PT  - JOURNAL ARTICLE
AU  - Leclerc, X.
AU  - Guillaud, O.
AU  - Reyns, N.
AU  - Hodel, J.
AU  - Outteryck, O.
AU  - Bala, F.
AU  - Bricout, N.
AU  - Bretzner, M.
AU  - Ramdane, N.
AU  - Pruvo, J.-P.
AU  - Hacein-Bey, L.
AU  - Kuchcinski, G.
TI  - Follow-Up MRI for Small Brain AVMs Treated by Radiosurgery: Is Gadolinium Really Necessary?
AID  - 10.3174/ajnr.A6404
DP  - 2020 Feb 06
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2020/02/06/ajnr.A6404.short
4100  - http://www.ajnr.org/content/early/2020/02/06/ajnr.A6404.full
AB  - BACKGROUND AND PURPOSE: Follow-up MR imaging of brain AVMs currently relies on contrast-enhanced sequences. Noncontrast techniques, including arterial spin-labeling and TOF, may have value in detecting a residual nidus after radiosurgery. The aim of this study was to compare noncontrast with contrast-enhanced MR imaging for the differentiation of residual-versus-obliterated brain AVMs in radiosurgically treated patients.MATERIALS AND METHODS: Twenty-eight consecutive patients with small brain AVMs (<20 mm) treated by radiosurgery were followed with the same MR imaging protocol. Three neuroradiologists, blinded to the results, independently reviewed the following: 1) postcontrast images alone (4D contrast-enhanced MRA and postcontrast 3D T1 gradient recalled-echo), 2) arterial spin-labeling and TOF images alone, and 3) all MR images combined. The primary end point was the detection of residual brain AVMs using a 5-point scale, with DSA as the reference standard.RESULTS: The highest interobserver agreement was for arterial spin-labeling/TOF (κ = 0.81; 95% confidence interval, 0.66–0.93). Regarding brain AVM detection, arterial spin-labeling/TOF had higher sensitivity (sensitivity, 85%; specificity, 100%; 95% CI, 62–97) than contrast-enhanced MR imaging (sensitivity, 55%; specificity, 100%; 95% CI, 27–73) and all MR images combined (sensitivity, 75%; specificity, 100%; 95% CI, 51–91) (P = .008). All nidus obliterations on DSA were detected on MR imaging. In 6 patients, a residual brain AVM present on DSA was only detected with arterial spin-labeling/TOF, including 3 based solely on arterial spin-labeling images.CONCLUSIONS: In this study of radiosurgically treated patients with small brain AVMs, arterial spin-labeling/TOF was found to be superior to gadolinium-enhanced MR imaging in detecting residual AVMs.ASLarterial spin-labelingAVSarteriovenous shuntingBAVMbrain AVMGREgradient recalled-echoPLDpost label delay