Noninvasive Evaluation of Cerebral Arteriovenous Malformations by 4D-MRA for Preoperative Planning and Postoperative Follow-Up in 56 Patients: Comparison with DSA and Intraoperative Findings
Noninvasive Evaluation of Cerebral Arteriovenous Malformations by 4D-MRA for Preoperative Planning and Postoperative Follow-Up in 56 Patients: Comparison with DSA and Intraoperative Findings
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DOI：
10.3174/ajnr.a2921
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发表时间：
2012-06-01
影响因子：
3.5
通讯作者：
Willinek, W. A.
中科院分区：
文献类型：
--
作者：
Hadizadeh, D. R.;Kukuk, G. M.;Willinek, W. A.
背景与目的：4D-MRA在cavm的诊断和随访中是一种很有前途的技术。本研究的目的是比较4D-MRA在cavm术前和术后的评价与DSA或术中发现作为定性和定量参数的参考标准。材料与方法：56例cavm患者（30名女性）连续接受4D-MRA和DSA检查。1例患者（运动伪影）术前4D-MRA被排除在分析之外。25例患者接受了cavm手术，并在术前和术后进行了影像学检查。用0.5 mol/L钆-二乙烯-三胺五乙酸进行4D-MRA(组1：体素大小，1.1 x 1.1 x 1.4 mm(3)；608 ms/动态帧；19例患者)或1.0 mol/L gadobutrol(第二组：体素大小，1.1 x 1.1 x 1.1 mm(3)；572毫秒/动态帧；额外的交替视图共享；37名患者)。两位读者独立回顾了4D-MRA和DSA关于Spetzler-Martin分类、动脉喂食器和术后残留填充的内容。定量4D-MRA血管清晰度、血管直径、VBC。结果：55/55例患者术前斯佩茨勒-马丁分级4D-MRA与DSA评分匹配(斯佩茨勒-马丁分级：I、12、II、22、Ill、15、IV、5、V. 11和93/100条动脉喂食器通过术前4D-MRA正确识别（另外7条仅通过DSA识别的动脉喂食器：1组，3/19；2组，4/36）。25例患者术后4D-MRA与DSA匹配（残余填充，1/25）。两组间血管锐度和直径无显著差异。2组VBC明显增高（P < 0.005）。结论：4D-MRA是预测Spetzler-Martin分类和术后残留填充的可靠工具；因此，它允许替代DSA在脑AVMs患者的术前和术后评估。
BACKGROUND AND PURPOSE: 4D-MRA is a promising technique in the diagnosis and follow-up of cAVMs. The purpose of this study was to compare 4D-MRA in the pre- and postoperative evaluation of cAVMs with DSA or intraoperative findings as the standards of reference regarding qualitative and quantitative parameters.MATERIALS AND METHODS: Fifty-six consecutive patients with cAVMs (30 women) underwent both 4D-MRA and DSA. Preoperative 4D-MRA was excluded from analysis in 1 patient (movement artifacts). Twenty-five patients underwent surgery on cAVMs and underwent both imaging modalities pre- and postoperatively. 4D-MRA was performed with either 0.5-mol/L gadolinium-diethylene-triamine pentaacetic acid (group 1: voxel size, 1.1 x 1.1 X 1.4 mm(3); 608 ms/dynamic frame; 19 patients) or 1.0-mol/L gadobutrol (group 2: voxel size, 1.1 x 1.1 x 1.1 mm(3); 572 ms/dynamic frame; additional alternating view sharing; 37 patients). Two readers independently reviewed 4D-MRA and DSA regarding the Spetzler-Martin classification, arterial feeders, and postoperative residual filling. Vessel sharpness, vessel diameter, and VBC of 4D-MRA were quantified.RESULTS: Preoperative Spetzler-Martin classification 4D-MRA and DSA ratings matched in 55/55 patients (Spetzler-Martin grades: I, 12; II, 22; Ill, 15; IV, 5; V. 11, and 93/100 arterial feeders were correctly identified by preoperative 4D-MRA (7 additional arterial feeders identified by DSA only: group 1, 3/19; group 2, 4/36). Postoperative 4D-MRA and DSA matched in 25/25 patients (residual filling, 1/25). Vessel sharpness and diameters did not differ substantially between the 2 groups. VBC was significantly higher in group 2 (P < .005).CONCLUSIONS: 4D-MRA is a reliable tool that allows predicting Spetzler-Martin classification and postoperative residual filling; it hence allows substituting DSA in the pre- and postoperative evaluation of patients with cerebral AVMs.