Non contrast, pseudo-continuous arterial spin labeling and accelerated 3-dimensional radial acquisition intracranial 3-dimensional magnetic resonance angiography for the detection and classification of intracranial arteriovenous shunts

Tilman Schubert; Zachary Clark; Carolina Sandoval-Garcia; Ryan Zea; Oliver Wieben; Huimin Wu; Patrick A. Turski; Kevin M. Johnson

doi:10.1097/RLI.0000000000000411

Non contrast, pseudo-continuous arterial spin labeling and accelerated 3-dimensional radial acquisition intracranial 3-dimensional magnetic resonance angiography for the detection and classification of intracranial arteriovenous shunts

Tilman Schubert, Zachary Clark, Carolina Sandoval-Garcia, Ryan Zea, Oliver Wieben, Huimin Wu, Patrick A. Turski, Kevin M. Johnson

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

Objectives: The aim of this study was to assess the sensitivity and specificity of pseudo-continuous arterial spin labeling (PCASL) magnetic resonance angiography (MRA) with 3-dimensional (3D) radial acquisition for the detection of intracranial arteriovenous (AV) shunts. Materials and Methods: A total of 32 patients who underwent PCASL-MRA, clinical magnetic resonance imaging (MRI)/MRA exam, and digital subtraction angiography (DSA) were included in this retrospective analysis. Twelve patients presented with AV shunts. Among these were 8 patients with AV malformations (AVM) and 4 patients with AV fistulas (AVF). The clinical MRI/MRA included 3D time-of-flight MRA in all cases and time-resolved, contrast-enhanced MRA in 9 cases (6 cases with AV shunting). Research MRI and clinical MRI were independently evaluated by 2 neuroradiologists blinded to patient history. A third radiologist evaluated DSA imaging. A diagnostic confidence score was used for the presence of abnormalities associated with AV shunting (1-5). The AVMs were characterized using the Spetzler-Martin scale, whereas AVFs were characterized using the Borden classification. Statistics were applied to assess intermodality agreement. Results: Compared with clinical MRA, noncontrast PCASL-MRA with 3D radial acquisition yielded excellent sensitivity and specificity for the detection of intracranial AV shunts (reader 1: 100%/100%, clinical MRA: 91.7%, 94.4%; reader 2: 91.7%/100%, clinical MRA: 91.7%/100%). Diagnostic confidence was 4.8/4.66 with PCASL-MRA and 4.25/4.66 with clinical MRA. For AVM characterization with PCASL-MRA, intermodality agreement with DSA showed values of 0.43 and 0.6 for readers 1 and 2, respectively. For AVF characterization, intermodality agreement showed values of 0.56 for both readers. Conclusion: Noncontrast PCASL-MRAwith 3D radial acquisition is a potential tool for the detection and characterization of intracranial AV shunts with a sensitivity and specificity equivalent or higher than routine clinical MRA.

Original language	English (US)
Pages (from-to)	80-86
Number of pages	7
Journal	Investigative Radiology
Volume	53
Issue number	2
DOIs	https://doi.org/10.1097/RLI.0000000000000411
State	Published - 2018
Externally published	Yes

Bibliographical note

Funding Information:
Received for publication May 23, 2017; and accepted for publication, after revision, July 26, 2017. From the *Department of Radiology, University of Wisconsin, Madison; †Clinic of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland; Departments of ‡Neurological Surgery, §Biostatistics and Medical Informatics, and ||Medical Physics, University of Wisconsin, Madison. Conflicts of interest and sources of funding: none declared. Funded by NIH R01NS066982, Clinical and Translational Science Award (CTSA) program through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The content is solely the responsibility of the au-thors and does not necessarily represent the official views of the NIH. Tilman Schubert is supported by a fellowship grant (Helmut-Hartweg-Fonds) from the Swiss Academy of Medical Sciences. Correspondence to: Tilman Schubert, MD, Clinic for Radiology and Nuclear Medicine, Basel University Hospital, Petersgraben 4, 4031 Basel, Switzerland. E-mail: tilman.schubert@usb.ch. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0020-9996/18/5302–0080 DOI: 10.1097/RLI.0000000000000411

Publisher Copyright:
© 2017 Wolters Kluwer Health, Inc. All rights reserved.

