“Trapped labelled spins”-related signal on arterial spin labelling in the assessment of flow-diverted aneurysms: preliminary experience

Kulanthaivelu, Karthik; Peer, Sameer; Biswas, Shamick; Prasad, Chandrajit; Saini, Jitender; Pendharkar, Hima; Gupta, Arun Kumar; Ramalingaiah, Arvinda Hanumanthapura; Srinivas, Dwarakanath

doi:10.1007/s00234-021-02721-y

Cited by 3 publications

(3 citation statements)

References 36 publications

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“…In this regard, there may be few false positives while interpreting intraluminal ATA, such as excessive tortuosity of intracranial arteries, dolichoectasias, large intracranial aneurysms, and spin trapping after flow diversion of intracranial aneurysms. [ 18 , 37 ] In our study, we did not find any of these confounders; however, we may advise caution in interpreting intraluminal ATA in the presence of any such confounders and correlation of the findings with other sequences such as CT angiography, DSA, CE MRA, and vessel-wall imaging.…”

Section: Discussioncontrasting

confidence: 46%

Intraluminal arterial transit artifact as a predictor of intracranial large artery stenosis on 3D time of flight MR angiography: Expanding the application of arterial spin labeling MRI in ischemic stroke

Peer

Singh

2023

JCIS

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Objectives: The objective of this study was to evaluate the diagnostic value of “intraluminal arterial transit artifact” in the prediction of intracranial large artery stenosis and to determine if this finding is predictive of ischemic stroke in the territory of the involved artery. Material and Methods: The presence of arterial transit artifact (ATA) within the lumen of an intracranial large vessel was noted on three-dimensional time of flight (3D-TOF) magnetic resonance angiography (MRA) (ATA group). The patients with stenosis but with no ATA (no-ATA group), patients with total occlusion (total occlusion group), and patients with no stenosis/occlusion (normal group) were included in the analysis. Results: There were four groups of patients included in the final analysis, the ATA group (n = 22), the no-ATA group (n = 23), the normal group (n = 25), and the total occlusion group (n = 9). Among patients with any demonstrable stenosis (n = 45), the presence of ATA within the stenotic segment was predictive of stenosis of ≥56% (Sensitivity of 100% [85.2–100, 95% CI], specificity of 100% [86.4–100, 95% CI]), with area under curve of 1.0 (0.92–.0, 95% CI). The presence of intra-arterial ATA signal was significantly associated with ischemic stroke as compared with the no-ATA group (86.36% vs. 26.08%, P = 0.0003). Intraluminal ATA was found to be an independent predictor of infarction in the territory of the involved artery. Conclusion: Intraluminal ATA is predictive of stenosis of at least 56% in the involved artery on 3D-TOF MRA. Intraluminal ATA sign may be an independent predictor of infarction in the territory of the involved artery.

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Section: Discussioncontrasting

confidence: 46%

Intraluminal arterial transit artifact as a predictor of intracranial large artery stenosis on 3D time of flight MR angiography: Expanding the application of arterial spin labeling MRI in ischemic stroke

Peer

Singh

2023

JCIS

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“…In ASL for cerebral aneurysms, the pooled blood within the aneurysms can be detected by the ASL as trapped labeled spin within the aneurysm. 19 This ASL high signal was reported to be useful for detecting residual filling in cerebral aneurysms after treatment with flow diverter. 19 In our cases, ASL high signaling might reflect occlusion of the drainage system and subsequent pooled blood within the nidus, which facilitates rupture of the AVM.…”

Section: Discussionmentioning

confidence: 96%

“… 19 This ASL high signal was reported to be useful for detecting residual filling in cerebral aneurysms after treatment with flow diverter. 19 In our cases, ASL high signaling might reflect occlusion of the drainage system and subsequent pooled blood within the nidus, which facilitates rupture of the AVM. One of the conclusive mechanisms of AVM rupture is increased resistance in the drainage system.…”

