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<meta name="HW.identifier" content="/ajnr/early/2024/11/07/ajnr.A8420.atom" />
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<meta name="DC.Title" content="Diagnostic Performance of TOF, 4D MRA, Arterial Spin-Labeling, and Susceptibility-Weighted Angiography Sequences in the Post-Radiosurgery Monitoring of Brain AVMs" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8420" />
<meta name="DC.Date" content="2024-11-07" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND: Brain AVMs are congenital anomalies of the cerebrovascular system, often discovered incidentally or through symptomatic presentations such as intracranial hemorrhage, seizure, headache, or neurologic deficits. Various treatment modalities exist for AVMs, including radiosurgery, a treatment technique that is noninvasive and efficient. Accurate imaging is crucial for risk assessment, treatment planning, and monitoring of these patients before and after radiosurgery.

PURPOSE: Currently, DSA is the preferred imaging technique. Despite its efficacy, DSA is notably invasive, presenting inherent risks to the patients. This systematic review and meta-analysis aimed to evaluate the efficacy of MRI sequences for monitoring brain AVMs after radiosurgery.

DATA SOURCE: We performed a comprehensive search of PubMed, Scopus, Web of Science, and EMBASE databases and a methodologic quality assessment with the QUADAS-2 checklist diagnostic test accuracy.

STUDY SELECTION: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 3,220 abstracts were screened, 98 articles were reviewed in full text, and 14 articles met the inclusion criteria.

DATA ANALYSIS: We used the bivariate random-effects meta-analysis model with STATA/MP 17 software for data analysis.

DATA SYNTHESIS: No publication bias was detected. Fourteen studies were eligible for qualitative and quantitative analysis. MRI offers high sensitivity (85%) and specificity (99%) in detecting residual AVMs. Different MRI sequences, including 3D TOF-MRA, 4D MRA, and arterial spin-labeling (ASL) demonstrated varying diagnostic accuracies with areas under the curve of 0.92, 0.97, and 0.96, respectively. 4D MRA had a sensitivity of 72% and specificity of 99%, ASL showed a sensitivity of 90% and specificity of 92%, while 3D TOF-MRA had 90% sensitivity and 87% specificity.

LIMITATIONS: Meta-regression did not fully explain the sources of heterogeneity. Only 1 study assessed the susceptibility-weighted angiography (SWAN) method, and most studies involved small participant groups with varied MR techniques and sequences. Additionally, the retrospective nature of most studies may introduce bias, warranting cautious interpretation of the results.

CONCLUSIONS: MRI sequences show acceptable diagnostic performance in postradiosurgery monitoring of brain AVMs, with ASL and 4D MRA showing acceptable diagnostic accuracy. Combining different MRI sequences may further enhance diagnostic reliability. However, further investigation is needed to assess whether MRI sequences can serve as a feasible substitute for DSA, considering their risk-benefit profile, with the potential to establish them as the recommended standard.

