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High-resolution 3D volumetric contrast-enhanced MR angiography with a blood pool agent (ferumoxytol) for diagnostic evaluation of pediatric brain arteriovenous malformations.

Publication ,  Conference
Iv, M; Choudhri, O; Dodd, RL; Vasanawala, SS; Alley, MT; Moseley, M; Holdsworth, SJ; Grant, G; Cheshier, S; Yeom, KW
Published in: J Neurosurg Pediatr
September 2018

OBJECTIVE Patients with brain arteriovenous malformations (AVMs) often require repeat imaging with MRI or MR angiography (MRA), CT angiography (CTA), and digital subtraction angiography (DSA). The ideal imaging modality provides excellent vascular visualization without incurring added risks, such as radiation exposure. The purpose of this study is to evaluate the performance of ferumoxytol-enhanced MRA using a high-resolution 3D volumetric sequence (fe-SPGR) for visualizing and grading pediatric brain AVMs in comparison with CTA and DSA, which is the current imaging gold standard. METHODS In this retrospective cohort study, 21 patients with AVMs evaluated by fe-SPGR, CTA, and DSA between April 2014 and August 2017 were included. Two experienced raters graded AVMs using Spetzler-Martin criteria on all imaging studies. Lesion conspicuity (LC) and diagnostic confidence (DC) were assessed using a 5-point Likert scale, and interrater agreement was determined. The Kruskal-Wallis test was performed to assess the raters' grades and scores of LC and DC, with subsequent post hoc pairwise comparisons to assess for statistically significant differences between pairs of groups at p < 0.05. RESULTS Assigned Spetzler-Martin grades for AVMs on DSA, fe-SPGR, and CTA were not significantly different (p = 0.991). LC and DC scores were higher with fe-SPGR than with CTA (p < 0.05). A significant difference in LC scores was found between CTA and fe-SPGR (p < 0.001) and CTA and DSA (p < 0.001) but not between fe-SPGR and DSA (p = 0.146). A significant difference in DC scores was found among DSA, fe-SPGR, and CTA (p < 0.001) and between all pairs of the groups (p < 0.05). Interrater agreement was good to very good for all image groups (κ = 0.77-1.0, p < 0.001). CONCLUSIONS Fe-SPGR performed robustly in the diagnostic evaluation of brain AVMs, with improved visual depiction of AVMs compared with CTA and comparable Spetzler-Martin grading relative to CTA and DSA.

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Published In

J Neurosurg Pediatr

DOI

EISSN

1933-0715

Publication Date

September 2018

Volume

22

Issue

3

Start / End Page

251 / 260

Location

United States

Related Subject Headings

  • Young Adult
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Male
  • Magnetic Resonance Angiography
  • Intracranial Arteriovenous Malformations
  • Imaging, Three-Dimensional
  • Humans
  • Hematinics
  • Ferrosoferric Oxide
 

Citation

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Iv, M., Choudhri, O., Dodd, R. L., Vasanawala, S. S., Alley, M. T., Moseley, M., … Yeom, K. W. (2018). High-resolution 3D volumetric contrast-enhanced MR angiography with a blood pool agent (ferumoxytol) for diagnostic evaluation of pediatric brain arteriovenous malformations. In J Neurosurg Pediatr (Vol. 22, pp. 251–260). United States. https://doi.org/10.3171/2018.3.PEDS17723
Iv, Michael, Omar Choudhri, Robert L. Dodd, Shreyas S. Vasanawala, Marcus T. Alley, Michael Moseley, Samantha J. Holdsworth, Gerald Grant, Samuel Cheshier, and Kristen W. Yeom. “High-resolution 3D volumetric contrast-enhanced MR angiography with a blood pool agent (ferumoxytol) for diagnostic evaluation of pediatric brain arteriovenous malformations.” In J Neurosurg Pediatr, 22:251–60, 2018. https://doi.org/10.3171/2018.3.PEDS17723.
Iv, Michael, et al. “High-resolution 3D volumetric contrast-enhanced MR angiography with a blood pool agent (ferumoxytol) for diagnostic evaluation of pediatric brain arteriovenous malformations.J Neurosurg Pediatr, vol. 22, no. 3, 2018, pp. 251–60. Pubmed, doi:10.3171/2018.3.PEDS17723.
Iv M, Choudhri O, Dodd RL, Vasanawala SS, Alley MT, Moseley M, Holdsworth SJ, Grant G, Cheshier S, Yeom KW. High-resolution 3D volumetric contrast-enhanced MR angiography with a blood pool agent (ferumoxytol) for diagnostic evaluation of pediatric brain arteriovenous malformations. J Neurosurg Pediatr. 2018. p. 251–260.

Published In

J Neurosurg Pediatr

DOI

EISSN

1933-0715

Publication Date

September 2018

Volume

22

Issue

3

Start / End Page

251 / 260

Location

United States

Related Subject Headings

  • Young Adult
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Male
  • Magnetic Resonance Angiography
  • Intracranial Arteriovenous Malformations
  • Imaging, Three-Dimensional
  • Humans
  • Hematinics
  • Ferrosoferric Oxide