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Research ArticleNeurointervention

Assessment of 4D MR Angiography at 3T Compared with DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: A Dual-Center Study

B. Dissaux, F. Eugène, J. Ognard, J.-Y. Gauvrit, J.-C. Gentric and J.-C. Ferré
American Journal of Neuroradiology December 2020, DOI: https://doi.org/10.3174/ajnr.A6903
B. Dissaux
aFrom the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France
bDepartment of Medical Imaging (B.D., J.O., J.-C.G.), Centre Hospitalier Universitaire La Cavale Blanche, Brest, France
cGETBO group EA3878 (B.D., J.-C.G.), Université de Bretagne Occidentale, Brest, France
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F. Eugène
aFrom the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France
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J. Ognard
bDepartment of Medical Imaging (B.D., J.O., J.-C.G.), Centre Hospitalier Universitaire La Cavale Blanche, Brest, France
dLATIM U1101 (J.O.), INSERM, Université de Bretagne Occidentale, Brest, France
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J.-Y. Gauvrit
aFrom the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France
eEmpenn Unit U1228 (J.-Y.G., J.-C.F.), INSERM, INRIA, Université Rennes 1, Rennes, France.
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J.-C. Gentric
bDepartment of Medical Imaging (B.D., J.O., J.-C.G.), Centre Hospitalier Universitaire La Cavale Blanche, Brest, France
cGETBO group EA3878 (B.D., J.-C.G.), Université de Bretagne Occidentale, Brest, France
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J.-C. Ferré
aFrom the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France
eEmpenn Unit U1228 (J.-Y.G., J.-C.F.), INSERM, INRIA, Université Rennes 1, Rennes, France.
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    FIG 1.

    Flow chart.

  • FIG 2.
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    FIG 2.

    A, Sagittal MIP of 4D-MRA at arterial phase. B, Cerebral arteriography through the left vertebral artery in a sagittal view. The white arrow in A and the black arrow in B show early opacification of an epiphyseal vein, before the superior sagittal sinus, confirming an arteriovenous shunt. This examination was rated type III on both imaging modalities.

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    FIG 3.

    A, Sagittal MIP of 4D-MRA at late arterial phase. B, Cerebral arteriography through the left external carotid artery in a sagittal view. The black arrow in B shows early opacification of an occipital vein, confirming an arteriovenous shunt not found in A.

Tables

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    Table 1:

    Interreader disagreement in 4D-MRA residual/recurrent DAVF classification

    Dural Fistula Location4D-MRA Classification Reader 14D-MRA Classification Reader 24D-MRA Classification ConsensusDSA Classification4D-MRA Consensus Quality Score
    Hemispheric right0IIIIIIIII 3
    Parasagittal right0III00 3
    SSS0IIa00 1
    Epiphyseal0IIIIIIIII 3
    Sinus lateralis leftI0II 3
    MedullaIII00V 3
    • Note:—SSS indicates superior sagittal sinus.

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    Table 2:

    Contingency table of residual/recurrent DAVF grading according to technique (4D-MRA and DSA)a

    DSA4D-MRA
    No ShuntType IbType IIabType IIbcType IIa+bcType IIIcType IVcType Vc
    No shunt280001000
    Type Ib13000000
    Type IIab10300000
    Type IIbc00100000
    Type IIa + bc00000000
    Type IIIc40000430
    Type IVc10000000
    Type Vc10000000
    • ↵a Consensus grading according to Cognard et al.5

    • ↵b Low bleeding risk.

    • ↵c High bleeding risk.

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    Table 3:

    Intermodality discrepancy in residual/recurrent dural arteriovenous fistula detection and classificationa

    LocationPretreatment Grading4D-MRA/DSA Interval (Days)DSA Grading4D-MRA Consensus Grading4D-MRA Reader Disagreement (Yes/No)Year4D-MRA Consensus Quality ScorePossible Explanation
    Parasagittal rightIII65IV0No20103Confusion between occipital artery and a cortical vein
    Cavernous sinus rightIII59III0No20152Cortical vein visible but missed by 4D-MRA readers
    Transverse sinus leftIIb112I0No20172Artery and vein overlay
    SSSIIb1290IIa + bNo20123Early drainage due to a meningioma
    Cavernous sinus leftIII0III0No20153Cortical vein visible but missed by 4D-MRA readers
    Posterior fossa rightIV43III0No20093Early opacification of all dural sinuses; shunt missed due to misinterpretation of time sequence in 4D-MRA
    Sigmoid sinus leftIII2IIa0No20112Cortical vein visible but missed by 4D-MRA readers
    MedullaV3V0Yes (III/0)20113Not visible in the FOV
    Parieto-occipital leftIII85III0No20182Cortical vein visible but missed by 4D-MRA readers
    • Note:—SSS indicates superior sagittal sinus.

    • ↵a Grading according to Cognard et al.5

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B. Dissaux, F. Eugène, J. Ognard, J.-Y. Gauvrit, J.-C. Gentric, J.-C. Ferré
Assessment of 4D MR Angiography at 3T Compared with DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: A Dual-Center Study
American Journal of Neuroradiology Dec 2020, DOI: 10.3174/ajnr.A6903

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Assessment of 4D MR Angiography at 3T Compared with DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: A Dual-Center Study
B. Dissaux, F. Eugène, J. Ognard, J.-Y. Gauvrit, J.-C. Gentric, J.-C. Ferré
American Journal of Neuroradiology Dec 2020, DOI: 10.3174/ajnr.A6903
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