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AJNR - American Journal of Neuroradiology

Published ahead of print on March 13, 2008
doi: 10.3174/ajnr.A0947

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American Journal of Neuroradiology 29:1024-1031, May 2008
© 2008 American Society of Neuroradiology

SPINE

Assessment of Craniospinal Arteriovenous Malformations at 3T with Highly Temporally and Highly Spatially Resolved Contrast-Enhanced MR Angiography

R.S. Saleh^a, D.G. Lohan^a, J.P. Villablanca^b, G. Duckwiler^c, S.T. Kee^d and J.P. Finn^a

^a Division of Diagnostic Cardiovascular Imaging, Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, Calif
^b Division of Neuroradiology, Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, Calif
^c Division of Neuro-Interventional Radiology, Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, Calif
^d Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, Calif

Please address correspondence to Roya S. Saleh, MD, University of California Los Angeles, Division of Diagnostic Cardiovascular Imaging, Magnetic Resonance Research Center, Peter V. Ueberroth Bldg, Suite 3371, 10945 Le Conte Ave, Los Angeles, CA 90095-7206; e-mail: rsaleh{at}mednet.ucla.edu

BACKGROUND AND PURPOSE: Patients with arteriovenous malformation (AVM) are known to have an elevated risk of complications with conventional catheter angiography (CCA) but nonetheless require monitoring of hemodynamics. Thus, we aimed to evaluate both anatomy and hemodynamics in patients with AVM noninvasively by using contrast-enhanced MR angiography (CE-MRA) at 3T and to compare the results with CCA.

MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained for this Health Insurance Portability and Accountability Act–compliant study. Twenty control subjects without vascular malformation (6 men, 18–70 years of age) and 10 patients with AVMs (6 men, 20–74 years of age) underwent supra-aortic time-resolved and high-spatial-resolution CE-MRA at 3T. Large-field-of-view coronal acquisitions extending from the root of the aorta to the cranial vertex were obtained for both MRA techniques. Image quality was assessed by 2 specialized radiologists by using a 4-point scale. AVM characteristics and nidus size were evaluated by using both CE-MRA and CCA in all patients.

RESULTS: In patients, 96.6% (319/330) of arterial segments on high-spatial-resolution MRA and 87.7% (272/310) of arterial segments on time-resolved MRA were graded excellent/good. MRA showed 100% specificity for detecting feeding arteries and venous drainage (n = 8) and complete obliteration of the AVM in 2 cases (concordance with CCA). Nidus diameters measured by both MRA and CCA resulted in a very strong correlation (r = 0.99) with a mild overestimation by MRA (0.10 cm by using the Bland-Altman plot).

CONCLUSION: By combining highly temporally resolved and highly spatially resolved MRA at 3T as complementary studies, one can assess vascular anatomy and hemodynamics noninvasively in patients with AVM.