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Interest of HYPR flow dynamic MRA for characterization of cerebral arteriovenous malformations: comparison with TRICKS MRA and catheter DSA

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Abstract

Objective

HYPR flow is a 3D dynamic contrast-enhanced MRA technique providing isotropic sub-millimetre resolution with half-second temporal resolution. We compared HYPR flow and time-resolved imaging of contrast kinetics (TRICKS) MRA for the characterization of cerebral arteriovenous malformations (cAVMs), using catheter DSA as reference.

Methods

Twenty-two patients underwent HYPR flow and TRICKS MRA within 15 days of DSA. HYPR flow and TRICKS datasets were reviewed separately by two readers for image quality, Spetzler–Martin grade, venous ectasia, and deep venous drainage.

Results

Image quality was better for HYPR flow than for TRICKS (narrower full width at half maximum; larger arterial diagnostic window; greater number of arterial frames, P ≤ 0.05). Using HYPR flow, inter-reader agreement was excellent for all cAVM characteristics. The agreement with DSA for the overall Spetzler–Martin grade was excellent for HYPR flow (ICC = 0.96 and 0.98, depending on the reader) and TRICKS (ICC = 0.82 and 0.95). In comparison to TRICKS, HYPR flow showed higher concordance with DSA for the identification of venous ectasia and deep venous drainage.

Conclusion

Owing to an excellent agreement with DSA with respect to depiction of the vascular architecture of cAVMs, HYPR flow could be useful for the non-invasive characterization of cAVMs.

Key Points

• Dynamic MRA is used for cerebral AVM depiction and follow-up

• HYPR flow is a new, highly-resolved dynamic MRA sequence

• HYPR flow provides whole brain coverage

• HYPR flow provides excellent agreement with the Spetzler–Martin grade

• Compared to TRICKS MRA, HYPR flow improves cerebral AVM characterization

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Abbreviations

ADW:

Arterial diagnostic window

cAVM:

cerebral arteriovenous malformation

D-CE-MRA:

Dynamic time-resolved contrast-enhanced MRA

FWHM:

Full width at half maximum

HYPR flow:

Highly constrained back-projection with phase contrast as a constraint

ICC:

Intraclass correlation coefficients

PC:

Phase contrast

SD:

Standard deviation

TRICKS:

Time-resolved imaging of contrast kinetics

VIPR:

Vastly undersampled isotropic voxel radial projection imaging

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Acknowledgments

We thank the Delegation à la Recherche Clinique of Sainte-Anne Hospital and the URC/CIC of Necker - Cochin Hospital for their help in conducting the study. The results of this work were presented at the ISMRM 21st Annual Meeting, in April 2013. The scientific guarantor of this publication is Pr Catherine Oppenheim. One the authors of this manuscript declares relationships with the following company: Cécile Rabrait was empoyed by GE Healthcare® at the time of the study. This study has received funding by the “Société Française de Radiologie” (French Radiology Society). One of the authors (Olivier Naggara) has significant statistical expertise. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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    Authors and Affiliations

    1. Department of Radiology, Centre de Psychiatrie et Neuroscience, INSERM S894, Centre Hospitalier Sainte-Anne, Université Paris Descartes Sorbonne Paris Cité, DHU Neurovasc, 1 rue Cabanis, 75014, Paris, France

      Raphaël Dautry, Myriam Edjlali, Pauline Roca, Denis Trystram, Christine Rodriguez-Régent, Fawaz Alshareef, Jean-François Meder, Olivier Naggara & Catherine Oppenheim

    2. GE Healthcare, Vélizy-Villacoublay, France

      Cécile Rabrait

    3. Department of Medical Physics and Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

      Yijing Wu, Kevin Johnson, Olivier Wieben & Patrick Turski

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    1. Raphaël Dautry
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    Correspondence to Catherine Oppenheim.

    Additional information

    Raphaël Dautry and Myriam Edjlali contributed equally to this work.

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    Dautry, R., Edjlali, M., Roca, P. et al. Interest of HYPR flow dynamic MRA for characterization of cerebral arteriovenous malformations: comparison with TRICKS MRA and catheter DSA. Eur Radiol 25, 3230–3237 (2015). https://doi.org/10.1007/s00330-015-3745-9

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