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?

Rojas-Villabona, A.; Pizzini, F.B.; Solbach, T.; Sokolska, M.; Ricciardi, G.; Lemonis, C.; DeVita, E.; Suzuki, Y.; Osch, M.J.P. van; Foroni, R.I.; Longhi, M.; Montemezzi, S.; Atkinson, D.; Kitchen, N.; Nicolato, A.; Golay, X.; Jager, H.R.

doi:doi:10.3174/ajnr.A6990

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.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...Show moreCombining 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.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 (?) are maximized using arterial spin-labeling MRA and contrast-enhanced time-resolved MRA in combination (area under receiver operating characteristic curve?= 1, P??=?1, P?Show less

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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?