An intracranial arteriovenous shunt (AVS) resulting from an arteriovenous
malformation (AVM) or dural arteriovenous ;stula (DAVF) can lead to neurological
complications including acute intracranial hemorrhage. Digital subtraction
angiography (DSA) is the reference standard to con;rm and assess AVS.
However, DSA is an invasive procedure that also involves the administration
of contrast and exposes the patient and clinician to ionizing radiation.
4D contrast-enhanced MR angiography (CE-MRA) has been explored as an
alternative diagnostic method. Yet, post-contrast MR sequences may produce
;ndings that are less speci;c, as dilated intracranial veins may be found in a
wide range of conditions. Further, 4D CE-MRA remains time-consuming and
requires more experience to achieve accurate and con;dent results.
We assessed the accuracy of the combined use of arterial spin-labeling (ASL) and
susceptibility weighted imaging (SWI) for detecting intracranial AVS in comparison
with conventional MR imaging.1 Ninety-two consecutive patients with a known
(n24) or suspected arteriovenous shunting (n68) underwent DSA and brain MR
imaging, including ASL/SWI and conventional angiographic MR imaging (3D TOF, 4D
time-resolved and 3D contrast-enhanced MRA).
ASL/SWI and conventional MR imaging were reviewed separately in a randomized
order by two blinded radiologists who judged the presence or absence of AVS. The
accuracy of ASL/SWI for the detection of AVS was calculated by using the area
under receiver operating curve with DSA as a reference standard. Compared with
conventional MR imaging, ASL/SWI was signi;cantly more sensitive (0.98 versus
0.90, P = .04), equally speci;c (0.97) and showed signi;cantly higher agreement
with DSA (k = 0.95 versus 0.84, P = .01) and higher area under the receiver operating
curve (0.97 versus 0.93, P = .02).
Neuroimaging with ASL and SWAN
for detection of AVS
By Jerome Hodel, MD, PhD, Head of the Neuroradiology Department,
Henri Mondor Hospital, Creteil, France
Case Study | Neuroimaging
Jérôme Hodel, MD, PhD,
Department of Neuroradiology,
Head of the Neuroradiology Department,
Henri Mondor Hospital, Creteil, France.