Department of Radiology, University of Bonn, Bonn, Germany.
Invest Radiol. 2010 Mar;45(3):126-32. doi: 10.1097/RLI.0b013e3181c7bcfe.
Prospective intraindividual comparison of 4-dimensional contrast-enhanced MR angiography (4D-MRA) in combination with selective arterial spin labeling (ASL) at 3.0 Tesla and digital subtraction angiography (DSA) for anatomic and functional characterization of cerebral arteriovenous malformations (AVMs).
In a prospective intraindividual comparative study, 16 patients diagnosed with symptomatic cerebral AVMs underwent 4D-MRA at an isotropic spatial resolution of 1.1 x 1.1 x 1.1 mm and a temporal resolution of 572 milliseconds, regional brain perfusion imaging using selective ASL and DSA. Selective ASL was performed for selective labeling of both carotid arteries and the vertebrobasilar complex. In a stepwise approach, all images were evaluated by 2 radiologists according to technical success rate, Spetzler-Martin classification, identification of arterial feeders, and existence of anatomic variants or functional cross-filling.
4D-MRA allowed for the same Spetzler-Martin classification as DSA in all patients. Of 28, 26 (93%) feeding arteries were correctly identified by both readers using 4D-MRA alone. Selective ASL provided additional functional or anatomic information in 4 of 16 cases (25%), enabling the detection of a cross-filling feeding artery that was not identified by 4D-MRA without selective ASL, thus improving the sensitivity of MRI in identification of arterial feeders from 26/28 (93%) to 27/28 (96%). The additional functional information regarding anatomic variants and cross-filling provided by selective ASL was confirmed by DSA in all cases.
4D-MRA in combination with selective arterial spin labeling is a promising tool for the noninvasive assessment of cerebral AVMs providing functional information that so far has been gained only with DSA.
在 3.0T 磁共振上，前瞻性个体内比较 4 维对比增强磁共振血管成像（4D-MRA）联合选择性动脉自旋标记（ASL）与数字减影血管造影（DSA）在脑动静脉畸形（AVM）解剖和功能特征方面的应用。
在一项前瞻性个体内比较研究中，16 例有症状的脑动静脉畸形患者在 3.0T 磁共振上进行了 4D-MRA 检查，空间分辨率为 1.1x1.1x1.1mm，时间分辨率为 572 毫秒，使用选择性 ASL 进行区域性脑灌注成像和 DSA。选择性 ASL 用于选择性标记颈内动脉和椎基底动脉复合体。两位放射科医生按照技术成功率、斯佩茨勒-马丁（Spetzler-Martin）分级、动脉供血动脉的识别以及解剖变异或功能交叉充盈的存在，逐步对所有图像进行评估。
4D-MRA 允许对所有患者进行相同的斯佩茨勒-马丁（Spetzler-Martin）分级，两位读者使用单独的 4D-MRA 正确识别了 28 条供血动脉中的 26 条（93%）。选择性 ASL 在 4 例（25%）中提供了额外的功能或解剖信息，从而检测到未通过选择性 ASL 而未被 4D-MRA 识别的交叉供血动脉，从而将 MRI 对动脉供血动脉的识别灵敏度从 26/28（93%）提高到 27/28（96%）。选择性 ASL 提供的关于解剖变异和交叉充盈的额外功能信息在所有病例中均通过 DSA 得到证实。
4D-MRA 联合选择性动脉自旋标记是一种很有前途的脑动静脉畸形无创评估工具，提供了目前仅通过 DSA 才能获得的功能信息。
