Comparison of imaging modalities for the accurate delineation of arteriovenous malformation, with reference to stereotactic radiosurgery

Aoyama, Hidefumi; Shirato, Hiroki; Katoh, Norio; Kudo, Kohsuke; Asano, Takeshi; Kuroda, Satoshi; Ishikawa, Tatsuya; Miyasaka, Kazuo

doi:10.1016/j.ijrobp.2005.03.039

Cited by 18 publications

(12 citation statements)

References 23 publications

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“…Neuroimaging, including CT and MRI, provides good anatomic resolution, but cannot discriminate the AVM nidus from the feeding arteries and draining veins [14]. On the other hand, conventional angiography provides orthogonal 2-dimensional projections of the AVM that dose outline the nidus margins and geometry; however, spatial information is lost because the dimensional reduction represents a source of inaccuracy in nidus definition, particularly in patients with irregularly shaped AVMs [14,15,16,17]. It has been suggested that AVM definition using images from multiple modalities for treatment planning is important and should be used as a routine tool for target delineation [18].…”

Section: Discussionmentioning

confidence: 99%

“…The mean angiography volume was larger than the other volumes, whereas the mean CT and MRI volumes were similar. This is likely because conventional angiography provides orthogonal 2-dimensional projections of the AVM, and spatial information is lost because of dimensional reduction [15,16]. Volumes rendered from information with reduced dimensions are thought to be overestimated.…”

Section: Discussionmentioning

confidence: 99%

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Consistency between Targets Delineated by Angiography, Computed Tomography, and Magnetic Resonance Imaging in Stereotactic Radiosurgery for Arteriovenous Malformation

Yu-jie

Hsu

Lee

et al. 2017

Stereotact Funct Neurosurg

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Background: Target identification is important for radiosurgery for arteriovenous malformations (AVMs). Targets defined by different imaging modalities may be inconsistent in practice. Objectives: The goal of this study is to review and analyze the consistency between targets defined by different imaging modalities in radiosurgery for AVMs. Methods: From March 2007 to June 2011, AVM patients for radiosurgery whose targets were delineated by angiography/computed tomography (CT)/magnetic resonance imaging (MRI) were reviewed. Spetzler-Martin grades, hemorrhage history, and treatment volumes were checked. Dice similarity coefficients (DSCs) between targets were calculated and analyzed. Results: Twenty-three patients were enrolled. The mean DSCs were between 0.37 and 0.51 for targets by different modalities. There was no significant difference in DSCs regarding Spetzler-Martin grades and hemorrhage history. For CT-delineated target volumes <3 cm³, MRI-delineated target volumes <5 cm³, and angiography-delineated target volumes <2 cm³, the DSCs between the different image modalities were significantly decreased. Conclusions: Consistency between targets delineated using different image modalities was likely to be unsatisfactory and worsen significantly in niduses with volumes <5 cm³. An iterative multimodality approach to confirm the delineated targets of AVMs is suggested to be indispensable for robust treatment in radiosurgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Consistency between Targets Delineated by Angiography, Computed Tomography, and Magnetic Resonance Imaging in Stereotactic Radiosurgery for Arteriovenous Malformation

Yu-jie

Hsu

Lee

et al. 2017

Stereotact Funct Neurosurg

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“…Yu et al (16) found that volumes based solely on MRI overestimated the actual treatment volume, which is delineated on angiography-guided MRI by a mean of 57% for AVMs larger than 2 cm 3 and by a mean of 25% for AVMs smaller than 2 cm 3 . Groups from Japan also found that the target defined on MRA might have included an unnecessary area of the AVM (the feeding artery or draining vein) but missed an important portion (the nidus) (17). Kenieda et al (18) investigated the use of intra-arterial CT angiography using a helical CT scan protocol (18).…”

Section: Discussionmentioning

confidence: 99%

Planning Evaluation of C-Arm Cone Beam CT Angiography for Target Delineation in Stereotactic Radiation Surgery of Brain Arteriovenous Malformations