Keywords

Arteriovenous shunting
Magnetic resonance angiography
Noncontrast

Access

10.1097/RLI.0000000000000411

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5746460

OpenUrl availability

Full text

Fingerprint

Dive into the research topics of 'Non contrast, pseudo-continuous arterial spin labeling and accelerated 3-dimensional radial acquisition intracranial 3-dimensional magnetic resonance angiography for the detection and classification of intracranial arteriovenous shunts'. Together they form a unique fingerprint.

Cite this

Schubert, T., Clark, Z., Sandoval-Garcia, C., Zea, R., Wieben, O., Wu, H., Turski, P. A., & Johnson, K. M. (2018). Non contrast, pseudo-continuous arterial spin labeling and accelerated 3-dimensional radial acquisition intracranial 3-dimensional magnetic resonance angiography for the detection and classification of intracranial arteriovenous shunts. Investigative Radiology, 53(2), 80-86. https://doi.org/10.1097/RLI.0000000000000411

Non contrast, pseudo-continuous arterial spin labeling and accelerated 3-dimensional radial acquisition intracranial 3-dimensional magnetic resonance angiography for the detection and classification of intracranial arteriovenous shunts. / Schubert, Tilman; Clark, Zachary; Sandoval-Garcia, Carolina et al.
In: Investigative Radiology, Vol. 53, No. 2, 2018, p. 80-86.

Research output: Contribution to journal › Article › peer-review

Schubert, T, Clark, Z, Sandoval-Garcia, C, Zea, R, Wieben, O, Wu, H, Turski, PA & Johnson, KM 2018, 'Non contrast, pseudo-continuous arterial spin labeling and accelerated 3-dimensional radial acquisition intracranial 3-dimensional magnetic resonance angiography for the detection and classification of intracranial arteriovenous shunts', Investigative Radiology, vol. 53, no. 2, pp. 80-86. https://doi.org/10.1097/RLI.0000000000000411

Schubert T, Clark Z, Sandoval-Garcia C, Zea R, Wieben O, Wu H et al. Non contrast, pseudo-continuous arterial spin labeling and accelerated 3-dimensional radial acquisition intracranial 3-dimensional magnetic resonance angiography for the detection and classification of intracranial arteriovenous shunts. Investigative Radiology. 2018;53(2):80-86. doi: 10.1097/RLI.0000000000000411

Schubert, Tilman ; Clark, Zachary ; Sandoval-Garcia, Carolina et al. / Non contrast, pseudo-continuous arterial spin labeling and accelerated 3-dimensional radial acquisition intracranial 3-dimensional magnetic resonance angiography for the detection and classification of intracranial arteriovenous shunts. In: Investigative Radiology. 2018 ; Vol. 53, No. 2. pp. 80-86.

@article{90ff77e7bdb14079846e635b2c62c91b,

title = "Non contrast, pseudo-continuous arterial spin labeling and accelerated 3-dimensional radial acquisition intracranial 3-dimensional magnetic resonance angiography for the detection and classification of intracranial arteriovenous shunts",

abstract = "Objectives: The aim of this study was to assess the sensitivity and specificity of pseudo-continuous arterial spin labeling (PCASL) magnetic resonance angiography (MRA) with 3-dimensional (3D) radial acquisition for the detection of intracranial arteriovenous (AV) shunts. Materials and Methods: A total of 32 patients who underwent PCASL-MRA, clinical magnetic resonance imaging (MRI)/MRA exam, and digital subtraction angiography (DSA) were included in this retrospective analysis. Twelve patients presented with AV shunts. Among these were 8 patients with AV malformations (AVM) and 4 patients with AV fistulas (AVF). The clinical MRI/MRA included 3D time-of-flight MRA in all cases and time-resolved, contrast-enhanced MRA in 9 cases (6 cases with AV shunting). Research MRI and clinical MRI were independently evaluated by 2 neuroradiologists blinded to patient history. A third radiologist evaluated DSA imaging. A diagnostic confidence score was used for the presence of abnormalities associated with AV shunting (1-5). The AVMs were characterized using the Spetzler-Martin scale, whereas AVFs were characterized using the Borden classification. Statistics were applied to assess intermodality agreement. Results: Compared with clinical MRA, noncontrast PCASL-MRA with 3D radial acquisition yielded excellent sensitivity and specificity for the detection of intracranial AV shunts (reader 1: 100%/100%, clinical MRA: 91.7%, 94.4%; reader 2: 91.7%/100%, clinical MRA: 91.7%/100%). Diagnostic confidence was 4.8/4.66 with PCASL-MRA and 4.25/4.66 with clinical MRA. For AVM characterization with PCASL-MRA, intermodality agreement with DSA showed values of 0.43 and 0.6 for readers 1 and 2, respectively. For AVF characterization, intermodality agreement showed values of 0.56 for both readers. Conclusion: Noncontrast PCASL-MRAwith 3D radial acquisition is a potential tool for the detection and characterization of intracranial AV shunts with a sensitivity and specificity equivalent or higher than routine clinical MRA.",

