Dj. Warren et al., Cerebral arteriovenous malformations: Comparison of novel magnetic resonance angiographic techniques and conventional catheter angiography, NEUROSURGER, 48(5), 2001, pp. 973-982
OBJECTIVE: To investigate the potential of novel magnetic resonance (MR) an
giographic techniques for the assessment of cerebral arteriovenous malforma
tions.
METHODS: Forty patients who were about to undergo stereotactic radiosurgery
were prospectively recruited. Three-dimensional, sliding-slab interleaved
k(y) (SLINKY), time-of-flight acquisition was performed, as was a dynamic M
R digital subtraction angiography (DSA) procedure in which single thick sli
ces (6-10 cm) were obtained using a radiofrequency spoiled Fourier-acquired
steady-state sequence (1 image/s). Sixty images were acquired, in two or t
hree projections, during passage of a 6- to 10-ml bolus of gadolinium chela
te. Subtraction and postprocessing were performed, and images were viewed i
n an inverted cine mode. SLINKY time-of-flight acquisition was repeated aft
er the administration of gadolinium. Routine stereotactic conventional cath
eter angiography was performed after MR imaging. All images were assessed t
in a blinded randomized manner) for Spetzler-Martin grading and determinati
on of associated vascular pathological features.
RESULTS: Forty-one arteriovenous malformations were assessed in 40 patients
. Contrast-enhanced (CE) SLINKY MR angiography was the most consistent MR i
maging technique, yielding a 95% correlation with the Spetzler-Martin class
ification defined by conventional catheter angiography; MR DSA exhibited 90
% agreement, and SLINKY MR angiography exhibited 81% agreement. CE SLINKY M
R angiography provided improved nidus delineation, compared with non-CE SLI
NKY MR angiography. Dynamic information from MR DSA significantly improved
the observation of early-draining veins and associated aneurysms.
CONCLUSION: CE SLINKY MR angiographic assessment of cerebral arteriovenous
malformations offers significant advantages, compared with the use of non-C
E SLINKY MR angiography, including improved nidus demonstration. MR DSA sho
ws promise as a noninvasive method for dynamic angiography but is presently
restricted by limitations in both temporal and spatial resolution.