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01-12-2020 | Angiography | Neuro

Vessel-selective 4D-MR angiography using super-selective pseudo-continuous arterial spin labeling may be a useful tool for assessing brain AVM hemodynamics

Authors: Osamu Togao, Makoto Obara, Michael Helle, Koji Yamashita, Kazufumi Kikuchi, Daichi Momosaka, Yoshitomo Kikuchi, Ataru Nishimura, Koichi Arimura, Tatsuhiro Wada, Hiroo Murazaki, Koji Iihara, Marc Van Cauteren, Akio Hiwatashi

Published in: European Radiology | Issue 12/2020

Abstract

Objectives

To evaluate the usefulness of 4D-MR angiography based on super-selective pseudo-continuous ASL combined with keyhole and view-sharing (4D-S-PACK) for vessel-selective visualization and to examine the ability of this technique to visualize brain arteriovenous malformations (AVMs).

Methods

In this retrospective study, 15 patients (ten men and five women, mean age 44.0 ± 16.9 years) with brain AVMs were enrolled. All patients were imaged with 4D-PACK (non-selective), 4D-S-PACK, and digital subtraction angiography (DSA). Observers evaluated vessel selectivity, identification of feeding arteries and venous drainage patterns, visualization scores, and contrast-to-noise ratio (CNR) for each AVM component. Measurements were compared between the MR methods.

Results

Vessel selectivity was graded 4 in 43/45 (95.6%, observer 1) and 42/45 (93.3%, observer 2) territories and graded 3 in two (observer 1) and three (observer 2) territories. The sensitivity and specificity for identification of feeding arteries for both observers was 88.9% and 100% on 4D-PACK, and 100% and 100% on 4D-S-PACK, respectively. For venous drainage, the sensitivity and specificity was 100% on both methods for observer 1. The sensitivity and specificity for observer 2 was 94.4% and 83.3% on 4D-PACK, and 94.4% and 91.7% on 4D-S-PACK, respectively. The CNRs at the timepoint of 1600 ms were slightly lower in 4D-S-PACK than in 4D-PACK for all AVM components (Feeding artery, p = .02; nidus, p = .001; and draining artery, p = .02). The visualization scores for both observers were not significantly different between 4D-PACK and 4D-S-PACK for all components.

Conclusions

4D-S-PACK could be a useful non-invasive clinical tool for assessing hemodynamics in brain AVMs.

Key Points

• The 4D-MR angiography based on super-selective pseudo-continuous arterial spin labeling combined with CENTRA-keyhole and view-sharing (4D-S-PACK) enabled excellent vessel selectivity.

• The 4D-S-PACK enabled the perfect identification of feeding arteries of brain arteriovenous malformation (AVM).

• 4D-S-PACK could be a non-invasive clinical tool for assessing hemodynamics in brain AVMs.

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Title: Vessel-selective 4D-MR angiography using super-selective pseudo-continuous arterial spin labeling may be a useful tool for assessing brain AVM hemodynamics
Authors: Osamu Togao
Makoto Obara
Michael Helle
Koji Yamashita
Kazufumi Kikuchi
Daichi Momosaka
Yoshitomo Kikuchi
Ataru Nishimura
Koichi Arimura
Tatsuhiro Wada
Hiroo Murazaki
Koji Iihara
Marc Van Cauteren
Akio Hiwatashi
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Angiography
MR Angiography
Brain Arteriovenous Malformation
Arteriovenous Malformation
Published in: European Radiology / Issue 12/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07057-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Vessel-selective 4D-MR angiography using super-selective pseudo-continuous arterial spin labeling may be a useful tool for assessing brain AVM hemodynamics

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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