TY - JOUR T1 - Color-Mapping of 4D-CTA for the Detection of Cranial Arteriovenous Shunts JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. DO - 10.3174/ajnr.A6156 AU - M. Meijs AU - S.A.H. Pegge AU - K. Murayama AU - H.D. Boogaarts AU - M. Prokop AU - P.W.A. Willems AU - R. Manniesing AU - F.J.A. Meijer Y1 - 2019/08/08 UR - http://www.ajnr.org/content/early/2019/08/08/ajnr.A6156.abstract N2 - BACKGROUND AND PURPOSE: 4D CT angiography is increasingly used in clinical practice for the assessment of different neurovascular disorders. Optimized processing of 4D-CTA is crucial for diagnostic interpretation because of the large amount of data that is generated. A color-mapping method for 4D-CTA is presented for improved and enhanced visualization of the cerebral vasculature hemodynamics. This method was applied to detect cranial AVFs.MATERIALS AND METHODS: All patients who underwent both 4D-CTA and DSA in our hospital from 2011 to 2018 for the clinical suspicion of a cranial AVF or carotid cavernous fistula were retrospectively collected. Temporal information in the cerebral vasculature was visualized using a patient-specific color scale. All color-maps were evaluated by 3 observers for the presence or absence of an AVF or carotid cavernous fistula. The presence or absence of cortical venous reflux was evaluated as a secondary outcome measure.RESULTS: In total, 31 patients were included, 21 patients with and 10 without an AVF. Arterialization of venous structures in AVFs was accurately visualized using color-mapping. There was high sensitivity (86%–100%) and moderate-to-high specificity (70%–100%) for the detection of AVFs on color-mapping 4D-CTA, even without the availability of dynamic subtraction rendering. The diagnostic performance of the 3 observers in the detection of cortical venous reflux was variable (sensitivity, 43%–88%; specificity, 60%–80%).CONCLUSIONS: Arterialization of venous structures can be visualized using color-mapping of 4D-CTA and proves to be accurate for the detection of cranial AVFs. This finding makes color-mapping a promising visualization technique for assessing temporal hemodynamics in 4D-CTA.CCFcarotid cavernous fistulaTTStime-to-signal ER -