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<meta name="DC.Title" content="Value of 4D MR Angiography at 3T Compared with DSA for the Follow-Up of Treated Brain Arteriovenous Malformation" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3982" />
<meta name="DC.Date" content="2014-10-01" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Four-dimensional, contrast-enhanced MRA is a useful technique for the diagnosis and classification of brain AVM. The purpose of this study was to evaluate its usefulness in the follow-up of treated brain AVM.

MATERIALS AND METHODS: Patients with treated brain AVM (embolization, radiosurgery, and/or surgery) were investigated with both DSA (the “gold standard”) and 4D MRA. Four-dimensional MRA was performed at 3T using a 4D sequence, combining contrast-enhanced timing-robust angiography, keyhole, and sensitivity encoding techniques. Examinations were evaluated by 2 independent readers and disagreements were resolved by a third reader. Interobserver and intermodality agreement with respect to residual nidus, residual venous drainage, and brain AVM patency were determined.

RESULTS: Between May 2008 and February 2013, 37 patients with a median age of 45 years (interquartile range = 26–55) were prospectively included. Examinations were acquired 36 months (IQR = 10–45.5) after the last treatment. Interobserver agreement for brain AVM patency was very good for both 4D MRA (κ 0.82, 95% CI .67–.98) and DSA (κ 0.84, 95% CI .69–.98). After consensus reading, intermodality agreement for the evaluation of brain AVM patency was good (κ 0.73, 95% CI .55–.90). Diagnostic accuracy of 4D MRA for residual brain AVM compared with DSA, reached a sensitivity of 73.7%, specificity 100%, positive predictive value 100%, and negative predictive value 78.3%. Agreements by technique of treatment are also detailed.

CONCLUSIONS: Four-dimensional MRA is a useful radiation-free technique for the follow-up of patients with treated brain AVM, especially patients treated by radiosurgery. However, given its actual limitations it is not sufficient to assert the cure; DSA remains mandatory for this purpose.

4D-MRA
:   4D contrast-enhanced MRA
bAVM
:   brain AVM
CENTRA
:   contrast-enhanced timing-robust angiography
SENSE
:   sensitivity encoding" />
<meta name="DC.Contributor" content="S. Soize" />
<meta name="DC.Contributor" content="F. Bouquigny" />
<meta name="DC.Contributor" content="K. Kadziolka" />
<meta name="DC.Contributor" content="C. Portefaix" />
<meta name="DC.Contributor" content="L. Pierot" />
<meta name="article:published_time" content="2014-10-01" />
<meta name="article:section" content="Brain" />
<meta name="citation_title" content="Value of 4D MR Angiography at 3T Compared with DSA for the Follow-Up of Treated Brain Arteriovenous Malformation" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Four-dimensional, contrast-enhanced MRA is a useful technique for the diagnosis and classification of brain AVM. The purpose of this study was to evaluate its usefulness in the follow-up of treated brain AVM.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Patients with treated brain AVM (embolization, radiosurgery, and/or surgery) were investigated with both DSA (the “gold standard”) and 4D MRA. Four-dimensional MRA was performed at 3T using a 4D sequence, combining contrast-enhanced timing-robust angiography, keyhole, and sensitivity encoding techniques. Examinations were evaluated by 2 independent readers and disagreements were resolved by a third reader. Interobserver and intermodality agreement with respect to residual nidus, residual venous drainage, and brain AVM patency were determined.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Between May 2008 and February 2013, 37 patients with a median age of 45 years (interquartile range = 26–55) were prospectively included. Examinations were acquired 36 months (IQR = 10–45.5) after the last treatment. Interobserver agreement for brain AVM patency was very good for both 4D MRA (κ 0.82, 95% CI .67–.98) and DSA (κ 0.84, 95% CI .69–.98). After consensus reading, intermodality agreement for the evaluation of brain AVM patency was good (κ 0.73, 95% CI .55–.90). Diagnostic accuracy of 4D MRA for residual brain AVM compared with DSA, reached a sensitivity of 73.7%, specificity 100%, positive predictive value 100%, and negative predictive value 78.3%. Agreements by technique of treatment are also detailed.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Four-dimensional MRA is a useful radiation-free technique for the follow-up of patients with treated brain AVM, especially patients treated by radiosurgery. However, given its actual limitations it is not sufficient to assert the cure; DSA remains mandatory for this purpose.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="twitter:title" content="Value of 4D MR Angiography at 3T Compared with DSA for the Follow-Up of Treated Brain Arteriovenous Malformation" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Four-dimensional, contrast-enhanced MRA is a useful technique for the diagnosis and classification of brain AVM. The purpose of this study was to evaluate its usefulness in the follow-up of treated brain AVM.

