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J Neuroradiol. 2019 Jan 15. pii: S0150-9861(18)30377-8. doi: 10.1016/j.neurad.2018.12.004. [Epub ahead of print]

Arterial-spin labeling MRI identifies residual cerebral arteriovenous malformation following stereotactic radiosurgery treatment.

Author information

1
Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University Hospital, 300, Pasteur Drive, Stanford, CA 94305, US. Electronic address: jheit@stanford.edu.
2
Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University Hospital, 300, Pasteur Drive, Stanford, CA 94305, US.
3
Department of Neurosurgery, Stanford University Hospital, 300, Pasteur Drive, Stanford, CA 94305, US.

Abstract

BACKGROUND AND PURPOSE:

Brain arteriovenous malformation (AVM) treatment by stereotactic radiosurgery (SRS) is effective, but AVM obliteration following SRS may take two years or longer. MRI with arterial-spin labeling (ASL) may detect brain AVMs with high sensitivity. We determined whether brain MRI with ASL may accurately detect residual AVM following SRS treatment.

MATERIALS AND METHODS:

We performed a retrospective cohort study of patients who underwent brain AVM evaluation by DSA between June 2010 and June 2015. Inclusion criteria were: (1) AVM treatment by SRS, (2) follow-up MRI with ASL at least 30 months after SRS, (3) DSA within 3 months of the follow-up MRI with ASL, and (4) no intervening AVM treatment between the MRI and DSA. Four neuroradiologists blindly and independently reviewed follow-up MRIs. Primary outcome measure was residual AVM indicated by abnormal venous ASL signal.

RESULTS:

15 patients (12 females, mean age 29 years) met inclusion criteria. There were three posterior fossa AVMs and 12 supratentorial AVMs. Spetzler-Martin (SM) Grades were: SM1 (8%), SM2 (33%), SM3 (17%), SM4 (25%), and SM5 (17%). DSA demonstrated residual AVM in 10 patients. The pooled sensitivity, specificity, positive predictive value, and negative predictive value of venous ASL signal for predicting residual AVM were 100% (95% CI: 0.9-1.0), 95% (95% CI: 0.7-1.0), 98% (95% CI: 0.9-1.0), and 100% (95% CI: 0.8-1.0), respectively. High inter-reader agreement as found by Fleiss' Kappa analysis (k = 0.92; 95% CI: 0.8-1.0; P < 0.0001).

CONCLUSIONS:

ASL is highly sensitive and specific in the detection of residual cerebral AVM following SRS treatment.

KEYWORDS:

ASL; AVM; Arterial-spin labeling; Digital subtraction angiography; MRI; Stereotactic radiosurgery

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