@article {Meijs1498, author = {M. Meijs and S.A.H. Pegge and K. Murayama and H.D. Boogaarts and M. Prokop and P.W.A. Willems and R. Manniesing and F.J.A. Meijer}, title = {Color-Mapping of 4D-CTA for the Detection of Cranial Arteriovenous Shunts}, volume = {40}, number = {9}, pages = {1498--1504}, year = {2019}, doi = {10.3174/ajnr.A6156}, publisher = {American Journal of Neuroradiology}, abstract = {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\%{\textendash}100\%) and moderate-to-high specificity (70\%{\textendash}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\%{\textendash}88\%; specificity, 60\%{\textendash}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}, issn = {0195-6108}, URL = {https://www.ajnr.org/content/40/9/1498}, eprint = {https://www.ajnr.org/content/40/9/1498.full.pdf}, journal = {American Journal of Neuroradiology} }