AUC
:   area under the curve
ASL
:   arterial spin-labeling
DOR
:   diagnostic OR
SROC
:   summary receiver operating characteristic
SWAN
:   susceptibility-weighted angiography" />
<meta name="DC.Contributor" content="Shahriar Kolahi" />
<meta name="DC.Contributor" content="Mohammadreza Tahamtan" />
<meta name="DC.Contributor" content="Masoumeh Sarvari" />
<meta name="DC.Contributor" content="Diana Zarei" />
<meta name="DC.Contributor" content="Mahshad Afsharzadeh" />
<meta name="DC.Contributor" content="Kavous Firouznia" />
<meta name="DC.Contributor" content="David M. Yousem" />
<meta name="article:published_time" content="2024-11-07" />
<meta name="article:section" content="NEUROVASCULAR/STROKE IMAGING" />
<meta name="citation_title" content="Diagnostic Performance of TOF, 4D MRA, Arterial Spin-Labeling, and Susceptibility-Weighted Angiography Sequences in the Post-Radiosurgery Monitoring of Brain AVMs" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND:&lt;/h3&gt;
&lt;p&gt;Brain AVMs are congenital anomalies of the cerebrovascular system, often discovered incidentally or through symptomatic presentations such as intracranial hemorrhage, seizure, headache, or neurologic deficits. Various treatment modalities exist for AVMs, including radiosurgery, a treatment technique that is noninvasive and efficient. Accurate imaging is crucial for risk assessment, treatment planning, and monitoring of these patients before and after radiosurgery.&lt;/p&gt;&lt;h3&gt;PURPOSE:&lt;/h3&gt;
&lt;p&gt;Currently, DSA is the preferred imaging technique. Despite its efficacy, DSA is notably invasive, presenting inherent risks to the patients. This systematic review and meta-analysis aimed to evaluate the efficacy of MRI sequences for monitoring brain AVMs after radiosurgery.&lt;/p&gt;&lt;h3&gt;DATA SOURCE:&lt;/h3&gt;
&lt;p&gt;We performed a comprehensive search of PubMed, Scopus, Web of Science, and EMBASE databases and a methodologic quality assessment with the QUADAS-2 checklist diagnostic test accuracy.&lt;/p&gt;&lt;h3&gt;STUDY SELECTION:&lt;/h3&gt;
&lt;p&gt;According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 3,220 abstracts were screened, 98 articles were reviewed in full text, and 14 articles met the inclusion criteria.&lt;/p&gt;&lt;h3&gt;DATA ANALYSIS:&lt;/h3&gt;
&lt;p&gt;We used the bivariate random-effects meta-analysis model with STATA/MP 17 software for data analysis.&lt;/p&gt;&lt;h3&gt;DATA SYNTHESIS:&lt;/h3&gt;
&lt;p&gt;No publication bias was detected. Fourteen studies were eligible for qualitative and quantitative analysis. MRI offers high sensitivity (85%) and specificity (99%) in detecting residual AVMs. Different MRI sequences, including 3D TOF-MRA, 4D MRA, and arterial spin-labeling (ASL) demonstrated varying diagnostic accuracies with areas under the curve of 0.92, 0.97, and 0.96, respectively. 4D MRA had a sensitivity of 72% and specificity of 99%, ASL showed a sensitivity of 90% and specificity of 92%, while 3D TOF-MRA had 90% sensitivity and 87% specificity.&lt;/p&gt;&lt;h3&gt;LIMITATIONS:&lt;/h3&gt;
&lt;p&gt;Meta-regression did not fully explain the sources of heterogeneity. Only 1 study assessed the susceptibility-weighted angiography (SWAN) method, and most studies involved small participant groups with varied MR techniques and sequences. Additionally, the retrospective nature of most studies may introduce bias, warranting cautious interpretation of the results.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;MRI sequences show acceptable diagnostic performance in postradiosurgery monitoring of brain AVMs, with ASL and 4D MRA showing acceptable diagnostic accuracy. Combining different MRI sequences may further enhance diagnostic reliability. However, further investigation is needed to assess whether MRI sequences can serve as a feasible substitute for DSA, considering their risk-benefit profile, with the potential to establish them as the recommended standard.&lt;/p&gt;" />
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<meta name="twitter:title" content="Diagnostic Performance of TOF, 4D MRA, Arterial Spin-Labeling, and Susceptibility-Weighted Angiography Sequences in the Post-Radiosurgery Monitoring of Brain AVMs" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND: Brain AVMs are congenital anomalies of the cerebrovascular system, often discovered incidentally or through symptomatic presentations such as intracranial hemorrhage, seizure, headache, or neurologic deficits. Various treatment modalities exist for AVMs, including radiosurgery, a treatment technique that is noninvasive and efficient. Accurate imaging is crucial for risk assessment, treatment planning, and monitoring of these patients before and after radiosurgery.

PURPOSE: Currently, DSA is the preferred imaging technique. Despite its efficacy, DSA is notably invasive, presenting inherent risks to the patients. This systematic review and meta-analysis aimed to evaluate the efficacy of MRI sequences for monitoring brain AVMs after radiosurgery.