keywords = "Arteriovenous shunting, Magnetic resonance angiography, Noncontrast",

author = "Tilman Schubert and Zachary Clark and Carolina Sandoval-Garcia and Ryan Zea and Oliver Wieben and Huimin Wu and Turski, {Patrick A.} and Johnson, {Kevin M.}",

note = "Funding Information: Received for publication May 23, 2017; and accepted for publication, after revision, July 26, 2017. From the *Department of Radiology, University of Wisconsin, Madison; †Clinic of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland; Departments of ‡Neurological Surgery, §Biostatistics and Medical Informatics, and ||Medical Physics, University of Wisconsin, Madison. Conflicts of interest and sources of funding: none declared. Funded by NIH R01NS066982, Clinical and Translational Science Award (CTSA) program through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The content is solely the responsibility of the au-thors and does not necessarily represent the official views of the NIH. Tilman Schubert is supported by a fellowship grant (Helmut-Hartweg-Fonds) from the Swiss Academy of Medical Sciences. Correspondence to: Tilman Schubert, MD, Clinic for Radiology and Nuclear Medicine, Basel University Hospital, Petersgraben 4, 4031 Basel, Switzerland. E-mail: tilman.schubert@usb.ch. Copyright {\textcopyright} 2017 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0020-9996/18/5302–0080 DOI: 10.1097/RLI.0000000000000411 Publisher Copyright: {\textcopyright} 2017 Wolters Kluwer Health, Inc. All rights reserved.",

year = "2018",

doi = "10.1097/RLI.0000000000000411",

language = "English (US)",

volume = "53",

pages = "80--86",

journal = "Investigative Radiology",

issn = "0020-9996",

publisher = "Lippincott Williams and Wilkins",

number = "2",

}

TY - JOUR

T1 - Non contrast, pseudo-continuous arterial spin labeling and accelerated 3-dimensional radial acquisition intracranial 3-dimensional magnetic resonance angiography for the detection and classification of intracranial arteriovenous shunts

AU - Schubert, Tilman

AU - Clark, Zachary

AU - Sandoval-Garcia, Carolina

AU - Zea, Ryan

AU - Wieben, Oliver

AU - Wu, Huimin

AU - Turski, Patrick A.

AU - Johnson, Kevin M.

N1 - Funding Information: Received for publication May 23, 2017; and accepted for publication, after revision, July 26, 2017. From the *Department of Radiology, University of Wisconsin, Madison; †Clinic of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland; Departments of ‡Neurological Surgery, §Biostatistics and Medical Informatics, and ||Medical Physics, University of Wisconsin, Madison. Conflicts of interest and sources of funding: none declared. Funded by NIH R01NS066982, Clinical and Translational Science Award (CTSA) program through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The content is solely the responsibility of the au-thors and does not necessarily represent the official views of the NIH. Tilman Schubert is supported by a fellowship grant (Helmut-Hartweg-Fonds) from the Swiss Academy of Medical Sciences. Correspondence to: Tilman Schubert, MD, Clinic for Radiology and Nuclear Medicine, Basel University Hospital, Petersgraben 4, 4031 Basel, Switzerland. E-mail: tilman.schubert@usb.ch. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0020-9996/18/5302–0080 DOI: 10.1097/RLI.0000000000000411 Publisher Copyright: © 2017 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2018

