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AJNR - American Journal of Neuroradiology

Publication Preview: Published October 15, 2009

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American Journal of Neuroradiology
DOI 10.3174/ajnr.A1898

BRAIN

Evaluation of Dural Arteriovenous Fistulas with 4D Contrast-Enhanced MR Angiography at 3T

S. Nishimura, T. Hirai, A. Sasao, M. Kitajima, M. Morioka, Y. Kai, Y. Omori, T. Okuda, R. Murakami, H. Fukuoka, K. Awai, J.-I. Kuratsu and Y. Yamashita

From the Departments of Diagnostic Radiology (S.N., T.H., A.S., M.K., T.O., H.F., K.A., Y.Y.), Neurosurgery (M.M., Y.O., J.-I.K.), and Radiation Oncology (R.M.), Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and Department of Neurosurgery (Y.K.), Ryukyu University, Okinawa, Japan.

Please address correspondence to Toshinori Hirai, MD, Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1–1-1 Honjo, Kumamoto, 860-8556 Japan; e-mail: t-hirai{at}kumamoto-u.ac.jp

BACKGROUND AND PURPOSE: Four-dimensional contrast-enhanced MR angiography (4D-CE-MRA) at 3T may replace digital subtraction angiography (DSA) for certain diagnostic purposes in patients with intracranial dural arteriovenous fistula (DAVF). The aim of this study was to test the hypothesis that 4D-CE-MRA at 3T enables the same characterization of intracranial DAVFs as DSA.

MATERIALS AND METHODS: The study population consisted of 18 consecutive patients with intracranial DAVFs (11 women, 7 men; age range, 35–82 years; mean age, 64.8 years). They underwent 4D-CE-MRA at 3T and DSA. The 4D-CE-MRA series combined randomly segmented central k-space ordering, keyhole imaging, sensitivity encoding, and half-Fourier imaging. We obtained 30 dynamic scans every 1.9 seconds with a spatial resolution of 1 x 1 x 1.5 mm. Two independent readers reviewed the 4D-CE-MRA images for main arterial feeders, fistula site, and venous drainage. Interobserver and intermodality agreement was assessed by statistics.

RESULTS: At DSA, 8 fistulas were located at the transverse sigmoid sinus; 8, at the cavernous sinus; and 2, at the sinus adjacent to the foramen magnum. Interobserver agreement was fair for the main arterial feeders ( = 0.59), excellent for the fistula site ( = 0.91), and good for venous drainage ( = 0.86). Intermodality agreement was moderate for the main arterial feeders ( = 0.68) and excellent for the fistula site ( = 1.0) and venous drainage ( = 1.0).

CONCLUSIONS: The agreement between 4D-CE-MRA and DSA findings was good to excellent with respect to the fistula site and venous drainage.