Invest Radiol. 2018 Feb;53(2):80-86. doi: 10.1097/RLI.0000000000000411.
The aim of this study was to assess the sensitivity and specificity of pseudo-continuous arterial spin labeling (PCASL) magnetic resonance angiography (MRA) with 3-dimensional (3D) radial acquisition for the detection of intracranial arteriovenous (AV) shunts.
A total of 32 patients who underwent PCASL-MRA, clinical magnetic resonance imaging (MRI)/MRA exam, and digital subtraction angiography (DSA) were included in this retrospective analysis. Twelve patients presented with AV shunts. Among these were 8 patients with AV malformations (AVM) and 4 patients with AV fistulas (AVF). The clinical MRI/MRA included 3D time-of-flight MRA in all cases and time-resolved, contrast-enhanced MRA in 9 cases (6 cases with AV shunting). Research MRI and clinical MRI were independently evaluated by 2 neuroradiologists blinded to patient history. A third radiologist evaluated DSA imaging. A diagnostic confidence score was used for the presence of abnormalities associated with AV shunting (1-5). The AVMs were characterized using the Spetzler-Martin scale, whereas AVFs were characterized using the Borden classification. κ Statistics were applied to assess intermodality agreement.
Compared with clinical MRA, noncontrast PCASL-MRA with 3D radial acquisition yielded excellent sensitivity and specificity for the detection of intracranial AV shunts (reader 1: 100%/100%, clinical MRA: 91.7%, 94.4%; reader 2: 91.7%/100%, clinical MRA: 91.7%/100%). Diagnostic confidence was 4.8/4.66 with PCASL-MRA and 4.25/4.66 with clinical MRA. For AVM characterization with PCASL-MRA, intermodality agreement with DSA showed κ values of 0.43 and 0.6 for readers 1 and 2, respectively. For AVF characterization, intermodality agreement showed κ values of 0.56 for both readers.
Noncontrast PCASL-MRA with 3D radial acquisition is a potential tool for the detection and characterization of intracranial AV shunts with a sensitivity and specificity equivalent or higher than routine clinical MRA.
本研究旨在评估三维（3D）径向采集伪连续动脉自旋标记（PCASL）磁共振血管造影（MRA）检测颅内动静脉（AV）分流的敏感性和特异性。
本回顾性分析共纳入 32 例接受 PCASL-MRA、临床磁共振成像（MRI）/MRA 检查和数字减影血管造影（DSA）的患者。其中 12 例患者存在 AV 分流。这些患者中包括 8 例动静脉畸形（AVM）和 4 例动静脉瘘（AVF）。所有患者的临床 MRI/MRA 均包括 3D 时飞法 MRA，9 例包括时间分辨、对比增强 MRA（6 例存在 AV 分流）。2 名神经放射科医生对研究 MRI 和临床 MRI 进行独立评估，不了解患者病史。第三名放射科医生评估 DSA 成像。使用诊断置信度评分评估与 AV 分流相关的异常（1-5 分）。使用 Spetzler-Martin 量表对 AVM 进行特征描述，使用 Borden 分类法对 AVF 进行特征描述。应用 κ 统计评估模态间的一致性。
与临床 MRA 相比，3D 径向采集非对比 PCASL-MRA 对颅内 AV 分流的检测具有优异的敏感性和特异性（读者 1：100%/100%，临床 MRA：91.7%，94.4%；读者 2：91.7%/100%，临床 MRA：91.7%/100%）。PCASL-MRA 的诊断置信度评分为 4.8/4.66，临床 MRA 为 4.25/4.66。对于 PCASL-MRA 对 AVM 的特征描述，与 DSA 的模态间一致性，读者 1 和 2 的 κ 值分别为 0.43 和 0.6。对于 AVF 的特征描述，模态间一致性的 κ 值为 0.56。
3D 径向采集非对比 PCASL-MRA 是一种潜在的工具，可用于检测和特征描述颅内 AV 分流，其敏感性和特异性与常规临床 MRA 相当或更高。
