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Time-resolved magnetic resonance angiography (MRA) at 3.0 Tesla for evaluation of hemodynamic characteristics of vascular malformations: description of distinct subgroups

  • Magnetic Resonance
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Abstract

Objectives

Quantitative evaluation of hemodynamic characteristics of arteriovenous and venous malformations using time-resolved magnetic resonance angiography (MRA) at 3.0 Tesla.

Methods

Time-resolved MRA with interleaved stochastic trajectories (TWIST) at 3.0 Tesla was studied in 83 consecutive patients with venous malformations (VM) and arteriovenous malformations (AVM). Enhancement characteristics were calculated as percentage increase of signal intensity above baseline over time. Maximum percentage signal intensity increase (signalmax), time intervals between onset of arterial enhancement and lesion enhancement (tonset), and time intervals between beginning of lesion enhancement and maximum percentage of lesion enhancement (tmax) were analyzed.

Results

All AVMs showed a high-flow hemodynamic pattern. Two significantly different (p < 0.001) types of venous malformations emerged: VMs with arteriovenous fistulas (AVF) (median signalmax 737 %, IQR [interquartile range] = 511 – 1182 %; median tonset 5 s, IQR = 5 – 10 s; median tmax 35 s, IQR = 26 – 40 s) and without AVFs (median signalmax 284 %, IQR = 177–432 %; median tonset 23 s, IQR = 15 – 30 s; median tmax 60 s, IQR = 55 – 75 s).

Conclusions

Quantitative evaluation of time-resolved MRA at 3.0 Tesla provides hemodynamic characterization of vascular malformations. VMs can be subclassified into two hemodynamic subgroups due to presence or absence of AVFs.

Key points

• Time-resolved MRA at 3.0 Tesla provides quantitative hemodynamic characterization of vascular malformations.

• Malformations significantly differ in time courses of enhancement and signal intensity increase.

• AVMs show a distinctive high-flow hemodynamic pattern.

• Two significantly different types of VMs emerged: VMs with and without AVFs.

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Abbreviations

AUC:

Area under the curve

AVF:

Arteriovenous fistula

AVM:

Arteriovenous malformation

IQR:

Interquartile range

MRI:

Magnetic resonance imaging

MRA:

Magnetic resonance angiography

ROC:

Receiver operating curve

ROI:

Region of interest

signal% :

Percentage increase of signal intensity above baseline

signalmax :

Maximum percentage signal intensity increase

tmax :

Time interval between beginning of enhancement and maximum percentage of enhancement

tonset :

Time interval between onset of enhancement in an adjacent artery and within the lesion

TWIST:

Time-resolved MRA with interleaved stochastic trajectories

VIBE:

Volumetric interpolated breath-hold examination

VM:

Venous malformation

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Acknowledgments

The scientific guarantor of this publication is Prof. Walter A. Wohlgemuth. 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. The authors state that this work has not received any funding. Mr. Florian Zeman kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board.

Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, University Hospital Regensburg, 93042, Regensburg, Germany

    Simone Hammer, Wibke Uller, Claudia Fellner & Walter A. Wohlgemuth

  2. Division of Vascular and Interventional Radiology, Boston Children’s Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA

    Wibke Uller

  3. Department of Nuclear Medicine, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany

    Florentine Manger

  4. Center for Clinical Trials, University Hospital Regensburg, 93042, Regensburg, Germany

    Florian Zeman

Authors
  1. Simone Hammer
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  2. Wibke Uller
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  3. Florentine Manger
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  4. Claudia Fellner
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  5. Florian Zeman
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  6. Walter A. Wohlgemuth
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Correspondence to Simone Hammer.

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Hammer, S., Uller, W., Manger, F. et al. Time-resolved magnetic resonance angiography (MRA) at 3.0 Tesla for evaluation of hemodynamic characteristics of vascular malformations: description of distinct subgroups. Eur Radiol 27, 296–305 (2017). https://doi.org/10.1007/s00330-016-4270-1

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  • DOI: https://doi.org/10.1007/s00330-016-4270-1

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