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Integration of arterial spin labeling into stereotactic radiosurgery planning of cerebral arteriovenous malformations
Author(s) -
Ozyurt Onur,
Dincer Alp,
Erdem Yildiz Mehmet,
Peker Selcuk,
Yilmaz Meltem,
Sengoz Meric,
Ozturk Cengizhan
Publication year - 2017
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.25690
Subject(s) - radiosurgery , medicine , digital subtraction angiography , nuclear medicine , reproducibility , arteriovenous malformation , magnetic resonance angiography , arterial spin labeling , intraclass correlation , radiology , angiography , magnetic resonance imaging , radiation therapy , mathematics , statistics
Purpose To test whether the combined use of 4D arterial spin labeling angiography (4D ASL) and contrast‐enhanced magnetic resonance angiography (4D CE‐MRA) can work as a prospective alternative to digital subtraction angiography (DSA) for the delineation of the arteriovenous malformation (AVM) nidus in stereotactic radiosurgery (SRS) planning. Materials and Methods A custom 4D ASL sequence and a proof‐of‐concept software tool to integrate 4D ASL data to SRS planning were implemented. Ten AVM patients were scanned at 3T. Two observers independently contoured niduses in two separate sessions. Reference niduses were contoured using DSA, 4D ASL, and 4D CE‐MRA. Test niduses were contoured using 4D ASL and 4D CE‐MRA only. Reference and test niduses from both observers were compared in terms of volume, distance between centers of volumes (dCOV), and the Jaccard index (JI). Results In volume comparisons, excellent intraobserver and interobserver agreements were obtained (intraclass correlation coefficients: 0.99 and 0.98, respectively). Median dCOV, JIs between reference and test niduses were 0.55 mm, 0.78 for Observer 1 and were 0.6 mm, 0.78 for Observer 2. None of the dCOV and JI parameters varied significantly among the delineation methods or the observers ( P = 0.84, P = 0.39). Conclusion Our preliminary results indicate that reproducibility of the target volumes with high agreement levels is achievable without using DSA. The combined use of high temporal resolution 4D ASL and high spatial resolution and vessel‐to‐background contrast 4D CE‐MRA provided sufficient spatiotemporal angiographic information for the delineation of AVM niduses. Level of Evidence: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1718–1727.