DATA SOURCE: We performed a comprehensive search of PubMed, Scopus, Web of Science, and EMBASE databases and a methodologic quality assessment with the QUADAS-2 checklist diagnostic test accuracy.

STUDY SELECTION: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 3,220 abstracts were screened, 98 articles were reviewed in full text, and 14 articles met the inclusion criteria.

DATA ANALYSIS: We used the bivariate random-effects meta-analysis model with STATA/MP 17 software for data analysis.

DATA SYNTHESIS: No publication bias was detected. Fourteen studies were eligible for qualitative and quantitative analysis. MRI offers high sensitivity (85%) and specificity (99%) in detecting residual AVMs. Different MRI sequences, including 3D TOF-MRA, 4D MRA, and arterial spin-labeling (ASL) demonstrated varying diagnostic accuracies with areas under the curve of 0.92, 0.97, and 0.96, respectively. 4D MRA had a sensitivity of 72% and specificity of 99%, ASL showed a sensitivity of 90% and specificity of 92%, while 3D TOF-MRA had 90% sensitivity and 87% specificity.

LIMITATIONS: Meta-regression did not fully explain the sources of heterogeneity. Only 1 study assessed the susceptibility-weighted angiography (SWAN) method, and most studies involved small participant groups with varied MR techniques and sequences. Additionally, the retrospective nature of most studies may introduce bias, warranting cautious interpretation of the results.

CONCLUSIONS: MRI sequences show acceptable diagnostic performance in postradiosurgery monitoring of brain AVMs, with ASL and 4D MRA showing acceptable diagnostic accuracy. Combining different MRI sequences may further enhance diagnostic reliability. However, further investigation is needed to assess whether MRI sequences can serve as a feasible substitute for DSA, considering their risk-benefit profile, with the potential to establish them as the recommended standard.

AUC
:   area under the curve
ASL
:   arterial spin-labeling
DOR
:   diagnostic OR
SROC
:   summary receiver operating characteristic
SWAN
:   susceptibility-weighted angiography" />
<meta name="og-title" property="og:title" content="Diagnostic Performance of TOF, 4D MRA, Arterial Spin-Labeling, and Susceptibility-Weighted Angiography Sequences in the Post-Radiosurgery Monitoring of Brain AVMs" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/11/07/ajnr.A8420" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND: Brain AVMs are congenital anomalies of the cerebrovascular system, often discovered incidentally or through symptomatic presentations such as intracranial hemorrhage, seizure, headache, or neurologic deficits. Various treatment modalities exist for AVMs, including radiosurgery, a treatment technique that is noninvasive and efficient. Accurate imaging is crucial for risk assessment, treatment planning, and monitoring of these patients before and after radiosurgery.

PURPOSE: Currently, DSA is the preferred imaging technique. Despite its efficacy, DSA is notably invasive, presenting inherent risks to the patients. This systematic review and meta-analysis aimed to evaluate the efficacy of MRI sequences for monitoring brain AVMs after radiosurgery.

DATA SOURCE: We performed a comprehensive search of PubMed, Scopus, Web of Science, and EMBASE databases and a methodologic quality assessment with the QUADAS-2 checklist diagnostic test accuracy.

STUDY SELECTION: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 3,220 abstracts were screened, 98 articles were reviewed in full text, and 14 articles met the inclusion criteria.

DATA ANALYSIS: We used the bivariate random-effects meta-analysis model with STATA/MP 17 software for data analysis.

DATA SYNTHESIS: No publication bias was detected. Fourteen studies were eligible for qualitative and quantitative analysis. MRI offers high sensitivity (85%) and specificity (99%) in detecting residual AVMs. Different MRI sequences, including 3D TOF-MRA, 4D MRA, and arterial spin-labeling (ASL) demonstrated varying diagnostic accuracies with areas under the curve of 0.92, 0.97, and 0.96, respectively. 4D MRA had a sensitivity of 72% and specificity of 99%, ASL showed a sensitivity of 90% and specificity of 92%, while 3D TOF-MRA had 90% sensitivity and 87% specificity.

