The use of 4D-CTA in the diagnostic work-up of brain arteriovenous malformations

Abstract

IntroductionWe aimed to evaluate the use of time-resolved whole-head CT angiography (4D-CTA) in patients with an untreated arteriovenous malformation of the brain (bAVM), as demonstrated by catheter angiography (DSA).MethodsSeventeen patients with a DSA-proven bAVM were enrolled. These were subjected to 4D-CTA imaging using a 320 detector row CT scanner. Using a standardized scoring sheet, all studies were analyzed by a panel of three readers. This panel was blind to the DSA results at the time of reading the 4D-CTA.Results4D-CTA detected all bAVMs. With regard to the Spetzler–Martin grade, 4D-CTA disagreed with DSA in only one case, where deep venous drainage was missed. Further discrepancies between 4D-CTA and DSA analyses included underestimation of the nidus size in small lesions (four cases), misinterpretation of a feeding vessel (one case), misinterpretation of indirect feeding through pial collaterals (three cases) and oversight of mild arterial enlargement (two cases). 4D-CTA correctly distinguished low-flow from high-flow lesions and detected dural/transosseous feeding (one case), venous narrowing (one case) and venous pouches (nine cases).ConclusionIn this series, 4D-CTA was able to detect all bAVMs. Although some angioarchitectural details were missed or misinterpreted when compared to DSA, 4D-CTA evaluation was sufficiently accurate to diagnose the shunt and classify it. Moreover, 4D-CTA adds cross-sectional imaging and perfusion maps, helpful in treatment planning. 4D-CTA appears to be a valuable new adjunct in the non-invasive diagnostic work-up of bAVMs and their follow-up when managed conservatively.

4D-CTA in Neurovascular Disease: A Review

“…In 1/17 patients, however, there were discrepancies in the identification of smaller and specific arterial branches. Good correlation of 4D-CTA with DSA for the detection and grading of cerebral AVMs was also found by Willems et al 27 In 17 patients, all AVMs were detected by 4D-CTA. With regard to the Spetzler-Martin grade, 4D-CTA disagreed with DSA in 1 patient in whom deep venous drainage was missed.…”

Classification of Cerebral Arteriovenous Malformations and Intranidal Flow Patterns by Color-Encoded 4D-Hybrid-MRA

“…4D MR angiography and lately also 4D-CTA 13 have been evolving in clinical routine as noninvasive supplements to DSA. We combined the benefits of 3D TOF MRA and 4D contrast-enhanced MRA to increase spatial resolution and obtain a virtual temporal resolution of up to 0.1-second inflow time points, which serve as a measure of blood flow velocity, are color-coded, and can be adjusted interactively, giving the impression of a contrast bolus flowing through the vessels.…”

Long-Term Outcome of 106 Consecutive Pediatric Ruptured Brain Arteriovenous Malformations After Combined Treatment

“…14 Based on the morphological bAVM characteristics obtained on DSA and CT angiography, 15 bAVMs were classified according to the 5-point Spetzler-Martin grading system 16 with its 3 elements: size (scored 1 for small size, 2 for medium size, and 3 for large size), drainage type (scored 1 for bAVM with any drainage into the internal, deep cerebral venous system), and location (scored 1 for bAVM in functionally important, ie, eloquent, brain regions). bAVM imaging data also included the presence of a venous ectasia and arterial aneurysm (proximal, nidal, or remote lesions), the latter defined on superselective microcatheterism on DSA.…”