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Research ArticleAdult Brain
Open Access

Arterial Spin-Labeling Improves Detection of Intracranial Dural Arteriovenous Fistulas with MRI

S.A. Amukotuwa, M.P. Marks, G. Zaharchuk, F. Calamante, R. Bammer and N. Fischbein
American Journal of Neuroradiology March 2018, DOI: https://doi.org/10.3174/ajnr.A5570
S.A. Amukotuwa
aFrom the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California
bFlorey Department of Neuroscience and Mental Health (S.A.A., F.C.), University of Melbourne, Melbourne, Victoria, Australia.
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M.P. Marks
aFrom the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California
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G. Zaharchuk
aFrom the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California
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F. Calamante
bFlorey Department of Neuroscience and Mental Health (S.A.A., F.C.), University of Melbourne, Melbourne, Victoria, Australia.
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R. Bammer
aFrom the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California
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N. Fischbein
aFrom the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California
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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

Indicates open access to non-subscribers at www.ajnr.org

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S.A. Amukotuwa, M.P. Marks, G. Zaharchuk, F. Calamante, R. Bammer, N. Fischbein
Arterial Spin-Labeling Improves Detection of Intracranial Dural Arteriovenous Fistulas with MRI
American Journal of Neuroradiology Mar 2018, DOI: 10.3174/ajnr.A5570

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Arterial Spin-Labeling Improves Detection of Intracranial Dural Arteriovenous Fistulas with MRI
S.A. Amukotuwa, M.P. Marks, G. Zaharchuk, F. Calamante, R. Bammer, N. Fischbein
American Journal of Neuroradiology Mar 2018, DOI: 10.3174/ajnr.A5570
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