Two-dimensional thick-slice MR digital subtraction angiography in the assessment of small to medium-size intracranial arteriovenous malformations

BACKGROUND: Cerebral digital subtraction angiography (DSA) has established impaired hemodynamic drainage of intracranial arteriovenous malformations (iAVM) as a risk factor for iAVM hemorrhage. Unlike conventional DSA, MR-DSA offers a noninvasive means of characterizing iAVM hemodynamics. We hypothesize that MR-DSA will demonstrate impaired drainage in iAVMs with history of rupture when compared to iAVMs without history of rupture. METHODS: Consecutive patients with untreated, DSA-confirmed iAVM underwent MR-DSA on a 3T Whole-body MR-scanner. For each iAVM, regions of interest (ROI) were drawn on all feeder arteries and draining veins. Time-density curves were constructed for each ROI. The arteriovenous malformation transit time (ATT) was defined for each ROI as the time between contrast arrival and peak intravascular contrast density on the MR time-density curve. The drainage of each iAVM was characterized by the ratio of the draining vein ATT to the mean feeder artery ATT. The ATT ratio was compared between iAVMs with history of hemorrhage and those without. Statistical analysis was performed using a Student’s unpaired t-test with p <0.05 defined as statistically significant. RESULTS: From May 2011 to April 2012, 13 patients (7M:6F, 40.6±13.8 years old) were enrolled in our study, with 3 patients presenting with history of hemorrhage and the remainder presenting with history of seizure, focal neurological deficit, headache, or as an incidental finding. The ATT ratio was significantly higher in iAVMs with history of hemorrhage than in those without (1.17±0.06 vs 0.95±0.02, p <2.9E-7). CONCLUSION: MR-DSA identifies impaired drainage in iAVMs with history of rupture without exposing patients to the procedural risks and ionizing radiation associated with cerebral DSA. FIGURE A: MR-DSA with feeder artery (red) and draining vein (yellow) labeled. FIGURE B: Time-density curves of the artery (red) and vein (yellow) from which vessel ATTs were derived.

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Distal lower extremity arteries: evaluation with two-dimensional MR digital subtraction angiography.

Radiology ◽

10.1148/radiology.207.2.9577502 ◽

1998 ◽

Vol 207 (2) ◽

pp. 505-512 ◽

Cited By ~ 52

Author(s):

H M Lee ◽

Y Wang ◽

H D Sostman ◽

L H Schwartz ◽

N M Khilnani ◽

...

Keyword(s):

Lower Extremity ◽

Digital Subtraction Angiography ◽

Two Dimensional ◽

Digital Subtraction

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Surgical management of cerebral arteriovenous malformations with intraoperative digital subtraction angiography

Journal of Clinical Neuroscience ◽

10.1054/jocn.2000.0707 ◽

2000 ◽

Vol 7 ◽

pp. 33-35 ◽

Cited By ~ 12

Author(s):

Hiroyuki Hashimoto ◽

Jun-ichi lida ◽

Yasuo Hironaka ◽

Toshisuke Sakaki

Keyword(s):

Digital Subtraction Angiography ◽

Surgical Management ◽

Arteriovenous Malformations ◽

Digital Subtraction ◽

Cerebral Arteriovenous Malformations

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Angioembolization of Scrotal Arteriovenous Malformations: A Case Report and Literature Review

Case Reports in Vascular Medicine ◽

10.1155/2020/8373816 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Ammar Mohammad ◽

Wael Sahyouni ◽

Taisser Almeree ◽

Bayan Alsaid

Keyword(s):

Computed Tomography ◽

Case Report ◽

Literature Review ◽

Digital Subtraction Angiography ◽

Acute Pain ◽

Arteriovenous Malformations ◽

Duplex Ultrasound ◽

Digital Subtraction ◽

Acute Bleeding ◽

Scrotal Mass

Arteriovenous malformations (AVMs) of the scrotum are rare lesions, usually diagnosed incidentally during the evaluation of scrotal masses or infertility. It could be presented with acute bleeding or acute pain. We are presenting a case of painless bilateral infiltrated scrotal mass (more advanced in the left side) developed dramatically over a year, no other symptoms existed. The diagnosis was made using duplex ultrasound (DUS), computed tomography arteriography (CTA), and digital subtraction angiography (DSA). Three sessions of angioembolization were performed and followed by surgical resection of the left side of the scrotum.

