Acceleration-selective arterial spin labeling MR angiography for visualization of brain arteriovenous malformations

Purpose To evaluate the performance of acceleration-selective arterial spin labeling (AccASL) MR angiography in the visualization of brain arteriovenous malformations (AVMs) in comparison with digital subtraction angiography (DSA) and time-of-flight (TOF) MR angiography. Methods Twenty-one patients with brain AVM (mean age 31.1 +/- 18.6 years; 11 males, 10 females) underwent TOF and AccASL MR angiography and DSA. Two neuroradiologists conducted an observer study for detection, nidus size, eloquence, venous drainage pattern, and Spetzler-Martin (SM) grade. The evaluations included the visualization of each AVM component with reference to DSA and assessments of contrast-to-noise ratio (CNR). The kappa statistic, repeated measures analysis of variance, Wilcoxon matched pairs test, and paired t test were used. Results Both observers detected more AVMs with AccASL (95.2%, 90.5% for Observers 1 and 2) than with TOF (76.2% and 71.4%, respectively). The inter-modality agreement between AccASL and DSA was almost perfect for the eloquence, venous drainage pattern, and SM grade for Observer 1 and moderate for the venous drainage pattern and substantial for the eloquence and SM grade for Observer 2. The visualization scores were higher with AccASL than with TOF for the feeding artery (AccASL, 4.5 +/- 1.0 vs. TOF, 3.9 +/- 1.5, p = 0.0214), nidus (4.6 +/- 1.1 vs. 3.2 +/- 1.5, p = 0.0006), and draining vein (4.6 +/- 1.0 vs. 2.2 +/- 1.1, p < 0.0001), respectively. The CNRs in the nidus were higher in AccASL than in TOF (29.9 +/- 16.7 vs. 20.8 +/- 16.5, p = 0.0002), as in the draining vein (23.2 +/- 13.0 vs. 12.6 +/- 12.0, p = 0.0010), respectively. Conclusions AccASL better visualized brain AVMs compared with TOF and was useful for grading without the use of contrast agents.