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Ertl, L.; Brückmann, H.; Kunz, M.; Patzig, M.; Brem, C.; Forbrig, R. and Fesl, G. (2016): Assessment and treatment planning of lateral intracranial dural arteriovenous fistulas in 3 T MRI and DSA: A detailed analysis under consideration of time-resolved imaging of contrast kinetics (TRICKS) and ce-MRA sequences. In: European Radiology, Vol. 26, No. 12: pp. 4284-4292

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Abstract

The current gold standard in the assessment of lateral intracranial dural arteriovenous fistulas (LDAVF) is digital subtraction angiography (DSA). However, magnetic resonance imaging (MRI) is a non-invasive emerging tool for the evaluation of such lesions. The aim of our study was to compare the DSA to our 3 T MR-imaging protocol including a highly spatial resolved (ce-MRA) and a temporal resolved ("time-resolved imaging of contrast kinetics", TRICKS) contrast-enhanced MR angiography to evaluate if solely DSA can remain the gold-standard imaging modality for the treatment planning of LDAVF. We retrospectively reviewed matched pairs of DSA and 3 T MRI examinations of 24 patients with LDAVF (03/2008-04/2014) by the same list of relevant criteria for an endovascular LDAVF treatment planning. In particular, we determined intermodality agreement for the Cognard classification, the identifeication of arterial feeders, and the detailed assessment of each venous drainage pattern. Intermodality agreement for the Cognard classification was excellent (A = 1.0). Whereas MRI failed in identifying small arterial feeders, it was superior to the DSA in the assessment of the sinus and the venous drainage pattern. The combination of MRI and DSA is the new gold standard in LDAVF treatment planning. aEuro cent DSA is superior to the MRI in detecting LDAVF arterial feeders. aEuro cent MRI excellently evaluates the venous side of an LDAVF. aEuro cent MRI can replace DSA in initial diagnosis and monitoring of LDAVF. aEuro cent MRI and DSA combined are the new gold standard in LDAVF treatment planning.

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