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Discrepancy between two-dimensional and three-dimensional digital subtraction angiography for the planning of endovascular coiling of small cerebral aneurysms <5 mm

Interventional Neuroradiology ◽

10.1177/1591019920925706 ◽

2020 ◽

Vol 26 (6) ◽

pp. 733-740

Author(s):

Te-Chang Wu ◽

Yu-Kun Tsui ◽

Tai-Yuan Chen ◽

Ching-Chung Ko ◽

Chien-Jen Lin ◽

...

Keyword(s):

Digital Subtraction Angiography ◽

Three Dimensional ◽

Cerebral Aneurysms ◽

Endovascular Coiling ◽

Parent Artery ◽

Two Dimensional ◽

Digital Subtraction ◽

Rotational Angiography ◽

Treatment Choices ◽

The Impact

Background To investigate the discrepancy between two-dimensional digital subtraction angiography and three-dimensional rotational angiography for small (<5 mm) cerebral aneurysms and the impact on decision making among neuro-interventional experts as evaluated by online questionnaire. Materials and methods Eight small (<5 mm) ruptured aneurysms were visually identified in 16 image sets in either two-dimensional or three-dimensional format for placement in a questionnaire for 11 invited neuro-interventionalists. For each set, two questions were posed: Question 1: “Which of the following is the preferred treatment choice: simple coiling, balloon remodeling or stent assisted coiling?”; Question 2: “Is it achievable to secure the aneurysm with pure simple coiling?” The discrepancies of angio-architecture parameters and treatment choices between two-dimensional-digital subtraction angiography and three-dimensional rotational angiography were evaluated. Results In all eight cases, the neck images via three-dimensional rotational angiography were larger than two-dimensional-digital subtraction angiography with a mean difference of 0.95 mm. All eight cases analyzed with three-dimensional rotational angiography, but only one case with two-dimensional-digital subtraction angiography were classified as wide-neck aneurysms with dome-to-neck ratio < 1.5. The treatment choices based on the two-dimensional or three-dimensional information were different in 56 of 88 (63.6%) paired answers. Simple coiling was the preferred choice in 66 (75%) and 26 (29.6%) answers based on two-dimensional and three-dimensional information, respectively. Three types of angio-architecture with a narrow gap between the aneurysm sidewall and parent artery were proposed as an explanation for neck overestimation with three-dimensional rotational angiography. Conclusions Aneurysm neck overestimation with three-dimensional rotational angiography predisposed neuro-interventionalists to more complex treatment techniques. Additional two-dimensional information is crucial for endovascular treatment planning for small cerebral aneurysms.

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COLOR INTENSITY PROJECTION OF DIGITALLY SUBTRACTED ANGIOGRAPHY FOR THE VISUALIZATION OF BRAIN ARTERIOVENOUS MALFORMATIONS

Neurosurgery ◽

10.1227/01.neu.0000255331.49791.b4 ◽

2007 ◽

Vol 60 (3) ◽

pp. 511-515 ◽

Cited By ~ 18

Author(s):

Keith S. Cover ◽

Frank J. Lagerwaard ◽

René van den Berg ◽

Dennis R. Buis ◽

Ben J. Slotman

Keyword(s):

Digital Subtraction Angiography ◽

Arteriovenous Malformations ◽

Color Image ◽

Circulatory System ◽

New Method ◽

Digital Subtraction ◽

Color Intensity ◽

Clinical Value ◽

Projection Images ◽

Grayscale Images

Abstract OBJECTIVE Reliable and rapid delineation of arteriovenous malformations enables the application of effective treatments such as stereotactic radiosurgery. We describe a new method to improve the speed and reliability of visualizing the flow of contrast images with digital subtraction angiography. METHODS In line with current practices, digital subtraction angiography was used to produce a sequence of grayscale images. The new method combines the standard grayscale images produced by digital subtraction angiography into a single composite color image that encodes the contrast arrival time at each point of the brain's circulatory system. The algorithm is simple, fast, and easy to implement. RESULTS The technique allows the flow of contrast from a series of angiography images to be summarized in a single color image. CONCLUSION This visualization method promises to improve the speed of manual delineation of arteriovenous malformations. Further studies are required to evaluate the clinical value of the use of color intensity projection images, supplemented by grayscale images as necessary, in comparison with contouring on grayscale images only.

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