4D Radial Acquisition Contrast-Enhanced MR Angiography and Intracranial Arteriovenous Malformations Quickly Approaching Digital Subtraction Angiography
4D Radial Acquisition Contrast-Enhanced MR Angiography and Intracranial Arteriovenous Malformations Quickly Approaching Digital Subtraction Angiography
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DOI：
10.1161/strokeaha.108.546663
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发表时间：
2009-08-01
期刊：
影响因子：
8.3
通讯作者：
Carroll, Timothy J.
中科院分区：
文献类型：
--
作者：
Eddleman, Christopher S.;Jeong, Hyun J.;Carroll, Timothy J.
背景和目的：目前颅内动静脉动静脉畸形成像的金标准包括基于导管的技术，即脑数字减影血管造影(DSA)。然而，DSA给患者带来了一些程序性风险。不幸的是，AVM患者通常在诊断和治疗过程中接受多次DSA检查，显著增加了他们的程序性风险暴露。因此，需要高质量的非侵入性成像。我们假设与常规血管造影相比，4D放射状增强MRA更接近AVM的血管构筑和血流动力学。方法：连续13例AVM患者接受4D放射状增强MRA和DSA检查。对4DRCE-MRA图像的位置、大小、Spetzler-Martin分级、动脉供血动脉的识别、引流方式和其他血管异常进行独立评估。除1例外，所有病例的Spetzler-Martin分级在评价者之间和不同成像方式之间都是正确的。评价者之间的病灶大小有很好的相关性，r=0.99，P<；0.000001。评价者对单次扫描的一致性很好(kappa=0.63~1)，而DSA和4DRCE-MRA图像的一致性也很好(kappa=0.61~0.85)。结论：我们开发了一种4D径向采集对比增强的MRA序列，能够成像与DSA相似的颅内AVM。图像分析在使用Spetzler-Martin分级标准对AVM进行分级方面证明了等价性。这种4DRCE-MRA序列有可能避免某些DSA的应用，从而使患者免于潜在的操作风险。(笔划。2009年；40：2749-2753。)
Background and Purpose-The current gold standard for imaging intracranial AVMs involves catheter-based techniques, namely cerebral digital subtraction angiography (DSA). However, DSA presents some procedural risks to the patient. Unfortunately, AVM patients usually undergo multiple DSA exams throughout their diagnostic and therapeutic course, significantly increasing their procedural risk exposure. As such, high-quality noninvasive imaging is desired. We hypothesize that 4D radial acquisition contrast-enhanced MRA approximates the vascular architecture and hemodynamics of AVMs compared to conventional angiography.Methods-Thirteen consecutive AVM patients were assessed by 4D radial acquisition contrast-enhanced MRA and DSA. The 4D rCE-MRA images were independently assessed regarding the location, nidal size, Spetzler-Martin grade, and identification of arterial feeders, drainage pattern, and any other vascular anomalies.Results-4D rCE-MRA correctly depicted the size, venous drainage pattern, and prominent arterial feeders in all cases. Spetzler-Martin grade was correctly determined between reviewers and between the different imaging modalities in all cases except 1. The nidus size was in good correlation between the reviewers, where r = 0.99, P < 0.000001. There was very good agreement between reviewers regarding the individual scans (kappa = 0.63 to 1), whereas the agreement between the DSA and 4D rCE-MRA images was also good (kappa = 0.61 to 0.85).Conclusions-We have developed a 4D radial acquisition contrast-enhanced MRA sequence capable of imaging intracranial AVMs approximating that of DSA. Image analysis demonstrates equivalency in terms of grading AVMs using the Spetzler-Martin grading scale. This 4D rCE-MRA sequence has the potential to avoid some applications of DSA, thus saving patients from potential procedural risks. (Stroke. 2009; 40: 2749-2753.)