Evaluation of sporadic intracranial cavernous malformations for detecting associated developmental venous anomalies: added diagnostic value of C-arm contrast-enhanced cone-beam CT to routine contrast-enhanced MRI
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Our purpose was to investigate the added diagnostic value of C-arm contrast-enhanced cone-beam CT (CE-CBCT) to routine contrast-enhanced MRI (CE-MRI) in detecting associated developmental venous anomalies (DVAs) in patients with sporadic intracranial cavernous malformations (ICMs).
Fifty-six patients (53 with single and three with double ICMs) met the inclusion criteria. All patients had routine CE-MRI scans performed at 1.5 Tesla. The imaging studies (CE-MRI and CE-CBCT) were retrospectively and independently reviewed by two observers, with consensus by a third. Group difference, intra- and interobserver agreement, and diagnostic performance of the modalities in detecting associated DVAs were calculated. Reference standard was CE-MRI.
On CE-MRI and CE-CBCT, 37 (66%; of 56) and 47 patients (84%; of 56) had associated DVAs, respectively. In 10 patients (52.6%; of CE-MRI negatives [n=19]), CE-CBCT improved the diagnosis. Nine patients (16%; of 56) had no DVA on both imaging techniques. Difference in proportions of associated DVAs on CE-MRI and CE-CBCT was statistically significant, p < 0.05. Sensitivity, specificity, positive likelihood ratio, and area under the curve of CE-CBCT were 100% (95% confidence interval [CI]: 90.5-100%), 47.3% (95% CI: 24.4-71.1%), 1.9 (95%CI: 1.240-2.911), 0.737 (95%CI: 0.602-0.845), respectively. Intraobserver agreement was excellent for CE-MRI, kappa (κ) coefficient = 0.960, and CE-CBCT, κ=0.931. Interobserver agreement was substantial for CE-MRI, κ=0.803, and excellent for CE-CBCT, κ=0.810.
CE-CBCT is a useful imaging technique especially in patients with negative routine CE-MRI in terms of detecting associated DVAs. In nearly half of these particular patients, it reveals an associated DVA as a new diagnosis.
• Although it is known to be the gold standard, some of the DVAs associated with ICMs are underdiagnosed with CE-MRI.
• In nearly half of the patients with negative routine CE-MRI, CE-CBCT reveals an associated DVA as a new diagnosis.
• Intra- and interobserver agreement on CE-CBCT is excellent in terms of detecting associated DVAs.
KeywordsCavernous haemangioma Cone-beam computed tomography Magnetic resonance imaging Central nervous system venous angioma
C-arm cone-beam computed tomography
C-arm contrast-enhanced cone-beam computed tomography
Contrast-enhanced magnetic resonance imaging
Digital subtraction angiography
Developmental venous anomaly
Field of view
Intracranial cavernous malformation
Magnetic resonance imaging
Negative likelihood ratio
A partial abstract of this study (maximum 250 words) has been submitted to ECR (European Congress of Radiology) 2018, accepted and presented as oral presentation (control number: 1976; presentation number: B-0687).
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Civan Islak.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors (Burak Kocak) has significant statistical expertise.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in authors’ previous publication Kocak B, Kizilkilic O, Oz B, Bakkaloglu DV, Isler C, Kocer N, Islak C. Ultra-high-resolution C-arm flat-detector CT angiography evaluation reveals 3-fold higher association rate for sporadic intracranial cavernous malformations and developmental venous anomalies: a retrospective study in consecutive 58 patients with 60 cavernous malformations. Eur Radiol. 2017 Jun;27(6):2629-2639. doi: 10.1007/s00330-016-4595-9. Epub 2016 Sep 21.
• diagnostic study
• performed at one institution
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