Soize S, Bouquigny F, Kadziolka K, Portefaix C, Pierot L
From the Department of Radiology, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France.
AJNR Am J Neuroradiol. 2014 Oct;35(10):1903-9. doi: 10.3174/ajnr.A3982. Epub 2014 Jun 5.
Four-dimensional, contrast-enhanced MRA is a useful technique for the diagnosis and classification of brain AVM. The purpose of this study was to evaluate its usefulness in the follow-up of treated brain AVM.
Patients with treated brain AVM (embolization, radiosurgery, and/or surgery) were investigated with both DSA (the "gold standard") and 4D MRA. Four-dimensional MRA was performed at 3T using a 4D sequence, combining contrast-enhanced timing-robust angiography, keyhole, and sensitivity encoding techniques. Examinations were evaluated by 2 independent readers and disagreements were resolved by a third reader. Interobserver and intermodality agreement with respect to residual nidus, residual venous drainage, and brain AVM patency were determined.
Between May 2008 and February 2013, 37 patients with a median age of 45 years (interquartile range = 26-55) were prospectively included. Examinations were acquired 36 months (IQR = 10-45.5) after the last treatment. Interobserver agreement for brain AVM patency was very good for both 4D MRA (κ 0.82, 95% CI .67-.98) and DSA (κ 0.84, 95% CI .69-.98). After consensus reading, intermodality agreement for the evaluation of brain AVM patency was good (κ 0.73, 95% CI .55-.90). Diagnostic accuracy of 4D MRA for residual brain AVM compared with DSA, reached a sensitivity of 73.7%, specificity 100%, positive predictive value 100%, and negative predictive value 78.3%. Agreements by technique of treatment are also detailed.
Four-dimensional MRA is a useful radiation-free technique for the follow-up of patients with treated brain AVM, especially patients treated by radiosurgery. However, given its actual limitations it is not sufficient to assert the cure; DSA remains mandatory for this purpose.
四维对比增强磁共振血管造影（MRA）是诊断和分类脑动静脉畸形（AVM）的一项有用技术。本研究的目的是评估其在已治疗脑AVM随访中的作用。
对接受过脑AVM治疗（栓塞、放射外科手术和/或手术）的患者进行DSA（“金标准”）和4D MRA检查。4D MRA在3T下使用4D序列进行，该序列结合了对比增强时间稳健血管造影、钥孔技术和敏感性编码技术。由2名独立阅片者对检查结果进行评估，分歧由第3名阅片者解决。确定了观察者间以及不同检查方法间在残留病灶、残留静脉引流和脑AVM通畅性方面的一致性。
2008年5月至2013年2月，前瞻性纳入了37例患者，中位年龄45岁（四分位间距=26 - 55岁）。检查在最后一次治疗后36个月（IQR = 10 - 45.5）进行。观察者间对脑AVM通畅性的一致性在4D MRA（κ = 0.82，95% CI 0.67 - 0.98）和DSA（κ = 0.84，95% CI 0.69 - 0.98）中均非常好。经过共识阅片后，不同检查方法间对脑AVM通畅性评估的一致性良好（κ = 0.73，95% CI 0.55 - 0.90）。与DSA相比，4D MRA对残留脑AVM的诊断准确性达到了73.7%的敏感性、100%的特异性、100%的阳性预测值和78.3%的阴性预测值。还详细说明了不同治疗技术的一致性情况。
四维MRA是一种用于已治疗脑AVM患者随访的有用的无辐射技术，尤其适用于接受放射外科手术治疗的患者。然而，鉴于其实际局限性，尚不足以确定治愈情况；为此DSA仍然是必需的。