MATERIALS AND METHODS: Patients with treated brain AVM (embolization, radiosurgery, and/or surgery) were investigated with both DSA (the “gold standard”) and 4D MRA. Four-dimensional MRA was performed at 3T using a 4D sequence, combining contrast-enhanced timing-robust angiography, keyhole, and sensitivity encoding techniques. Examinations were evaluated by 2 independent readers and disagreements were resolved by a third reader. Interobserver and intermodality agreement with respect to residual nidus, residual venous drainage, and brain AVM patency were determined.

RESULTS: Between May 2008 and February 2013, 37 patients with a median age of 45 years (interquartile range = 26–55) were prospectively included. Examinations were acquired 36 months (IQR = 10–45.5) after the last treatment. Interobserver agreement for brain AVM patency was very good for both 4D MRA (κ 0.82, 95% CI .67–.98) and DSA (κ 0.84, 95% CI .69–.98). After consensus reading, intermodality agreement for the evaluation of brain AVM patency was good (κ 0.73, 95% CI .55–.90). Diagnostic accuracy of 4D MRA for residual brain AVM compared with DSA, reached a sensitivity of 73.7%, specificity 100%, positive predictive value 100%, and negative predictive value 78.3%. Agreements by technique of treatment are also detailed.

CONCLUSIONS: Four-dimensional MRA is a useful radiation-free technique for the follow-up of patients with treated brain AVM, especially patients treated by radiosurgery. However, given its actual limitations it is not sufficient to assert the cure; DSA remains mandatory for this purpose.

4D-MRA
:   4D contrast-enhanced MRA
bAVM
:   brain AVM
CENTRA
:   contrast-enhanced timing-robust angiography
SENSE
:   sensitivity encoding" />
<meta name="og-title" property="og:title" content="Value of 4D MR Angiography at 3T Compared with DSA for the Follow-Up of Treated Brain Arteriovenous Malformation" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/35/10/1903" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Four-dimensional, contrast-enhanced MRA is a useful technique for the diagnosis and classification of brain AVM. The purpose of this study was to evaluate its usefulness in the follow-up of treated brain AVM.

MATERIALS AND METHODS: Patients with treated brain AVM (embolization, radiosurgery, and/or surgery) were investigated with both DSA (the “gold standard”) and 4D MRA. Four-dimensional MRA was performed at 3T using a 4D sequence, combining contrast-enhanced timing-robust angiography, keyhole, and sensitivity encoding techniques. Examinations were evaluated by 2 independent readers and disagreements were resolved by a third reader. Interobserver and intermodality agreement with respect to residual nidus, residual venous drainage, and brain AVM patency were determined.

RESULTS: Between May 2008 and February 2013, 37 patients with a median age of 45 years (interquartile range = 26–55) were prospectively included. Examinations were acquired 36 months (IQR = 10–45.5) after the last treatment. Interobserver agreement for brain AVM patency was very good for both 4D MRA (κ 0.82, 95% CI .67–.98) and DSA (κ 0.84, 95% CI .69–.98). After consensus reading, intermodality agreement for the evaluation of brain AVM patency was good (κ 0.73, 95% CI .55–.90). Diagnostic accuracy of 4D MRA for residual brain AVM compared with DSA, reached a sensitivity of 73.7%, specificity 100%, positive predictive value 100%, and negative predictive value 78.3%. Agreements by technique of treatment are also detailed.

CONCLUSIONS: Four-dimensional MRA is a useful radiation-free technique for the follow-up of patients with treated brain AVM, especially patients treated by radiosurgery. However, given its actual limitations it is not sufficient to assert the cure; DSA remains mandatory for this purpose.

