Classification of cerebral arteriovenous malformations and intranidal flow patterns by color-encoded 4D-hybrid-MRA.
AJNR Am J Neuroradiol
; 34(1): 46-53, 2013 Jan.
Article
em En
| MEDLINE
| ID: mdl-22878012
ABSTRACT
BACKGROUND AND PURPOSE:
4D MRA has been evolving as a noninvasive supplement for DSA. The purpose of this study was to evaluate the feasibility of a newly developed blood flow visualization technique for the classification of cerebral AVMs. We hypothesized that 4D-hMRA allows detection of different flow patterns within the nidus as well as differentiation of feeders and draining veins and has very good agreement with DSA regarding the Spetzler-Martin grade. MATERIALS ANDMETHODS:
Thirty-one consecutive patients with AVMs were evaluated by using 4D-hMRA and DSA by 2 blinded raters. Rating criteria included Spetzler-Martin score and other morphologic variables together with a new scale for 3 intranidal flow patterns (homogeneous = 1, unidirectional = 2, heterogeneous = 3).RESULTS:
The Spetzler-Martin grades were rated different from DSA in 5 cases by rater 1 and in 3 cases by rater 2 with an excellent interrater reliability of κ = 0.96 (4/31, 1 by size and 3 by drainage). Each reader missed 5 feeders on 4D-hMRA. Draining veins were distinguished in the temporal course in 7 on DSA but in 8 and 12 on 4D-hybrid-MRA (raters 1 and 2 respectively), with κ = 0.79. A type 1 intranidal flow pattern was recognizable in 9 (30%) patients; type 2, in 19 (60%); and type 3, in 3 (10%).CONCLUSIONS:
4D-hMRA allows reliable Spetzler-Martin grading and detection of brain arteriovenous malformation feeding arteries and draining veins, with the drawback that for small vessels DSA is still needed. Draining veins might even be detected with higher sensitivity than on DSA. Discrimination of different intranidal flow patterns is possible, but their relevance for hemorrhage risk assessment and therapy planning requires further study.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Algoritmos
/
Interpretação de Imagem Assistida por Computador
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Malformações Arteriovenosas Intracranianas
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Circulação Cerebrovascular
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Angiografia por Ressonância Magnética
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
/
Risk_factors_studies
Limite:
Adolescent
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Adult
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Aged
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Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article