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<meta name="DC.Title" content="Classification of Cerebral Arteriovenous Malformations and Intranidal Flow Patterns by Color-Encoded 4D-Hybrid-MRA" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3204" />
<meta name="DC.Date" content="2013-01-01" />
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<meta name="DC.Description" content="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 AND METHODS: 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.

4D-hMRA
:   4D-hybrid-MRA
ACA
:   anterior cerebral artery
PCA
:   posterior cerebral artery
SM
:   Spetzler Martin
TOF
:   time of flight
TREAT
:   time-resolved echo-shared angiographic technique" />
<meta name="DC.Contributor" content="T. Illies" />
<meta name="DC.Contributor" content="N.D. Forkert" />
<meta name="DC.Contributor" content="T. Ries" />
<meta name="DC.Contributor" content="J. Regelsberger" />
<meta name="DC.Contributor" content="J. Fiehler" />
<meta name="article:published_time" content="2013-01-01" />
<meta name="article:section" content="Brain" />
<meta name="citation_title" content="Classification of Cerebral Arteriovenous Malformations and Intranidal Flow Patterns by Color-Encoded 4D-Hybrid-MRA" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;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.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;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).&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;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%).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;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.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2013/01/01" />
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<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
<meta name="citation_doi" content="10.3174/ajnr.A3204" />
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<meta name="citation_author" content="T. Illies" />
<meta name="citation_author_institution" content="aFrom the Departments of Diagnostic and Interventional Neuroradiology (T.I., T.R., J.F.)" />
<meta name="citation_author" content="N.D. Forkert" />
<meta name="citation_author_institution" content="bComputational Neuroscience (N.D.F.)" />
<meta name="citation_author" content="T. Ries" />
<meta name="citation_author_institution" content="aFrom the Departments of Diagnostic and Interventional Neuroradiology (T.I., T.R., J.F.)" />
<meta name="citation_author" content="J. Regelsberger" />
<meta name="citation_author_institution" content="cNeurosurgery (J.R.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany." />
<meta name="citation_author" content="J. Fiehler" />
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<meta name="twitter:title" content="Classification of Cerebral Arteriovenous Malformations and Intranidal Flow Patterns by Color-Encoded 4D-Hybrid-MRA" />
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<meta name="twitter:description" content="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 AND METHODS: 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.

4D-hMRA
:   4D-hybrid-MRA
ACA
:   anterior cerebral artery
PCA
:   posterior cerebral artery
SM
:   Spetzler Martin
TOF
:   time of flight
TREAT
:   time-resolved echo-shared angiographic technique" />
<meta name="og-title" property="og:title" content="Classification of Cerebral Arteriovenous Malformations and Intranidal Flow Patterns by Color-Encoded 4D-Hybrid-MRA" />
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<meta name="og-description" property="og:description" content="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 AND METHODS: 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.

4D-hMRA
:   4D-hybrid-MRA
ACA
:   anterior cerebral artery
PCA
:   posterior cerebral artery
SM
:   Spetzler Martin
TOF
:   time of flight
TREAT
:   time-resolved echo-shared angiographic technique" />
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      <h1 class="highwire-cite-title" id="page-title">Classification of Cerebral Arteriovenous Malformations and Intranidal Flow Patterns by Color-Encoded 4D-Hybrid-MRA</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">T. Illies</span>, <span class="highwire-citation-author" data-delta="1">N.D. Forkert</span>, <span class="highwire-citation-author" data-delta="2">T. Ries</span>, <span class="highwire-citation-author" data-delta="3">J. Regelsberger</span> and <span class="highwire-citation-author" data-delta="4">J. Fiehler</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">January 2013,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">46-53; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3204 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-12411--620722783" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">T. Illies </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Diagnostic and Interventional Neuroradiology (T.I., T.R., J.F.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.%2BIllies%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Illies%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AT.%2BIllies%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">N.D. Forkert </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Computational Neuroscience (N.D.F.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.D.%2BForkert%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Forkert%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AN.D.%2BForkert%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">T. Ries </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Diagnostic and Interventional Neuroradiology (T.I., T.R., J.F.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.%2BRies%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ries%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AT.%2BRies%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">J. Regelsberger </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurosurgery (J.R.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BRegelsberger%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Regelsberger%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.%2BRegelsberger%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">J. 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<p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> 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.</p>
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<p id="p-3"><strong>MATERIALS AND METHODS:</strong> 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).</p>
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<p id="p-4"><strong>RESULTS:</strong> 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%).</p>
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<p id="p-5"><strong>CONCLUSIONS:</strong> 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.</p>
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<h2>ABBREVIATIONS:</h2>
<dl id="def-list-1"><dt id="def-item-1">4D-hMRA<span class="def-item-dt-sep"></span></dt><dd>4D-hybrid-MRA<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">ACA<span class="def-item-dt-sep"></span></dt><dd>anterior cerebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">PCA<span class="def-item-dt-sep"></span></dt><dd>posterior cerebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">SM<span class="def-item-dt-sep"></span></dt><dd>Spetzler Martin<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">TOF<span class="def-item-dt-sep"></span></dt><dd>time of flight<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">TREAT<span class="def-item-dt-sep"></span></dt><dd>time-resolved echo-shared angiographic technique</dd></dl>
</div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2013 by American Journal of Neuroradiology</li></ul><div class="license" id="license-1"><p id="p-1">Indicates open access to non-subscribers at <a href="http://www.ajnr.org">www.ajnr.org</a></p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/34/1/46.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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      <div class="highwire-cite-title">Classification of Cerebral Arteriovenous Malformations and Intranidal Flow Patterns by Color-Encoded 4D-Hybrid-MRA</div>  
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