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Research ArticleAdult Brain

Intracranial Arteriovenous Shunting: Detection with Arterial Spin-Labeling and Susceptibility-Weighted Imaging Combined

J. Hodel, X. Leclerc, E. Kalsoum, M. Zuber, R. Tamazyan, M.A. Benadjaoud, J.-P. Pruvo, M. Piotin, H. Baharvahdat, M. Zins and R. Blanc
American Journal of Neuroradiology October 2016, DOI: https://doi.org/10.3174/ajnr.A4961
J. Hodel
From the Departments of Radiology (J.H., M.Z.) and Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France; Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France; Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France; Department of Radiobiology and Epidemiology (M.A.B.), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France; and Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France.
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X. Leclerc
From the Departments of Radiology (J.H., M.Z.) and Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France; Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France; Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France; Department of Radiobiology and Epidemiology (M.A.B.), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France; and Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France.
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E. Kalsoum
From the Departments of Radiology (J.H., M.Z.) and Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France; Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France; Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France; Department of Radiobiology and Epidemiology (M.A.B.), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France; and Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France.
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M. Zuber
From the Departments of Radiology (J.H., M.Z.) and Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France; Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France; Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France; Department of Radiobiology and Epidemiology (M.A.B.), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France; and Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France.
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R. Tamazyan
From the Departments of Radiology (J.H., M.Z.) and Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France; Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France; Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France; Department of Radiobiology and Epidemiology (M.A.B.), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France; and Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France.
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M.A. Benadjaoud
From the Departments of Radiology (J.H., M.Z.) and Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France; Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France; Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France; Department of Radiobiology and Epidemiology (M.A.B.), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France; and Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France.
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J.-P. Pruvo
From the Departments of Radiology (J.H., M.Z.) and Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France; Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France; Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France; Department of Radiobiology and Epidemiology (M.A.B.), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France; and Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France.
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M. Piotin
From the Departments of Radiology (J.H., M.Z.) and Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France; Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France; Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France; Department of Radiobiology and Epidemiology (M.A.B.), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France; and Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France.
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H. Baharvahdat
From the Departments of Radiology (J.H., M.Z.) and Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France; Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France; Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France; Department of Radiobiology and Epidemiology (M.A.B.), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France; and Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France.
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M. Zins
From the Departments of Radiology (J.H., M.Z.) and Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France; Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France; Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France; Department of Radiobiology and Epidemiology (M.A.B.), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France; and Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France.
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R. Blanc
From the Departments of Radiology (J.H., M.Z.) and Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France; Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France; Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France; Department of Radiobiology and Epidemiology (M.A.B.), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France; and Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France.
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Abstract

BACKGROUND AND PURPOSE: Arterial spin-labeling and susceptibility-weighted imaging are 2 MR imaging techniques that do not require gadolinium. The study aimed to assess the accuracy of arterial spin-labeling and SWI combined for detecting intracranial arteriovenous shunting in comparison with conventional MR imaging.

MATERIALS AND METHODS: Ninety-two consecutive patients with a known (n = 24) or suspected arteriovenous shunting (n = 68) underwent digital subtraction angiography and brain MR imaging, including arterial spin-labeling/SWI and conventional angiographic MR imaging (3D TOF, 4D time-resolved, and 3D contrast-enhanced MRA). Arterial spin-labeling/SWI and conventional MR imaging were reviewed separately in a randomized order by 2 blinded radiologists who judged the presence or absence of arteriovenous shunting. The accuracy of arterial spin-labeling/SWI for the detection of arteriovenous shunting was calculated by using the area under receiver operating curve with DSA as reference standard. κ coefficients were computed to determine interobserver and intermodality agreement.

RESULTS: Of the 92 patients, DSA showed arteriovenous shunting in 63 (arteriovenous malformation in 53 and dural arteriovenous fistula in 10). Interobserver agreement was excellent (κ =0.83–0.95). In 5 patients, arterial spin-labeling/SWI correctly detected arteriovenous shunting, while the conventional angiographic MR imaging did not. Compared with conventional MR imaging, arterial spin-labeling/SWI was significantly more sensitive (0.98 versus 0.90, P = .04) and equally specific (0.97) and showed significantly higher agreement with DSA (κ = 0.95 versus 0.84, P = .01) and higher area under the receiver operating curve (0.97 versus 0.93, P = .02).

CONCLUSIONS: Our study showed that the combined use of arterial spin-labeling and SWI may be an alternative to contrast-enhanced MRA for the detection of intracranial arteriovenous shunting.

Abbreviations

ASL
arterial spin-labeling
AUC
area under the receiver operating curve
AVS
arteriovenous shunting
DAVF
dural arteriovenous fistula
ICH
intracranial hemorrhage

Footnotes

  • J. Hodel and X. Leclerc are co-first authors

  • © 2017 American Society of Neuroradiology
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J. Hodel, X. Leclerc, E. Kalsoum, M. Zuber, R. Tamazyan, M.A. Benadjaoud, J.-P. Pruvo, M. Piotin, H. Baharvahdat, M. Zins, R. Blanc
Intracranial Arteriovenous Shunting: Detection with Arterial Spin-Labeling and Susceptibility-Weighted Imaging Combined
American Journal of Neuroradiology Oct 2016, DOI: 10.3174/ajnr.A4961

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Intracranial Arteriovenous Shunting: Detection with Arterial Spin-Labeling and Susceptibility-Weighted Imaging Combined
J. Hodel, X. Leclerc, E. Kalsoum, M. Zuber, R. Tamazyan, M.A. Benadjaoud, J.-P. Pruvo, M. Piotin, H. Baharvahdat, M. Zins, R. Blanc
American Journal of Neuroradiology Oct 2016, DOI: 10.3174/ajnr.A4961
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