PT  - JOURNAL ARTICLE
AU  - A.S. Al-Smadi
AU  - A. Elmokadem
AU  - A. Shaibani
AU  - M.C. Hurley
AU  - M.B. Potts
AU  - B.S. Jahromi
AU  - S.A. Ansari
TI  - Adjunctive Efficacy of Intra-Arterial Conebeam CT Angiography Relative to DSA in the Diagnosis and Surgical Planning of Micro-Arteriovenous Malformations
AID  - 10.3174/ajnr.A5745
DP  - 2018 Aug 09
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2018/08/09/ajnr.A5745.short
4100  - http://www.ajnr.org/content/early/2018/08/09/ajnr.A5745.full
AB  - BACKGROUND AND PURPOSE: Micro-arteriovenous malformations are an underrecognized etiology of intracranial hemorrhage. Our study aimed to assess the adjunctive efficacy of intra-arterial conebeam CTA relative to DSA in the diagnosis and surgical planning of intracranial micro-AVMs.MATERIALS AND METHODS: We performed a retrospective study of all micro-AVMs (≤1-cm nidus) at our institution. Blinded neuroradiologists qualitatively graded DSA and intra-arterial conebeam CTA images for the detection of specific micro-AVM anatomic parameters (arterial feeder, micronidus, and venous drainer) and defined an overall diagnostic value. Statistical and absolute differences in the overall diagnostic values defined the relative intra-arterial conebeam CTA diagnostic values, respectively. Blinded neurosurgeons reported their treatment approach after DSA and graded the adjunctive value of intra-arterial conebeam CTA to improve or modify treatment. Intra-arterial conebeam CTA efficacy was defined as interobserver agreement in the relative intra-arterial conebeam CTA diagnostic and/or treatment-planning value scores.RESULTS: Ten patients with micro-AVMs presented with neurologic deficits and/or intracranial hemorrhages. Both neuroradiologists assigned a higher overall intra-arterial conebeam CTA diagnostic value (P < .05), secondary to improved evaluation of both arterial feeders and the micronidus, with good interobserver agreement (τ = 0.66, P = .018) in the relative intra-arterial conebeam CTA diagnostic value. Both neurosurgeons reported that integrating the intra-arterial conebeam CTA data into their treatment plan would allow more confident localization for surgical/radiation treatment (8/10; altering the treatment plan in 1 patient), with good interobserver agreement in the relative intra-arterial conebeam CTA treatment planning value (τ = 0.73, P = .025).CONCLUSIONS: Adjunctive intra-arterial conebeam CTA techniques are more effective in the diagnostic identification and anatomic delineation of micro-AVMs, relative to DSA alone, with the potential to improve microsurgical or radiosurgery treatment planning.mAVMmicro-AVMIA-CBCTAintra-arterial conebeam CTA3DRA3D rotational angiography