University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
University of Leicester, Leicester, United Kingdom.
Br J Radiol. 2020 Jun;93(1110):20190830. doi: 10.1259/bjr.20190830. Epub 2020 Mar 25.
To compare the performance of arterial spin labelling (ASL) in evaluating arteriovenous malformations (AVMs) against the current gold standard of catheter angiography.
We systematically reviewed the published literature using EMBASE and Medline. We included studies that compared ASL to catheter angiography in the assessment of AVMs in three outcome domains: detection, angioarchitectural and haemodynamic features.
From 314 unique citations, 19 studies representing 289 patients with intracranial AVMs met our inclusion criteria. We did not pool data due to marked heterogeneity in study outcome measures. Seven studies showed high diagnostic performance of ASL in identifying arterial feeders, with sensitivity ranging from 84.6 to 100% and specificity ranging from 93.3 to 100%. Six studies showed strong ability in detecting arteriovenous shunting, with sensitivity ranging from 91.7 to 100% and specificity ranging from 90 to 100%. Seven studies demonstrated that ASL could identify nidal location and size as well as catheter angiography, while five studies showed relatively poorer performance in delineating venous drainage. Two studies showed 100% sensitivity of ASL in the identification of residual or obliterated AVMs following stereotactic radiosurgery.
Despite limitations in the current evidence base and technical challenges, this review suggests that ASL has a promising role in the work-up and post-treatment follow-up of AVMs. Larger scale prospective studies assessing the diagnostic performance of ASL are warranted.
ASL demonstrates overall validity in the evaluation of intracranial AVMs.
比较动脉自旋标记（ASL）在评估动静脉畸形（AVM）方面的性能与导管血管造影的当前金标准。
我们使用 EMBASE 和 Medline 系统地回顾了已发表的文献。我们纳入了在三个结果领域（检测、血管构筑和血流动力学特征）中比较 ASL 与导管血管造影评估 AVM 的研究：检测、血管构筑和血流动力学特征。
从 314 条独特的引文，19 项研究代表了 289 例颅内动静脉畸形患者符合我们的纳入标准。由于研究结果衡量标准存在明显的异质性，我们没有对数据进行汇总。七项研究表明 ASL 在识别动脉供血方面具有较高的诊断性能，其敏感性范围为 84.6%至 100%，特异性范围为 93.3%至 100%。六项研究显示出较强的检测动静脉分流的能力，其敏感性范围为 91.7%至 100%，特异性范围为 90%至 100%。七项研究表明 ASL 可以识别病灶位置和大小，以及与导管血管造影一样，而五项研究表明其在描绘静脉引流方面的表现相对较差。两项研究表明 ASL 在识别立体定向放射手术后残留或闭塞的 AVM 方面具有 100%的敏感性。
尽管当前证据基础和技术挑战存在局限性，但本综述表明 ASL 在 AVM 的检查和治疗后随访中具有很有前途的作用。需要更大规模的前瞻性研究来评估 ASL 的诊断性能。
ASL 证明了其在评估颅内 AVM 方面的整体有效性。
