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?

• DOI: 10.3174/ajnr.a6990
• Publication Date: 2021-02-04T17:40:17Z
• Authors: A. Rojas-Villabona; F.B. Pizzini; T. Solbach; M. Sokolska; G. Ricciardi; C. Lemonis; E. DeVita; Y. Suzuki; M.J.P. van Osch; R.I. Foroni; M. Longhi; S. Montemezzi; D. Atkinson; N. Kitchen; A. Nicolato; X. Golay; H.R. Jäger
• Keywords: Arteriovenous malformation; Arterial spin labeling; Intracranial Arteriovenous Malformations

<h3>BACKGROUND AND PURPOSE:</h3> Intra-arterial DSA has been traditionally used for confirmation of cure following gamma knife radiosurgery AVMs. Our aim was to evaluate whether 4D arterial spin-labeling MRA and contrast-enhanced time-resolved in combination can be an alternative AVM obliteration radiosurgery. <h3>MATERIALS METHODS:</h3> In this prospective study, 30 patients undergoing AVMs (criterion standard) also underwent MRA, including MRA. One dataset technically unsatisfactory, the case excluded. The datasets 29 were independently blindly evaluated by 2 observers regarding presence/absence residual <h3>RESULTS:</h3> mean time between follow-up DSA/MRA 53 months (95% CI, 42–64 months; range, 22–168 months). total scanning 9 minutes 17 seconds. Residual detected on subjects (obliteration rate = 69%). All at least 1 sequence. Arterial showed excellent specificity positive predictive values individually (100%). However, their sensitivity negative suboptimal due false-negative with (sensitivity 88% 77%, 95% 90%, respectively). Both increased 100% if a composite assessment both sequences performed. Diagnostic accuracy (receiver operating characteristic) agreement (κ) are maximized using (area under receiver characteristic curve 1, <i>P </i>&lt; .001; κ<i> </i>1, .001, <h3>CONCLUSIONS:</h3> Combining holds promise as brain AVMs, having provided study. Their combined use enables reliable characterization lesions.