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AJNR Am J Neuroradiol. 2019 Aug 8. doi: 10.3174/ajnr.A6156. [Epub ahead of print]

Color-Mapping of 4D-CTA for the Detection of Cranial Arteriovenous Shunts.

Author information

1
From the Departments of Radiology and Nuclear Medicine (M.M., S.A.H.P., M.P., R.M., F.J.A.M.) Midas.Meijs@radboudumc.nl.
2
From the Departments of Radiology and Nuclear Medicine (M.M., S.A.H.P., M.P., R.M., F.J.A.M.).
3
Department of Radiology (K.M.), Fujita Health University, Toyoake, Japan.
4
Neurosurgery (H.D.B.), Radboud University Medical Center, Nijmegen, the Netherlands.
5
Department of Neurosurgery (P.W.A.W.), University Medical Center Utrecht, Utrecht, the Netherlands.

Abstract

BACKGROUND AND PURPOSE:

4D CT angiography is increasingly used in clinical practice for the assessment of different neurovascular disorders. Optimized processing of 4D-CTA is crucial for diagnostic interpretation because of the large amount of data that is generated. A color-mapping method for 4D-CTA is presented for improved and enhanced visualization of the cerebral vasculature hemodynamics. This method was applied to detect cranial AVFs.

MATERIALS AND METHODS:

All patients who underwent both 4D-CTA and DSA in our hospital from 2011 to 2018 for the clinical suspicion of a cranial AVF or carotid cavernous fistula were retrospectively collected. Temporal information in the cerebral vasculature was visualized using a patient-specific color scale. All color-maps were evaluated by 3 observers for the presence or absence of an AVF or carotid cavernous fistula. The presence or absence of cortical venous reflux was evaluated as a secondary outcome measure.

RESULTS:

In total, 31 patients were included, 21 patients with and 10 without an AVF. Arterialization of venous structures in AVFs was accurately visualized using color-mapping. There was high sensitivity (86%-100%) and moderate-to-high specificity (70%-100%) for the detection of AVFs on color-mapping 4D-CTA, even without the availability of dynamic subtraction rendering. The diagnostic performance of the 3 observers in the detection of cortical venous reflux was variable (sensitivity, 43%-88%; specificity, 60%-80%).

CONCLUSIONS:

Arterialization of venous structures can be visualized using color-mapping of 4D-CTA and proves to be accurate for the detection of cranial AVFs. This finding makes color-mapping a promising visualization technique for assessing temporal hemodynamics in 4D-CTA.

PMID:
31395664
DOI:
10.3174/ajnr.A6156

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