LIMITATIONS: Meta-regression did not fully explain the sources of heterogeneity. Only 1 study assessed the susceptibility-weighted angiography (SWAN) method, and most studies involved small participant groups with varied MR techniques and sequences. Additionally, the retrospective nature of most studies may introduce bias, warranting cautious interpretation of the results.

CONCLUSIONS: MRI sequences show acceptable diagnostic performance in postradiosurgery monitoring of brain AVMs, with ASL and 4D MRA showing acceptable diagnostic accuracy. Combining different MRI sequences may further enhance diagnostic reliability. However, further investigation is needed to assess whether MRI sequences can serve as a feasible substitute for DSA, considering their risk-benefit profile, with the potential to establish them as the recommended standard.

AUC
:   area under the curve
ASL
:   arterial spin-labeling
DOR
:   diagnostic OR
SROC
:   summary receiver operating characteristic
SWAN
:   susceptibility-weighted angiography" />
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      <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">NEUROVASCULAR/STROKE IMAGING</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Diagnostic Performance of TOF, 4D MRA, Arterial Spin-Labeling, and Susceptibility-Weighted Angiography Sequences in the Post-Radiosurgery Monitoring of Brain AVMs</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Shahriar Kolahi</span>, <span class="highwire-citation-author" data-delta="1">Mohammadreza Tahamtan</span>, <span class="highwire-citation-author" data-delta="2">Masoumeh Sarvari</span>, <span class="highwire-citation-author" data-delta="3">Diana Zarei</span>, <span class="highwire-citation-author" data-delta="4">Mahshad Afsharzadeh</span>, <span class="highwire-citation-author" data-delta="5">Kavous Firouznia</span> and <span class="highwire-citation-author" data-delta="6">David M. Yousem</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">November 2024,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8420 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-111774--21588002627" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Shahriar Kolahi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Advanced Diagnostic and Interventional Radiology Research Center (S.K., M.T., M.S., D.Z., M.A., K.F.), Department of Radiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran</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=Shahriar%2BKolahi%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=Kolahi%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" 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</div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Advanced Diagnostic and Interventional Radiology Research Center (S.K., M.T., M.S., D.Z., M.A., K.F.), Department of Radiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Endocrinology and Metabolism Research Center (M.S.), Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran</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=Masoumeh%2BSarvari%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 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href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Diana%2BZarei%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=Zarei%20D&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"><a href="/search/author1%3ADiana%2BZarei%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-5468-9235" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Diana Zarei</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Mahshad Afsharzadeh </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Advanced Diagnostic and Interventional Radiology Research Center (S.K., M.T., M.S., D.Z., M.A., K.F.), Department of Radiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Isfahan Neurosciences Research Center (M.A.), Isfahan University of Medical Sciences, Isfahan, Iran</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=Mahshad%2BAfsharzadeh%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=Afsharzadeh%20M&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"><a href="/search/author1%3AMahshad%2BAfsharzadeh%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-6101-5431" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Mahshad Afsharzadeh</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">Kavous Firouznia </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Advanced Diagnostic and Interventional Radiology Research Center (S.K., M.T., M.S., D.Z., M.A., K.F.), Department of Radiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran</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=Kavous%2BFirouznia%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=Firouznia%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"><a href="/search/author1%3AKavous%2BFirouznia%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9201-8173" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Kavous Firouznia</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">David M. Yousem </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Office of Faculty (D.M.Y.), Johns Hopkins University School of Medicine, Baltimore, Maryland</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Radiology (D.M.Y.), Johns Hopkins University School of Medicine (JHUSOM), Baltimore, Maryland</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=David%2BM.