Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan.
Philips Japan, 13-37, Kohnan 2-chome, Minato-ku, Tokyo, 108-8507, Japan.
Eur Radiol. 2020 Dec;30(12):6452-6463. doi: 10.1007/s00330-020-07057-4. Epub 2020 Jul 21.
To evaluate the usefulness of 4D-MR angiography based on super-selective pseudo-continuous ASL combined with keyhole and view-sharing (4D-S-PACK) for vessel-selective visualization and to examine the ability of this technique to visualize brain arteriovenous malformations (AVMs).
In this retrospective study, 15 patients (ten men and five women, mean age 44.0 ± 16.9 years) with brain AVMs were enrolled. All patients were imaged with 4D-PACK (non-selective), 4D-S-PACK, and digital subtraction angiography (DSA). Observers evaluated vessel selectivity, identification of feeding arteries and venous drainage patterns, visualization scores, and contrast-to-noise ratio (CNR) for each AVM component. Measurements were compared between the MR methods.
Vessel selectivity was graded 4 in 43/45 (95.6%, observer 1) and 42/45 (93.3%, observer 2) territories and graded 3 in two (observer 1) and three (observer 2) territories. The sensitivity and specificity for identification of feeding arteries for both observers was 88.9% and 100% on 4D-PACK, and 100% and 100% on 4D-S-PACK, respectively. For venous drainage, the sensitivity and specificity was 100% on both methods for observer 1. The sensitivity and specificity for observer 2 was 94.4% and 83.3% on 4D-PACK, and 94.4% and 91.7% on 4D-S-PACK, respectively. The CNRs at the timepoint of 1600 ms were slightly lower in 4D-S-PACK than in 4D-PACK for all AVM components (Feeding artery, p = .02; nidus, p = .001; and draining artery, p = .02). The visualization scores for both observers were not significantly different between 4D-PACK and 4D-S-PACK for all components.
4D-S-PACK could be a useful non-invasive clinical tool for assessing hemodynamics in brain AVMs.
• The 4D-MR angiography based on super-selective pseudo-continuous arterial spin labeling combined with CENTRA-keyhole and view-sharing (4D-S-PACK) enabled excellent vessel selectivity. • The 4D-S-PACK enabled the perfect identification of feeding arteries of brain arteriovenous malformation (AVM). • 4D-S-PACK could be a non-invasive clinical tool for assessing hemodynamics in brain AVMs.
评估基于超选择性假性连续动脉自旋标记结合关键孔和视图共享（4D-S-PACK）的 4D-MRA 用于血管选择性可视化的有用性，并检查该技术显示脑动静脉畸形（AVM）的能力。
在这项回顾性研究中，纳入了 15 名患有脑 AVM 的患者（10 名男性，5 名女性，平均年龄 44.0±16.9 岁）。所有患者均进行了 4D-PACK（非选择性）、4D-S-PACK 和数字减影血管造影（DSA）检查。观察者评估了每个 AVM 成分的血管选择性、供血动脉和静脉引流模式的识别、可视化评分和对比噪声比（CNR）。比较了两种磁共振方法的测量结果。
在 45 个区域中，有 43 个（观察者 1 为 95.6%，观察者 2 为 93.3%）被评为 4 级，2 个（观察者 1）和 3 个（观察者 2）区域被评为 3 级。对于供血动脉的识别，两位观察者在 4D-PACK 上的敏感度和特异度分别为 88.9%和 100%，在 4D-S-PACK 上分别为 100%和 100%。对于静脉引流，观察者 1 在两种方法上的敏感度和特异度均为 100%。观察者 2 在 4D-PACK 上的敏感度和特异度分别为 94.4%和 83.3%，在 4D-S-PACK 上分别为 94.4%和 91.7%。在所有 AVM 成分中，4D-S-PACK 在 1600ms 时的 CNR 略低于 4D-PACK（供血动脉，p=0.02；病灶，p=0.001；引流动脉，p=0.02）。对于所有成分，两位观察者在 4D-PACK 和 4D-S-PACK 上的可视化评分均无显著差异。
4D-S-PACK 可能是一种有用的非侵入性临床工具，可用于评估脑 AVM 的血流动力学。
基于超选择性假性连续动脉自旋标记结合 CENTRA-关键孔和视图共享（4D-S-PACK）的 4D-MRA 可实现出色的血管选择性。
4D-S-PACK 可完美识别脑动静脉畸形（AVM）的供血动脉。
4D-S-PACK 可能是一种用于评估脑 AVM 血流动力学的非侵入性临床工具。
