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Acceleration-selective arterial spin labeling MR angiography for visualization of brain arteriovenous malformations

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

To evaluate the performance of acceleration-selective arterial spin labeling (AccASL) MR angiography in the visualization of brain arteriovenous malformations (AVMs) in comparison with digital subtraction angiography (DSA) and time-of-flight (TOF) MR angiography.

Methods

Twenty-one patients with brain AVM (mean age 31.1 ± 18.6 years; 11 males, 10 females) underwent TOF and AccASL MR angiography and DSA. Two neuroradiologists conducted an observer study for detection, nidus size, eloquence, venous drainage pattern, and Spetzler-Martin (SM) grade. The evaluations included the visualization of each AVM component with reference to DSA and assessments of contrast-to-noise ratio (CNR). The kappa statistic, repeated measures analysis of variance, Wilcoxon matched pairs test, and paired t test were used.

Results

Both observers detected more AVMs with AccASL (95.2%, 90.5% for Observers 1 and 2) than with TOF (76.2% and 71.4%, respectively). The inter-modality agreement between AccASL and DSA was almost perfect for the eloquence, venous drainage pattern, and SM grade for Observer 1 and moderate for the venous drainage pattern and substantial for the eloquence and SM grade for Observer 2. The visualization scores were higher with AccASL than with TOF for the feeding artery (AccASL, 4.5 ± 1.0 vs. TOF, 3.9 ± 1.5, p = 0.0214), nidus (4.6 ± 1.1 vs. 3.2 ± 1.5, p = 0.0006), and draining vein (4.6 ± 1.0 vs. 2.2 ± 1.1, p < 0.0001), respectively. The CNRs in the nidus were higher in AccASL than in TOF (29.9 ± 16.7 vs. 20.8 ± 16.5, p = 0.0002), as in the draining vein (23.2 ± 13.0 vs. 12.6 ± 12.0, p = 0.0010), respectively.

Conclusions

AccASL better visualized brain AVMs compared with TOF and was useful for grading without the use of contrast agents.

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Acknowledgements

The authors would like to thank Dr. Yukiko N. Kami for useful discussions on the statistical analyses.

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Authors and Affiliations

  1. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan

    Osamu Togao, Koji Yamashita, Daichi Momosaka & Hiroshi Honda

  2. Department of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan

    Akio Hiwatashi

  3. Philips Japan, 13-37, Kohnan 2-chome, Minato-ku, Tokyo, 108-8507, Japan

    Makoto Obara & Marc Van Cauteren

  4. Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan

    Ataru Nishimura, Koichi Arimura, Nobuhiro Hata & Koji Iihara

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  1. Osamu Togao
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Correspondence to Osamu Togao.

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MO and MVC are employees of Philips Japan.

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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was waived due to the retrospective nature of this study.

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Togao, O., Hiwatashi, A., Yamashita, K. et al. Acceleration-selective arterial spin labeling MR angiography for visualization of brain arteriovenous malformations. Neuroradiology 61, 979–989 (2019). https://doi.org/10.1007/s00234-019-02217-w

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