%2BYousem%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=Yousem%20DM&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"><a href="/search/author1%3ADavid%2BM.%2BYousem%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-1222-6643" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for David M. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-1"><strong>BACKGROUND:</strong> Brain AVMs are congenital anomalies of the cerebrovascular system, often discovered incidentally or through symptomatic presentations such as intracranial hemorrhage, seizure, headache, or neurologic deficits. Various treatment modalities exist for AVMs, including radiosurgery, a treatment technique that is noninvasive and efficient. Accurate imaging is crucial for risk assessment, treatment planning, and monitoring of these patients before and after radiosurgery.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>PURPOSE:</strong> Currently, DSA is the preferred imaging technique. Despite its efficacy, DSA is notably invasive, presenting inherent risks to the patients. This systematic review and meta-analysis aimed to evaluate the efficacy of MRI sequences for monitoring brain AVMs after radiosurgery.</p></div><div id="sec-3" class="subsection"><p id="p-3"><strong>DATA SOURCE:</strong> We performed a comprehensive search of PubMed, Scopus, Web of Science, and EMBASE databases and a methodologic quality assessment with the QUADAS-2 checklist diagnostic test accuracy.</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>STUDY SELECTION:</strong> According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 3,220 abstracts were screened, 98 articles were reviewed in full text, and 14 articles met the inclusion criteria.</p></div><div id="sec-5" class="subsection"><p id="p-5"><strong>DATA ANALYSIS:</strong> We used the bivariate random-effects meta-analysis model with STATA/MP 17 software for data analysis.</p></div><div id="sec-6" class="subsection"><p id="p-6"><strong>DATA SYNTHESIS:</strong> No publication bias was detected. Fourteen studies were eligible for qualitative and quantitative analysis. MRI offers high sensitivity (85%) and specificity (99%) in detecting residual AVMs. Different MRI sequences, including 3D TOF-MRA, 4D MRA, and arterial spin-labeling (ASL) demonstrated varying diagnostic accuracies with areas under the curve of 0.92, 0.97, and 0.96, respectively. 4D MRA had a sensitivity of 72% and specificity of 99%, ASL showed a sensitivity of 90% and specificity of 92%, while 3D TOF-MRA had 90% sensitivity and 87% specificity.</p></div><div id="sec-7" class="subsection"><p id="p-7"><strong>LIMITATIONS:</strong> Meta-regression did not fully explain the sources of heterogeneity. Only 1 study assessed the susceptibility-weighted angiography (SWAN) method, and most studies involved small participant groups with varied MR techniques and sequences. Additionally, the retrospective nature of most studies may introduce bias, warranting cautious interpretation of the results.</p></div><div id="sec-8" class="subsection"><p id="p-8"><strong>CONCLUSIONS:</strong> MRI sequences show acceptable diagnostic performance in postradiosurgery monitoring of brain AVMs, with ASL and 4D MRA showing acceptable diagnostic accuracy. Combining different MRI sequences may further enhance diagnostic reliability. However, further investigation is needed to assess whether MRI sequences can serve as a feasible substitute for DSA, considering their risk-benefit profile, with the potential to establish them as the recommended standard.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">AUC<span class="def-item-dt-sep"></span></dt><dd>area under the curve<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">ASL<span class="def-item-dt-sep"></span></dt><dd>arterial spin-labeling<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">DOR<span class="def-item-dt-sep"></span></dt><dd>diagnostic OR<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">SROC<span class="def-item-dt-sep"></span></dt><dd>summary receiver operating characteristic<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">SWAN<span class="def-item-dt-sep"></span></dt><dd>susceptibility-weighted angiography</dd></dl></div><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-equal" id="fn-2"><p id="p-58">Shahriar Kolahi, and Mohammadreza Tahamtan contributed equally to this manuscript.</p></li><li class="fn-financial-disclosure" id="fn-3"><p id="p-59"><a href="https://www.ajnr.org/sites/default/files/additional-assets/Disclosures/January%202025/0472.pdf">Disclosure forms</a> provided by the authors are available with the full text and PDF of this article at <a href="http://www.ajnr.org">www.ajnr.org</a>.</p></li></ul></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2025 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/early/2024/11/07/ajnr.A8420.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-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Nov 2024, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8420 </span></div>
  
  
  
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