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Detection and Classification of Cranial Dural Arteriovenous Fistulas Using 4D-CT Angiography: Initial Experience

Detection and Classification of Cranial Dural Arteriovenous Fistulas Using 4D-CT Angiography:... This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A2248v1 ajnr.A2248v2 32/1/49 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Willems, P. W. A. Articles by Krings, T. PubMed PubMed Citation Articles by Willems, P. W. A. Articles by Krings, T. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 32:49-53, January 2011 © 2011 American Society of Neuroradiology BRAIN Detection and Classification of Cranial Dural Arteriovenous Fistulas Using 4D-CT Angiography: Initial Experience P.W.A. Willems a , P.A. Brouwer a , J.J. Barfett b , K.G. terBrugge a ,b and T. Krings b a From the Department of Radiology (P.W.A.W., P.A.B., K.G.t.), Leiden University Medical Center, Leiden, the Netherlands b Department of Medical Imaging (J.J.B., K.G.t., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada. Please address correspondence to P.W.A. Willems, MD, PhD, Department of Radiology, Leiden University Medical Center, Postal Zone C2-S, PO Box 9600, 2300 RC Leiden, the Netherlands; e-mail: p.w.a.willems@lumc.nl BACKGROUND AND PURPOSE: The criterion standard to diagnose and classify cranial DAVFs is DSA. Since this is invasive, relatively expensive and time-consuming, a noninvasive alternative is of interest. We aimed to evaluate the capabilities and pitfalls of 4D-CTA in a consecutive series of patients who presented with a newly diagnosed cranial DAVF, as demonstrated by conventional DSA. MATERIALS AND METHODS: Eleven patients were included in this study after biplane DSA demonstrated a cranial DAVF. They subsequently underwent 4D-CTA imaging by using a 320-detector CT scanner. DSA and 4D-CTA studies were independently read by 2 blinded observers, by using a standardized scoring sheet. 4D-CTA results were analyzed with DSA as the criterion standard. RESULTS: In 10 cases, there was full agreement between DSA and 4D-CTA regarding the Borden classification. However, in the remaining patient, a slow-filling DAVF with a low shunt volume was missed by both readers on 4D-CTA. In all 10 detected cases, 1 of the major contributing arteries could be identified with 4D-CTA. Although, by using DSA, the 2 observers identified additional arterial feeders in 7 and 8 cases, respectively, these discrepancies did not influence clinical decision making. CONCLUSIONS: Although novel 4D-CTA imaging may not rule out a small slow-flow DAVF, it appears to be a valuable new adjunct in the noninvasive diagnostic work-up, treatment planning, and follow-up of patients with cranial DAVFs. Abbreviations: CTA, CT angiography • DAVF, dural arteriovenous fistula • 4D-CTA, 4D (time-resolved) CTA • DSA, digital subtraction angiography • ECA, external carotid artery • ICA, internal carotid artery • IV, intravenous • MRA, MR angiography • trMRA, time-resolved MRA • VA, vertebral artery Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2011 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Detection and Classification of Cranial Dural Arteriovenous Fistulas Using 4D-CT Angiography: Initial Experience

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2011 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A2248
Publisher site
See Article on Publisher Site

Abstract

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A2248v1 ajnr.A2248v2 32/1/49 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Willems, P. W. A. Articles by Krings, T. PubMed PubMed Citation Articles by Willems, P. W. A. Articles by Krings, T. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 32:49-53, January 2011 © 2011 American Society of Neuroradiology BRAIN Detection and Classification of Cranial Dural Arteriovenous Fistulas Using 4D-CT Angiography: Initial Experience P.W.A. Willems a , P.A. Brouwer a , J.J. Barfett b , K.G. terBrugge a ,b and T. Krings b a From the Department of Radiology (P.W.A.W., P.A.B., K.G.t.), Leiden University Medical Center, Leiden, the Netherlands b Department of Medical Imaging (J.J.B., K.G.t., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada. Please address correspondence to P.W.A. Willems, MD, PhD, Department of Radiology, Leiden University Medical Center, Postal Zone C2-S, PO Box 9600, 2300 RC Leiden, the Netherlands; e-mail: p.w.a.willems@lumc.nl BACKGROUND AND PURPOSE: The criterion standard to diagnose and classify cranial DAVFs is DSA. Since this is invasive, relatively expensive and time-consuming, a noninvasive alternative is of interest. We aimed to evaluate the capabilities and pitfalls of 4D-CTA in a consecutive series of patients who presented with a newly diagnosed cranial DAVF, as demonstrated by conventional DSA. MATERIALS AND METHODS: Eleven patients were included in this study after biplane DSA demonstrated a cranial DAVF. They subsequently underwent 4D-CTA imaging by using a 320-detector CT scanner. DSA and 4D-CTA studies were independently read by 2 blinded observers, by using a standardized scoring sheet. 4D-CTA results were analyzed with DSA as the criterion standard. RESULTS: In 10 cases, there was full agreement between DSA and 4D-CTA regarding the Borden classification. However, in the remaining patient, a slow-filling DAVF with a low shunt volume was missed by both readers on 4D-CTA. In all 10 detected cases, 1 of the major contributing arteries could be identified with 4D-CTA. Although, by using DSA, the 2 observers identified additional arterial feeders in 7 and 8 cases, respectively, these discrepancies did not influence clinical decision making. CONCLUSIONS: Although novel 4D-CTA imaging may not rule out a small slow-flow DAVF, it appears to be a valuable new adjunct in the noninvasive diagnostic work-up, treatment planning, and follow-up of patients with cranial DAVFs. Abbreviations: CTA, CT angiography • DAVF, dural arteriovenous fistula • 4D-CTA, 4D (time-resolved) CTA • DSA, digital subtraction angiography • ECA, external carotid artery • ICA, internal carotid artery • IV, intravenous • MRA, MR angiography • trMRA, time-resolved MRA • VA, vertebral artery Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2011 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Jan 1, 2011

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