Y1 - 2018

N2 - Objectives: The aim of this study was to assess the sensitivity and specificity of pseudo-continuous arterial spin labeling (PCASL) magnetic resonance angiography (MRA) with 3-dimensional (3D) radial acquisition for the detection of intracranial arteriovenous (AV) shunts. Materials and Methods: A total of 32 patients who underwent PCASL-MRA, clinical magnetic resonance imaging (MRI)/MRA exam, and digital subtraction angiography (DSA) were included in this retrospective analysis. Twelve patients presented with AV shunts. Among these were 8 patients with AV malformations (AVM) and 4 patients with AV fistulas (AVF). The clinical MRI/MRA included 3D time-of-flight MRA in all cases and time-resolved, contrast-enhanced MRA in 9 cases (6 cases with AV shunting). Research MRI and clinical MRI were independently evaluated by 2 neuroradiologists blinded to patient history. A third radiologist evaluated DSA imaging. A diagnostic confidence score was used for the presence of abnormalities associated with AV shunting (1-5). The AVMs were characterized using the Spetzler-Martin scale, whereas AVFs were characterized using the Borden classification. Statistics were applied to assess intermodality agreement. Results: Compared with clinical MRA, noncontrast PCASL-MRA with 3D radial acquisition yielded excellent sensitivity and specificity for the detection of intracranial AV shunts (reader 1: 100%/100%, clinical MRA: 91.7%, 94.4%; reader 2: 91.7%/100%, clinical MRA: 91.7%/100%). Diagnostic confidence was 4.8/4.66 with PCASL-MRA and 4.25/4.66 with clinical MRA. For AVM characterization with PCASL-MRA, intermodality agreement with DSA showed values of 0.43 and 0.6 for readers 1 and 2, respectively. For AVF characterization, intermodality agreement showed values of 0.56 for both readers. Conclusion: Noncontrast PCASL-MRAwith 3D radial acquisition is a potential tool for the detection and characterization of intracranial AV shunts with a sensitivity and specificity equivalent or higher than routine clinical MRA.

AB - Objectives: The aim of this study was to assess the sensitivity and specificity of pseudo-continuous arterial spin labeling (PCASL) magnetic resonance angiography (MRA) with 3-dimensional (3D) radial acquisition for the detection of intracranial arteriovenous (AV) shunts. Materials and Methods: A total of 32 patients who underwent PCASL-MRA, clinical magnetic resonance imaging (MRI)/MRA exam, and digital subtraction angiography (DSA) were included in this retrospective analysis. Twelve patients presented with AV shunts. Among these were 8 patients with AV malformations (AVM) and 4 patients with AV fistulas (AVF). The clinical MRI/MRA included 3D time-of-flight MRA in all cases and time-resolved, contrast-enhanced MRA in 9 cases (6 cases with AV shunting). Research MRI and clinical MRI were independently evaluated by 2 neuroradiologists blinded to patient history. A third radiologist evaluated DSA imaging. A diagnostic confidence score was used for the presence of abnormalities associated with AV shunting (1-5). The AVMs were characterized using the Spetzler-Martin scale, whereas AVFs were characterized using the Borden classification. Statistics were applied to assess intermodality agreement. Results: Compared with clinical MRA, noncontrast PCASL-MRA with 3D radial acquisition yielded excellent sensitivity and specificity for the detection of intracranial AV shunts (reader 1: 100%/100%, clinical MRA: 91.7%, 94.4%; reader 2: 91.7%/100%, clinical MRA: 91.7%/100%). Diagnostic confidence was 4.8/4.66 with PCASL-MRA and 4.25/4.66 with clinical MRA. For AVM characterization with PCASL-MRA, intermodality agreement with DSA showed values of 0.43 and 0.6 for readers 1 and 2, respectively. For AVF characterization, intermodality agreement showed values of 0.56 for both readers. Conclusion: Noncontrast PCASL-MRAwith 3D radial acquisition is a potential tool for the detection and characterization of intracranial AV shunts with a sensitivity and specificity equivalent or higher than routine clinical MRA.

KW - Arteriovenous shunting

KW - Magnetic resonance angiography

KW - Noncontrast

UR - http://www.scopus.com/inward/record.url?scp=85043701622&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85043701622&partnerID=8YFLogxK

U2 - 10.1097/RLI.0000000000000411

DO - 10.1097/RLI.0000000000000411

M3 - Article

C2 - 28937545

AN - SCOPUS:85043701622

SN - 0020-9996

VL - 53

SP - 80

EP - 86

JO - Investigative Radiology

JF - Investigative Radiology

IS - 2

ER -

Non contrast, pseudo-continuous arterial spin labeling and accelerated 3-dimensional radial acquisition intracranial 3-dimensional magnetic resonance angiography for the detection and classification of intracranial arteriovenous shunts

Abstract

Bibliographical note

Keywords

Access

OpenUrl availability

Other files and links

Fingerprint

Cite this