Kang

Huang

Gailloud

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Purpose Stereotactic radiation surgery (SRS) is one of the therapeutic modalities currently available to treat cerebral arteriovenous malformations (AVM). Conventionally, magnetic resonance imaging (MRI) and MR angiography (MRA) and digital subtraction angiography (DSA) are used in combination to identify the target volume for SRS treatment. The purpose of this study was to evaluate the use of C-arm cone beam computed tomography (CBCT) in the treatment planning of SRS for cerebral AVMs. Methods and Materials Sixteen consecutive patients treated for brain AVMs at our institution were included in this retrospective study. Prior to treatment, all patients underwent MRA, DSA, and C-arm CBCT. All images were coregistered using the GammaPlan planning system. AVM regions were delineated independently by 2 physicians using either C-arm CBCT or MRA, resulting in 2 volumes: a CBCT volume (VCBCT) and an MRA volume (VMRA). SRS plans were generated based on the delineated regions. Results The average volume of treatment targets delineated using C-arm CBCT and MRA were similar, 6.40 cm3 and 6.98 cm3, respectively (P = .82). However, significant regions of nonoverlap existed. On average, the overlap of the MRA with the C-arm CBCT was only 52.8% of the total volume. In most cases, radiation plans based on VMRA did not provide adequate dose to the region identified on C-arm CBCT; the mean minimum dose to VCBCT was 29.5%, whereas the intended goal was 45% (P<.001). The mean volume of normal brain receiving 12 Gy or more in C-arm CBCT-based plans was not greater than in the MRA-based plans. Conclusions Use of C-arm CBCT images significantly alters the delineated regions of AVMs for SRS planning, compared to that of MRA/MRI images. CT-based planning can be accomplished without increasing the dose to normal brain and may represent a more accurate definition of the nidus, increasing the chances for successful obliteration.

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“…2,5,11,16 Others have confirmed the value of MRA in defining vascular and parenchymal anatomy for AVM radiosurgery, particularly in patients who have not had prior embolization or surgery and who have compact, medium-size nidi. 1,3,4,7,9,10,12,14 Bednarz et al 3 have demonstrated that combining 3D TOF MRA and stereotactic angiography increased the accuracy of AVM radiosurgery and allowed for optimal dose planning. In addition, Petereit et al…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging/magnetic resonance angiography fusion technique for intraoperative navigation during microsurgical resection of cerebral arteriovenous malformations

Bekelis¹,

Missios²,

Desai³

et al. 2012

FOC

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Object Microsurgical resection of arteriovenous malformations (AVMs) is facilitated by real-time image guidance that demonstrates the precise size and location of the AVM nidus. Magnetic resonance images have routinely been used for intraoperative navigation, but there is no single MRI sequence that can provide all the details needed for characterization of the AVM. Additional information detailing the specific location of the feeding arteries and draining veins would be valuable during surgery, and this detail may be provided by fusing MR images and MR angiography (MRA) sequences. The current study describes the use of a technique that fuses contrast-enhanced MR images and 3D time-of-flight MR angiograms for intraoperative navigation in AVM resection. Methods All patients undergoing microsurgical resection of AVMs at the Dartmouth Cerebrovascular Surgery Program were evaluated from the surgical database. Between 2009 and 2011, 15 patients underwent surgery in which this contrast-enhanced MRI and MRA fusion technique was used, and these patient form the population of the present study. Results Image fusion was successful in all 15 cases. The additional data manipulation required to fuse the image sets was performed on the morning of surgery with minimal added setup time. The navigation system accurately identified feeding arteries and draining veins during resection in all cases. There was minimal imaging-related artifact produced by embolic materials in AVMs that had been preoperatively embolized. Complete AVM obliteration was demonstrated on intraoperative angiography in all cases. Conclusions Precise anatomical localization, as well as the ability to differentiate between arteries and veins during AVM microsurgery, is feasible with the aforementioned MRI/MRA fusion technique. The technique provides important information that is beneficial to preoperative planning, intraoperative navigation, and successful AVM resection.

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Comparison of imaging modalities for the accurate delineation of arteriovenous malformation, with reference to stereotactic radiosurgery

Cited by 18 publications

References 23 publications

Consistency between Targets Delineated by Angiography, Computed Tomography, and Magnetic Resonance Imaging in Stereotactic Radiosurgery for Arteriovenous Malformation

Consistency between Targets Delineated by Angiography, Computed Tomography, and Magnetic Resonance Imaging in Stereotactic Radiosurgery for Arteriovenous Malformation

Planning Evaluation of C-Arm Cone Beam CT Angiography for Target Delineation in Stereotactic Radiation Surgery of Brain Arteriovenous Malformations

Magnetic resonance imaging/magnetic resonance angiography fusion technique for intraoperative navigation during microsurgical resection of cerebral arteriovenous malformations

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