PT  - JOURNAL ARTICLE
AU  - Hodel, J.
AU  - Leclerc, X.
AU  - Kalsoum, E.
AU  - Zuber, M.
AU  - Tamazyan, R.
AU  - Benadjaoud, M.A.
AU  - Pruvo, J.-P.
AU  - Piotin, M.
AU  - Baharvahdat, H.
AU  - Zins, M.
AU  - Blanc, R.
TI  - Intracranial Arteriovenous Shunting: Detection with Arterial Spin-Labeling and Susceptibility-Weighted Imaging Combined
AID  - 10.3174/ajnr.A4961
DP  - 2016 Oct 27
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2016/10/27/ajnr.A4961.short
4100  - http://www.ajnr.org/content/early/2016/10/27/ajnr.A4961.full
AB  - 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.AbbreviationsASLarterial spin-labelingAUCarea under the receiver operating curveAVSarteriovenous shuntingDAVFdural arteriovenous fistulaICHintracranial hemorrhage