Cerebral vascular malformations: Time-resolved CT angiography compared to DSA

Abstract

Purpose: The purpose of this article is to prospectively test the hypothesis that time-resolved CT angiography (TRCTA) on a Toshiba 320-slice CT scanner enables the same characterization of cerebral vascular malformation (CVM) including arteriovenous malformation (AVM), dural arteriovenous fistula (DAVF), pial arteriovenous fistula (PAVF) and developmental venous anomaly (DVA) compared to digital subtraction angiography (DSA).

Materials and methods: Eighteen (eight males, 10 females) consecutive patients (11 AVM, four DAVF, one PAVF, and two DVA) underwent 19 TRCTA (Aquillion one, Toshiba) for suspected CVM diagnosed on routine CT or MRI. One patient with a dural AVF underwent TRCTA and DSA twice before and after treatment. Of the 18 patients, 13 were followed with DSA (Artis, Siemens) within two months of TRCTA. Twenty-three sequential volume acquisitions of the whole head were acquired after injection of 50 ml contrast at the rate of 4 ml/sec. Two patients with DVA did not undergo DSA. Two TRCTA were not assessed because of technical problems.TRCTAs were independently reviewed by two neuroradiologists and DSA by two other neuroradiologists and graded according to the Spetzler-Martin classification, Borden classification, overall diagnostic quality, and level of confidence. Weighted kappa coefficients (k) were calculated to compare reader's assessment of DSA vs TRCTA.

Results: There was excellent (k = 0.83 and 1) to good (k = 0.56, 0.61, 0.65 and 0.67) agreement between the different possible pairs of neuroradiologists for the assessment of vascular malformations.

Conclusion: TRCTA may be a sufficient noninvasive substitute for conventional DSA in certain clinical situations.

Keywords: arterio-venous fistula; arterio-venous malformation; digital subtraction angiogram; time resolved CT angiogram.

© The Author(s) 2015.

Figures

Figure 1.

A 50-year-old woman with right temporo-occipital AVM. Lateral (a) and oblique (b) projection of TRCTA and lateral (c) and oblique (d) views of DSA show arterial feeders from multiple temporal branches of the right middle cerebral artery. The AVM has a superficial drainage into the superior sagittal sinus (Spetzler-Martin grade 3). AVM: arteriovenous malformation; TRCTA: time-resolved computed tomography angiogram; DSA: digital subtraction angiography.

Figure 2.

A 36-year-old woman with right orbital AVF. Lateral (a) projection of TRCTA and lateral (b) views of DSA show a very similar picture of arterial feeders from the branches of right middle meningeal artery. The AVF has a drainage into the facial veins with no cortical venous reflux (Borden type 1). AVF: arteriovenous fistula; TRCTA: time-resolved computed tomography angiogram; DSA: digital subtraction angiography.

Figure 3.

The patient population and the result of TRCTA and CCA. TRCTA: time-resolved computed tomography angiogram; CCA: conventional catheter angiogram; AVM: arteriovenous malformation; AVF: arteriovenous fistula; DVA: developmental venous anomaly; DSA: digital subtraction angiography; CTA: computed tomography angiography.