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Assessment of 4D MR Angiography at 3T Compared with DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: A Dual-Center Study.
AJNR Am J Neuroradiol. 2021 01; 42(2):340-346.AA

Abstract

BACKGROUND AND PURPOSE

4D contrast-enhanced MRA in the follow-up of treated dural arteriovenous fistulas has rarely been evaluated. Our aim was to evaluate its diagnostic performance at 3T in the follow-up of embolized dural arteriovenous fistulas using DSA as the standard of reference.

MATERIALS AND METHODS

Patients treated for dural arteriovenous fistulas in 2 centers between 2008 and 2019 were included if they met the following criteria: 1) dural arteriovenous fistula embolization, and 2) follow-up imaging with <6 months between DSA and 4D contrast-enhanced MRA. Two readers reviewed the 4D contrast-enhanced MRA images, first independently, then in consensus to detect any residual/recurrent dural arteriovenous fistula and to grade cases according to the Cognard classification system. Interobserver and intermodality agreement for the detection of a residual dural arteriovenous fistula and stratification of bleeding risk (0-I-IIa; IIb-IIa+b-III-IV-V) was calculated using κ coefficients.

RESULTS

A total of 51 pairs of examinations for 44 patients (median age, 65 years; range, 25-81 years) were analyzed. Interobserver agreement for the detection and stratification of bleeding risk was, respectively, κ = 0.8 (95% CI, 0.6-1) and κ = 0.8 (95% CI, 0.5-1). After consensus review, the sensitivity and specificity of 4D contrast-enhanced MRA for the detection of residual/recurrent dural arteriovenous fistula was 63.6% (95% CI, 40.7%-82.8%) and 96.6% (95% CI, 82.2%-99.9%), respectively. The positive and negative predictive values of 4D contrast-enhanced MRA were 93.3% (95% CI, 68.1%-99.8%) and 77.8% (95% CI, 60.8%-89.9%). Intermodality agreement for the detection and stratification of bleeding risk was good, with κ = 0.60 (95% CI, 0.3-0.8).

CONCLUSIONS

4D contrast-enhanced MRA at 3T is of interest in the follow-up of treated dural arteriovenous fistulas but lacks the sensitivity to replace arteriography.

Authors+Show Affiliations

From the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France brieg.dissaux@chu-brest.fr. Department of Medical Imaging (B.D., J.O., J.-C.G.), Centre Hospitalier Universitaire La Cavale Blanche, Brest, France. GETBO group EA3878 (B.D., J.-C.G.), Université de Bretagne Occidentale, Brest, France.From the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France.Department of Medical Imaging (B.D., J.O., J.-C.G.), Centre Hospitalier Universitaire La Cavale Blanche, Brest, France. LATIM U1101 (J.O.), INSERM, Université de Bretagne Occidentale, Brest, France.From the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France. Empenn Unit U1228 (J.-Y.G., J.-C.F.), INSERM, INRIA, Université Rennes 1, Rennes, France.Department of Medical Imaging (B.D., J.O., J.-C.G.), Centre Hospitalier Universitaire La Cavale Blanche, Brest, France. GETBO group EA3878 (B.D., J.-C.G.), Université de Bretagne Occidentale, Brest, France.From the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France. Empenn Unit U1228 (J.-Y.G., J.-C.F.), INSERM, INRIA, Université Rennes 1, Rennes, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33334853

Citation

Dissaux, B, et al. "Assessment of 4D MR Angiography at 3T Compared With DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: a Dual-Center Study." AJNR. American Journal of Neuroradiology, vol. 42, no. 2, 2021, pp. 340-346.
Dissaux B, Eugène F, Ognard J, et al. Assessment of 4D MR Angiography at 3T Compared with DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: A Dual-Center Study. AJNR Am J Neuroradiol. 2021;42(2):340-346.
Dissaux, B., Eugène, F., Ognard, J., Gauvrit, J. Y., Gentric, J. C., & Ferré, J. C. (2021). Assessment of 4D MR Angiography at 3T Compared with DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: A Dual-Center Study. AJNR. American Journal of Neuroradiology, 42(2), 340-346. https://doi.org/10.3174/ajnr.A6903
Dissaux B, et al. Assessment of 4D MR Angiography at 3T Compared With DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: a Dual-Center Study. AJNR Am J Neuroradiol. 2021;42(2):340-346. PubMed PMID: 33334853.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of 4D MR Angiography at 3T Compared with DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: A Dual-Center Study. AU - Dissaux,B, AU - Eugène,F, AU - Ognard,J, AU - Gauvrit,J-Y, AU - Gentric,J-C, AU - Ferré,J-C, Y1 - 2020/12/17/ PY - 2020/03/19/received PY - 2020/09/27/accepted PY - 2020/12/19/pubmed PY - 2021/4/27/medline PY - 2020/12/18/entrez SP - 340 EP - 346 JF - AJNR. American journal of neuroradiology JO - AJNR Am J Neuroradiol VL - 42 IS - 2 N2 - BACKGROUND AND PURPOSE: 4D contrast-enhanced MRA in the follow-up of treated dural arteriovenous fistulas has rarely been evaluated. Our aim was to evaluate its diagnostic performance at 3T in the follow-up of embolized dural arteriovenous fistulas using DSA as the standard of reference. MATERIALS AND METHODS: Patients treated for dural arteriovenous fistulas in 2 centers between 2008 and 2019 were included if they met the following criteria: 1) dural arteriovenous fistula embolization, and 2) follow-up imaging with <6 months between DSA and 4D contrast-enhanced MRA. Two readers reviewed the 4D contrast-enhanced MRA images, first independently, then in consensus to detect any residual/recurrent dural arteriovenous fistula and to grade cases according to the Cognard classification system. Interobserver and intermodality agreement for the detection of a residual dural arteriovenous fistula and stratification of bleeding risk (0-I-IIa; IIb-IIa+b-III-IV-V) was calculated using κ coefficients. RESULTS: A total of 51 pairs of examinations for 44 patients (median age, 65 years; range, 25-81 years) were analyzed. Interobserver agreement for the detection and stratification of bleeding risk was, respectively, κ = 0.8 (95% CI, 0.6-1) and κ = 0.8 (95% CI, 0.5-1). After consensus review, the sensitivity and specificity of 4D contrast-enhanced MRA for the detection of residual/recurrent dural arteriovenous fistula was 63.6% (95% CI, 40.7%-82.8%) and 96.6% (95% CI, 82.2%-99.9%), respectively. The positive and negative predictive values of 4D contrast-enhanced MRA were 93.3% (95% CI, 68.1%-99.8%) and 77.8% (95% CI, 60.8%-89.9%). Intermodality agreement for the detection and stratification of bleeding risk was good, with κ = 0.60 (95% CI, 0.3-0.8). CONCLUSIONS: 4D contrast-enhanced MRA at 3T is of interest in the follow-up of treated dural arteriovenous fistulas but lacks the sensitivity to replace arteriography. SN - 1936-959X UR - https://www.unboundmedicine.com/medline/citation/33334853/Assessment_of_4D_MR_Angiography_at_3T_Compared_with_DSA_for_the_Follow_up_of_Embolized_Brain_Dural_Arteriovenous_Fistula:_A_Dual_Center_Study_ L2 - http://www.ajnr.org/cgi/pmidlookup?view=long&amp;pmid=33334853 DB - PRIME DP - Unbound Medicine ER -