A new time-resolved 3D angiographic technique (4D DSA): description, and assessment of its reliability in Spetzler-Martin grading of cerebral arteriovenous malformations

Publication date: Available online 20 December 2017
Source:Journal of Neuroradiology
Author(s): Julien Ognard, Elsa Magro, Jildaz Caroff, Douraied Ben Salem, Sebastien Andouard, Michel Nonent, Jean-Christophe Gentric
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 digital 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 inter-modality agreements were calculated by Kappas. Dose to patient was reported. Results: Considering the SM grade, the interobserver 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 cost.



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