Cerebral arteriovenous malformations: Comparison of novel magnetic resonance angiographic techniques and conventional catheter angiography

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.