A new time-resolved 3D angiographic technique (4D DSA): Description, and assessment of its reliability in Spetzler–Martin grading of cerebral arteriovenous malformations - 28/05/18
, Elsa Magro b, c, Jildaz Caroff d, Douraied Ben Salem a, b, Sebastien Andouard e, Michel Nonent a, f, Jean-Christophe Gentric a, fBienvenue sur EM-consulte, la référence des professionnels de santé.
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| pages | 9 |
| Iconographies | 5 |
| Vidéos | 0 |
| Autres | 0 |
Highlights |
• | 4D DSA is a new angiographic technique providing volumetric information resolved in time that is useful in characterizing cerebral arteriovenous malformations. |
• | 4D DSA provides reliable Spetzler–Martin grades studying cerebral arteriovenous malformations. (2D DSA/4D DSA intermodality agreement κ=0.76). |
• | Inter- and intra-observer agreement in 4D DSA are similar to the gold standard 2D DSA considering Spetzler–Martin grading of cerebral arteriovenous malformations. |
• | In an initial angiographic characterization of an AVM, the use of a single 4D DSA acquisition increases only about 6% the total dose (KAP, dose to the skin). |
Abstract |
Background and purpose |
The Spetzler and Martin (SM) cerebral arteriovenous malformation (AVM) classification is a widely used 5-tier classification. This common language allows specialists to exchange about AVMs and must be reliably characterized by the imaging methods. We presented an agreement study on a new method of digital subtracted 3D rotational angiography resolved in time (four-dimensional DSA: 4D DSA) compared to the gold standard (two-dimensional DSA: 2D DSA) in AVM grading using the SM classification.
Methods |
Ten patients with AVMs were included during one year, they had an angiographic exploration with both 4D DSA and 2D DSA. Three readers assessed the SM classification. One reader conducted a second reading. The inter-, intra-observer and intermodality agreements were calculated by Kappas. Dose to patient was reported.
Results |
Considering the SM grade, the inter-observer agreement between 4D DSA and 2D DSA was equivalent (κ=0.45 and 0.46), and calculated as substantial κ=0.76 between the 2 methods. The agreement between 4D DSA and 2D DSA was calculated as moderate κ=0.46 assessing the size of the nidus, slight κ=0.18 analyzing the drainage and almost perfect κ=0.95 depicting the localization. 4D DSA performed during a standard initial angiographic assessment of AVM represented approximately 6% of the total dose.
Conclusion |
The addition of this new technique 4D DSA could be performed regularly in addition to the 2D DSA if available, to assess SM grading, with an acceptable exposure to ionizing radiation.
Le texte complet de cet article est disponible en PDF.Keywords : 4D DSA, Time-resolved angiography, Spetzler–Martin, AVM
Abbreviations : 2D, 3D, 4D, KAP, SM, VRT
Plan
Vol 45 - N° 3
P. 177-185 - mai 2018 Retour au numéro
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