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

False-positive venous ASL signal in 2 patients. A, ASL signal in the A3 branches of the anterior cerebral arteries (white arrowheads) was mistaken for venous ASL signal in a 15-year-old male patient who presented with a right parietal parenchymal hematoma. B, T2-weighted images show localization of this signal to the anterior cerebral arteries (black arrowhead). C, ASL signal in the anterior aspect of the superior sagittal sinus in a 70-year-old man with subarachnoid hemorrhage (white arrow). This patient had no evidence of a DAVF or shunting on DSA.

ROC curves for each reader's individual diagnostic performance (A and B) and their pooled diagnostic performance (C) with each of the following: structural MR imaging (dotted line), structural MR imaging and TOF-MRA (sMRI + MRA, dashed line), and structural MR imaging with TOF-MRA and pCASL (sMRI + MRA + pCASL, solid line). The light gray diagonal is the line of no discrimination. The triangle and dot symbols on the curve indicate true-positive rate/false-positive rate pairs computed at different discrimination thresholds. With the addition of TOF-MRA and then pCASL to structural MR imaging, the ROC curve becomes more well-rounded with an incrementally higher AUC. This indicates increased diagnostic sensitivity for detection of a DAVF at a set specificity.