4D Radial-Sliding Window MR Angiograpy of Intracranial Arteriovenous Malformations: Correlation with Digital Subtraction Angiography

INTRODUCTION Intracranial arteriovenous malformations (iAVMs) are responsible for the majority of intracranial hemorrhages and confer significant morbidity and mortality in young adults. Expectant management, eventual therapy, and post-procedural follow up of iAVMs require detailed vascular imaging studies to delineate the angioarchitecture of the lesion, the surrounding normal vascular environment, and persistence of the vascular lesion after treatment, namely microsurgical, endovascular, radiosurgery, or combination. The current gold standard for imaging iAVMs involve catheter-based techniques, namely cerebral digital subtraction angiography (DSA), due mainly to its high spatial (0.2mm) and temporal (up to 24 frames/sec) resolution capabilities. However, acquiring DSA images presents some procedural risks to the patient (0.5-12.2%), including risk of thromboembolic complications, vascular injury, and exposure to radiation and iodinated-contrast dyes. Furthermore, iAVM patients likely require multiple follow-up imaging sessions, thus further increasing their exposure to procedural risks. As such, non-invasive imaging techniques have been desired. Recently, CE-MRA sequences have been developed with increasing temporal resolution using novel signal acquisition sequences, e.g., 4D CE-MRA with radial sliding window (4D RS-MRA), which allows the non-invasive acquisition of diagnostic quality images at a high enough frame rate (~6 frames/sec) such that the phases of intracranial circulation are separately captured, allowing the separation of arterial and venous phases. In this technical report, we imaged intracranial AVMs using 4D RS-MRA at 3T and verified the grading of these AVMs between our sequences and DSA from the same patient