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Research ArticleINTERVENTIONAL

Assessment of 4D MR Angiography at 3T Compared with DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: A Dual-Center Study

B. Dissaux, F. Eugène, J. Ognard, J.-Y. Gauvrit, J.-C. Gentric and J.-C. Ferré
American Journal of Neuroradiology December 2020, DOI: https://doi.org/10.3174/ajnr.A6903
B. Dissaux
aFrom the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France
bDepartment of Medical Imaging (B.D., J.O., J.-C.G.), Centre Hospitalier Universitaire La Cavale Blanche, Brest, France
cGETBO group EA3878 (B.D., J.-C.G.), Université de Bretagne Occidentale, Brest, France
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F. Eugène
aFrom the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France
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J. Ognard
bDepartment of Medical Imaging (B.D., J.O., J.-C.G.), Centre Hospitalier Universitaire La Cavale Blanche, Brest, France
dLATIM U1101 (J.O.), INSERM, Université de Bretagne Occidentale, Brest, France
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J.-Y. Gauvrit
aFrom the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France
eEmpenn Unit U1228 (J.-Y.G., J.-C.F.), INSERM, INRIA, Université Rennes 1, Rennes, France.
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J.-C. Gentric
bDepartment of Medical Imaging (B.D., J.O., J.-C.G.), Centre Hospitalier Universitaire La Cavale Blanche, Brest, France
cGETBO group EA3878 (B.D., J.-C.G.), Université de Bretagne Occidentale, Brest, France
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J.-C. Ferré
aFrom the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France
eEmpenn Unit U1228 (J.-Y.G., J.-C.F.), INSERM, INRIA, Université Rennes 1, Rennes, France.
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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.

ABBREVIATIONS:

DAVF
dural arteriovenous fistula
4D-MRA
4D contrast-enhanced magnetic resonance angiography

Footnotes

  • Disclosures: François Eugène—UNRELATED: Consultancy: Biomodex. Jean-Christophe Gentric—UNRELATED: Consultancy: Medtronic, Stryker, Balt; Stock/Stock Options: INTRADYS.

  • © 2020 by American Journal of Neuroradiology
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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
B. Dissaux, F. Eugène, J. Ognard, J.-Y. Gauvrit, J.-C. Gentric, J.-C. Ferré
American Journal of Neuroradiology Dec 2020, DOI: 10.3174/ajnr.A6903

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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
B. Dissaux, F. Eugène, J. Ognard, J.-Y. Gauvrit, J.-C. Gentric, J.-C. Ferré
American Journal of Neuroradiology Dec 2020, DOI: 10.3174/ajnr.A6903
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