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Open Access 01-02-2012 | Diagnostic Neuroradiology

The use of 4D-CTA in the diagnostic work-up of brain arteriovenous malformations

Authors: Peter W. A. Willems, Patamintita Taeshineetanakul, Barry Schenk, Patrick A. Brouwer, Karel G. Terbrugge, Timo Krings

Published in: Neuroradiology | Issue 2/2012

Abstract

Introduction

We aimed to evaluate the use of time-resolved whole-head CT angiography (4D-CTA) in patients with an untreated arteriovenous malformation of the brain (bAVM), as demonstrated by catheter angiography (DSA).

Methods

Seventeen patients with a DSA-proven bAVM were enrolled. These were subjected to 4D-CTA imaging using a 320 detector row CT scanner. Using a standardized scoring sheet, all studies were analyzed by a panel of three readers. This panel was blind to the DSA results at the time of reading the 4D-CTA.

Results

4D-CTA detected all bAVMs. With regard to the Spetzler–Martin grade, 4D-CTA disagreed with DSA in only one case, where deep venous drainage was missed. Further discrepancies between 4D-CTA and DSA analyses included underestimation of the nidus size in small lesions (four cases), misinterpretation of a feeding vessel (one case), misinterpretation of indirect feeding through pial collaterals (three cases) and oversight of mild arterial enlargement (two cases). 4D-CTA correctly distinguished low-flow from high-flow lesions and detected dural/transosseous feeding (one case), venous narrowing (one case) and venous pouches (nine cases).

Conclusion

In this series, 4D-CTA was able to detect all bAVMs. Although some angioarchitectural details were missed or misinterpreted when compared to DSA, 4D-CTA evaluation was sufficiently accurate to diagnose the shunt and classify it. Moreover, 4D-CTA adds cross-sectional imaging and perfusion maps, helpful in treatment planning. 4D-CTA appears to be a valuable new adjunct in the non-invasive diagnostic work-up of bAVMs and their follow-up when managed conservatively.

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Title: The use of 4D-CTA in the diagnostic work-up of brain arteriovenous malformations
Authors: Peter W. A. Willems
Patamintita Taeshineetanakul
Barry Schenk
Patrick A. Brouwer
Karel G. Terbrugge
Timo Krings
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Neuroradiology / Issue 2/2012
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-011-0864-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The use of 4D-CTA in the diagnostic work-up of brain arteriovenous malformations

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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