Section: Discussionmentioning

confidence: 96%

Efficacy of arterial spin labeling for detection of the ruptured micro-arteriovenous malformation: illustrative cases

Kochi¹,

Endo

Uchida³

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Diagnosis of a microarteriovenous malformation (micro-AVM) is difficult, especially in the acute stage of rupture because of the small size of the nidus and the existence of hematoma. We report two cases of ruptured micro-AVMs detected by arterial spin labeling (ASL). OBSERVATIONS In one case, a 45-year-old male was transported with a complaint of right hemiparesis. Computed tomography (CT) revealed a right parietal lobar hemorrhage. Standard magnetic resonance imaging (MRI) showed no abnormal findings as the cause of the hemorrhage. ASL 23 days after the onset demonstrated high signals on the medial wall of the hematoma. Digital subtraction angiography (DSA) showed a micro-AVM in accordance with the site of high signals on ASL. In another case, a 38-year-old female was transported with a complaint of left hemianopsia. CT on admission revealed a right parietal lobar hemorrhage. Standard MRI showed no abnormal findings as the cause of the hemorrhage. ASL 15 days after the onset demonstrated high signals on the internal wall of the hematoma. DSA showed micro-AVM in accordance with the site of high signaling on ASL. Both cases were successfully treated with open surgery. LESSONS ASL can manifest micro-AVMs as high signals within the hematoma. ASL is a useful less-invasive screening tool for the detection of ruptured micro-AVMs.

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Arterial spin labeling detects trapped labeled spins in flow-diverted aneurysms and it reflects intra-aneurysmal flow stasis

Oki,

Tsuji,

Ishida

et al. 2024

Interv Neuroradiol

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Background This study evaluated arterial spin labeling (ASL) imaging findings in flow-diverted aneurysms (FD-ANs). Methods Twenty-one patients with internal carotid artery aneurysms treated with flow-diverter stent (FDS) were included. Time-of-flight magnetic resonance angiography (TOF-MRA) and ASL were performed before and after follow-up digital subtraction angiography (DSA) on the day, 6 months, and/or 1 year after treatment. Two radiologists rated the clarity of the depiction of FD-ANs for MRA on a 3-point scale and the ASL signal intensity of the aneurysm as negative or positive. A neurosurgeon assessed DSA findings using the O’Kelly–Marotta (OKM) grading scale, categorizing them into filling and stasis grades. The 23 examinations were classified according to the OKM grading scale, and the proportion of ASL-positive cases and the proportion of cases with MRA scores of 1–2 (detectable) were calculated for each grade. The relationship between the OKM grading scale and ASL positivity or MRA detectable was examined using Fisher's exact test. Results Of seven examinations where the statis grade was 1 or 2, no examinations showed ASL positivity. However, among the 16 examinations in which the stasis grade was 3, 9 examinations showed ASL positivity. A significant association was observed between stasis grade and ASL positivity ( p = 0.035). In contrast, no significant relationship was observed between the OKM grading scale and the MRA 3-point scale. Conclusion High-signal ASL in FD-ANs could reflect stasis within the aneurysm; therefore, noninvasive ASL can indicate reduction in intra-aneurysmal blood flow after treatment and reperfusion during posttreatment observation.

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“Trapped labelled spins”-related signal on arterial spin labelling in the assessment of flow-diverted aneurysms: preliminary experience

Cited by 3 publications

References 36 publications

Intraluminal arterial transit artifact as a predictor of intracranial large artery stenosis on 3D time of flight MR angiography: Expanding the application of arterial spin labeling MRI in ischemic stroke

Intraluminal arterial transit artifact as a predictor of intracranial large artery stenosis on 3D time of flight MR angiography: Expanding the application of arterial spin labeling MRI in ischemic stroke

Efficacy of arterial spin labeling for detection of the ruptured micro-arteriovenous malformation: illustrative cases

Arterial spin labeling detects trapped labeled spins in flow-diverted aneurysms and it reflects intra-aneurysmal flow stasis

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