Eur Radiol (2006) 16: 583–591
DOI 10.1007/s00330-005-0011-6
NEURO
Jean-Yves Gauvrit
Catherine Oppenheim
Francois Nataf
Olivier Naggara
Denis Trystram
Thierry Munier
Daniel Fredy
Jean-Pierre Pruvo
François-Xavier Roux
Xavier Leclerc
Jean-François Meder
Received: 7 April 2005
Revised: 19 July 2005
Accepted: 18 August 2005
Published online: 12 October 2005
# Springer-Verlag 2005
Three-dimensional dynamic magnetic
resonance angiography for the evaluation
of radiosurgically treated cerebral
arteriovenous malformations
Abstract We assessed the value of
three-dimensional (3D) dynamic
magnetic resonance angiography
(MRA) for the follow-up of patients
with radiosurgically treated cerebral
arteriovenous malformations (AVMs).
Fifty-four patients with cerebral
AVMs treated by radiosurgery (RS)
were monitored using conventional
catheter angiography (CCA) and 3D
dynamic MRA with sensitivity en-
coding based on the parallel imaging.
Cerebral AVM was qualitatively clas-
sified by two radiologists into one of
five categories in terms of residual
nidus size and persistence of early
draining vein (I, >6 cm; II, 3–6 cm; III,
<3 cm; IV, isolated early draining
vein; V, complete obliteration). 3D
MRA findings showed a good agree-
ment with CCA in 40 cases (κ=0.62).
Of 23 nidus detected on CCA, 3D
dynamic MRA showed 14 residual
nidus. Of 28 occluded nidus on 3D
dynamic MRA, 22 nidus were oc-
cluded on CCA. The sensitivity and
specificity of 3D dynamic MRA for
the detection of residual AVM were
81% and 100%. 3D dynamic MRA
after RS may therefore be useful in
association with MRI and can be
repeated as long as opacification of the
nidus or early venous drainage per-
sists, one CCA remaining indispens-
able to affirm the complete occlusion
at the end of follow-up.
Keywords Cerebral arteriovenous
malformation
.
Radiosurgery
.
Dynamic three-dimensional magnetic
resonance angiography
Introduction
Complete obliteration of cerebral arteriovenous malforma-
tions (AVMs) after radiosurgery (RS) can occur as early as
4 months or as late as 5 years after treatment; this vasooc-
clusive effect often developing slowly and progressively.
Because the risk of bleeding persists as long as complete
obliteration is not obtained, the time course of nidus
changes after RS is crucial for patient management. Con-
ventional catheter angiography (CCA) is essential at the
end of follow-up to confirm complete occlusion and to
stop annual imaging follow-up [1]. For intermediate con-
trols magnetic resonance angiography (MRA) with time of
flight (TOF) or phase contrast techniques or computed
tomography angiography (CTA) are usually used as an
alternative to CCA for the assessment of cerebral vascular
diseases [2–5]. For the assessment of cerebral AVMs,
however, most teams consider this technique as an ad-
ditional tool since its limited temporal resolution and lack
of hemodynamic information do not allow the arterial
J.-Y. Gauvrit (*)
.
J.-P. Pruvo
.
X. Leclerc
Department of Neuroradiology,
EA 2691, Roger Salengro Hospital,
rue du Pr. E Laine,
59037 Lille, France
e-mail: jygauvrit@chru-lille.fr
Tel.: +33-3-20446468
Fax: +33-3-20446488
J.-Y. Gauvrit
.
C. Oppenheim
.
O. Naggara
.
D. Trystram
.
D. Fredy
.
J.-F. Meder
Department of Neuroradiology,
Sainte-Anne Hospital,
1 rue Cabanis,
75674 Paris cedex 14, France
F. Nataf
.
F.-X. Roux
Department of Neurosurgery,
Sainte-Anne Hospital,
1 rue Cabanis,
75674 Paris cedex 14, France
T. Munier
General Electric Healthcare Technologies,
283 rue Minière,
78530 Buc, France