Abstract
BACKGROUND AND PURPOSE: Intracranial dural arteriovenous fistulas carry a risk of substantial neurologic complications but can be difficult to detect on structural MR imaging and TOF-MRA. The purpose of this study was to assess the accuracy and added value of 3D pseudocontinuous arterial spin-labeling MR imaging for the detection of these lesions.
MATERIALS AND METHODS: This retrospective study included 39 patients with a dural arteriovenous fistula and 117 controls who had undergone both DSA and MR imaging with pseudocontinuous arterial spin-labeling. Two neuroradiologists blinded to the DSA results independently assessed MR imaging with and without pseudocontinuous arterial spin-labeling. They recorded specific signs, including venous arterial spin-labeling signal, and the likelihood of a dural arteriovenous fistula using a 5-point Likert scale. Logistic regression and receiver operating characteristic analyses were performed to determine the accuracy of specific signs and the added value of pseudocontinuous arterial spin-labeling. Interobserver agreement was determined by using κ statistics.
RESULTS: Identification of the venous arterial spin-labeling signal had a high sensitivity (94%) and specificity (88%) for the presence a dural arteriovenous fistula. Receiver operating characteristic analysis showed significant improvement in diagnostic performance with the addition of pseudocontinuous arterial spin-labeling in comparison with structural MR imaging (Δarea under the receiver operating characteristic curve = 0.179) and a trend toward significant improvement in comparison with structural MR imaging with time-of-flight MRA (Δarea under the receiver operating characteristic curve = 0.043). Interobserver agreement for the presence of a dural arteriovenous fistula improved substantially and was almost perfect with the addition of pseudocontinuous arterial spin-labeling (κ = 0.92).
CONCLUSIONS: Venous arterial spin-labeling signal has high sensitivity and specificity for the presence of a dural arteriovenous fistula, and the addition of pseudocontinuous arterial spin-labeling increases confidence in the diagnosis of this entity on MR imaging.
ABBREVIATIONS:
- ASL
- arterial spin-labeling
- AUC
- area under the ROC curve
- DAVF
- dural arteriovenous fistula
- NCH
- nodular and/or curvilinear hyperintensities
- NPV
- negative predictive value
- pCASL
- pseudocontinuous ASL
- PPV
- positive predictive value
- ROC
- receiver operating characteristic
- sMRI
- structural MRI
Footnotes
Disclosures: Shalini A. Amukotuwa—RELATED: Grant: National Institute of Biomedical Imaging and Bioengineering, Comments: grant numbers 5R21EB021029, 3R01EB002711-06S1.* Fernando Calamante—RELATED: Grant: National Health and Medical Research Council of Australia; UNRELATED: Grant: Australian Research Council; Payment for Lectures Including Service on Speakers Bureaus: Siemens.* Greg Zaharchuk—UNRELATED: Grants/Grants Pending: GE Healthcare, National Institutes of Health. Roland Bammer—RELATED: Grant: National Institute of Biomedical Imaging and Bioengineering, Comments: grant numbers 5R21EB021029, 3R01EB002711-06S1*; Support for Travel to Meetings for the Study or Other Purposes: National Institutes of Health (National Institute of Biomedical Imaging and Bioengineering).* *Money paid to the institution.
Drs Amukotuwa and Bammer are supported by National Institutes of Health (National Institute of Biomedical Imaging and Bioengineering) grants 3R01EB002711-06S1 and 5R21EB021029. Dr Calamante is supported by the National Health and Medical Research Council of Australia, grant APP1117724.
- © 2018 by American Journal of Neuroradiology
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