Intracranial dural arteriovenous fistulas: evaluation with 3-T four-dimensional MR angiography using arterial spin labeling.

ABSTRACT

PURPOSE: To evaluate whether 3-T four-dimensional (4D) arterial spin-labeling (ASL)-based magnetic resonance (MR) angiography is useful for the evaluation of shunt lesions in patients with intracranial dural arteriovenous fistulas (AVFs). MATERIALS AND METHODS: Institutional review board approval and prior written informed consent from all patients were obtained. Nine patients with intracranial dural AVF (seven men, two women; age range, 52-77 years; mean age, 63 years) underwent 4D ASL MR angiography at 3 T and digital subtraction angiography (DSA). Spin tagging was with flow-sensitive alternating inversion recovery with Look-Locker sampling. At 300-millisecond intervals, seven dynamic images with a spatial resolution of 0.5 × 0.5 × 0.6 mm(3) were obtained. The 4D ASL MR angiographic and DSA images were read by two sets of two independent readers each. Interobserver and intermodality agreement was assessed with the κ statistic. RESULTS: On all 4D ASL MR angiographic images, the major intracranial arteries were demonstrated at a temporal resolution of 300 milliseconds. Interobserver agreement was excellent for the fistula site (κ = 1.00; 95% confidence interval [CI] 1.00, 1.00), moderate for the main arterial feeders (κ = 0.53; 95% CI 0.08, 0.98), and good for venous drainage (κ = 0.77; 95% CI 0.35, 1.00). Intermodality agreement was excellent for the fistula site and venous drainage (κ = 1.00; 95% CI 1.00, 1.00) and good for the main arterial feeders (κ = 0.80; 95% CI 0.58, 1.00). CONCLUSION: The good-to-excellent agreement between 3-T 4D ASL MR angiographic and DSA findings suggests that 3-T 4D ASL MR angiography is a useful tool for the evaluation of intracranial dural AVFs.