PT - JOURNAL ARTICLE AU - A. Rojas-Villabona AU - F.B. Pizzini AU - T. Solbach AU - M. Sokolska AU - G. Ricciardi AU - C. Lemonis AU - E. DeVita AU - Y. Suzuki AU - M.J.P. van Osch AU - R.I. Foroni AU - M. Longhi AU - S. Montemezzi AU - D. Atkinson AU - N. Kitchen AU - A. Nicolato AU - X. Golay AU - H.R. Jäger TI - Are Dynamic Arterial Spin-Labeling MRA and Time-Resolved Contrast-Enhanced MRA Suited for Confirmation of Obliteration following Gamma Knife Radiosurgery of Brain Arteriovenous Malformations? AID - 10.3174/ajnr.A6990 DP - 2021 Apr 01 TA - American Journal of Neuroradiology PG - 671--678 VI - 42 IP - 4 4099 - http://www.ajnr.org/content/42/4/671.short 4100 - http://www.ajnr.org/content/42/4/671.full SO - Am. J. Neuroradiol.2021 Apr 01; 42 AB - BACKGROUND AND PURPOSE: Intra-arterial DSA has been traditionally used for confirmation of cure following gamma knife radiosurgery for AVMs. Our aim was to evaluate whether 4D arterial spin-labeling MRA and contrast-enhanced time-resolved MRA in combination can be an alternative to DSA for confirmation of AVM obliteration following gamma knife radiosurgery.MATERIALS AND METHODS: In this prospective study, 30 patients undergoing DSA for confirmation of obliteration following gamma knife radiosurgery for AVMs (criterion standard) also underwent MRA, including arterial spin-labeling MRA and contrast-enhanced time-resolved MRA. One dataset was technically unsatisfactory, and the case was excluded. The DSA and MRA datasets of 29 patients were independently and blindly evaluated by 2 observers regarding the presence/absence of residual AVMs.RESULTS: The mean time between gamma knife radiosurgery and follow-up DSA/MRA was 53 months (95% CI, 42–64 months; range, 22–168 months). MRA total scanning time was 9 minutes and 17 seconds. Residual AVMs were detected on DSA in 9 subjects (obliteration rate = 69%). All residual AVMs were detected on at least 1 MRA sequence. Arterial spin-labeling MRA and contrast-enhanced time-resolved MRA showed excellent specificity and positive predictive values individually (100%). However, their sensitivity and negative predictive values were suboptimal due to 1 false-negative with arterial spin-labeling MRA and 2 with contrast-enhanced time-resolved MRA (sensitivity = 88% and 77%, negative predictive values = 95% and 90%, respectively). Both sensitivity and negative predictive values increased to 100% if a composite assessment of both MRA sequences was performed. Diagnostic accuracy (receiver operating characteristic) and agreement (κ) are maximized using arterial spin-labeling MRA and contrast-enhanced time-resolved MRA in combination (area under receiver operating characteristic curve = 1, P < .001; κ = 1, P < .001, respectively).CONCLUSIONS: Combining arterial spin-labeling MRA with contrast-enhanced time-resolved MRA holds promise as an alternative to DSA for confirmation of obliteration following gamma knife radiosurgery for brain AVMs, having provided 100% sensitivity and specificity in the study. Their combined use also enables reliable characterization of residual lesions.ASLarterial spin-labelingCEtime-resolved contrast-enhancedGKRgamma knife radiosurgeryNPVnegative predictive valuePPVpositive predictive valueROCreceiver operating characteristic