4D-MRA
:   4D contrast-enhanced MRA
bAVM
:   brain AVM
CENTRA
:   contrast-enhanced timing-robust angiography
SENSE
:   sensitivity encoding" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node13756--5" data-node-nid="13756" id="top-node-13756--6464257624" data-pisa="ajnr;35/10/1903" data-pisa-master="ajnr;ajnr.A3982" data-apath="/ajnr/35/10/1903.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Brain</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Value of 4D MR Angiography at 3T Compared with DSA for the Follow-Up of Treated Brain Arteriovenous Malformation</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">S. Soize</span>, <span class="highwire-citation-author" data-delta="1">F. Bouquigny</span>, <span class="highwire-citation-author" data-delta="2">K. Kadziolka</span>, <span class="highwire-citation-author" data-delta="3">C. Portefaix</span> and <span class="highwire-citation-author" data-delta="4">L. Pierot</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">October 2014,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">35 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1903-1909; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3982 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-13756--6464257624" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">S. Soize </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France.</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=S.%2BSoize%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=Soize%20S&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%3AS.%2BSoize%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">F. Bouquigny </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France.</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=F.%2BBouquigny%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=Bouquigny%20F&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%3AF.%2BBouquigny%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">K. Kadziolka </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France.</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=K.%2BKadziolka%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=Kadziolka%20K&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%3AK.%2BKadziolka%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">C. Portefaix </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France.</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=C.%2BPortefaix%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=Portefaix%20C&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%3AC.%2BPortefaix%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">L. Pierot </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France.</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=L.%2BPierot%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=Pierot%20L&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%3AL.%2BPierot%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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<p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> Four-dimensional, contrast-enhanced MRA is a useful technique for the diagnosis and classification of brain AVM. The purpose of this study was to evaluate its usefulness in the follow-up of treated brain AVM.</p>
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<p id="p-2"><strong>MATERIALS AND METHODS:</strong> Patients with treated brain AVM (embolization, radiosurgery, and/or surgery) were investigated with both DSA (the “gold standard”) and 4D MRA. Four-dimensional MRA was performed at 3T using a 4D sequence, combining contrast-enhanced timing-robust angiography, keyhole, and sensitivity encoding techniques. Examinations were evaluated by 2 independent readers and disagreements were resolved by a third reader. Interobserver and intermodality agreement with respect to residual nidus, residual venous drainage, and brain AVM patency were determined.</p>
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<p id="p-3"><strong>RESULTS:</strong> Between May 2008 and February 2013, 37 patients with a median age of 45 years (interquartile range = 26–55) were prospectively included. Examinations were acquired 36 months (IQR = 10–45.5) after the last treatment. Interobserver agreement for brain AVM patency was very good for both 4D MRA (κ 0.82, 95% CI .67–.98) and DSA (κ 0.84, 95% CI .69–.98). After consensus reading, intermodality agreement for the evaluation of brain AVM patency was good (κ 0.73, 95% CI .55–.90). Diagnostic accuracy of 4D MRA for residual brain AVM compared with DSA, reached a sensitivity of 73.7%, specificity 100%, positive predictive value 100%, and negative predictive value 78.3%. Agreements by technique of treatment are also detailed.</p>
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<p id="p-4"><strong>CONCLUSIONS:</strong> Four-dimensional MRA is a useful radiation-free technique for the follow-up of patients with treated brain AVM, especially patients treated by radiosurgery. However, given its actual limitations it is not sufficient to assert the cure; DSA remains mandatory for this purpose.</p>
</div></div><div class="section glossary" id="glossary-1">
<h2>ABBREVIATIONS:</h2>
<dl id="def-list-1"><dt id="def-item-1">4D-MRA<span class="def-item-dt-sep"></span></dt><dd>4D contrast-enhanced MRA<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">bAVM<span class="def-item-dt-sep"></span></dt><dd>brain AVM<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">CENTRA<span class="def-item-dt-sep"></span></dt><dd>contrast-enhanced timing-robust angiography<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">SENSE<span class="def-item-dt-sep"></span></dt><dd>sensitivity encoding</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2014 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/35/10/1903.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">Value of 4D MR Angiography at 3T Compared with DSA for the Follow-Up of Treated Brain Arteriovenous Malformation</div>  
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