Julien Ognard1, Elsa Magro2, Jildaz Caroff3, Douraied Ben Salem4, Sebastien Andouard5, Michel Nonent6, Jean-Christophe Gentric6. 1. Service d'imagerie médicale, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France; Inserm UMR 1101, laboratoire de traitement de l'information médicale (LaTIM), 5, avenue Foch, 29200 Brest cedex, France. Electronic address: julien.ognard@chu-brest.fr. 2. Inserm UMR 1101, laboratoire de traitement de l'information médicale (LaTIM), 5, avenue Foch, 29200 Brest cedex, France; Service de neurochirurgie, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France. 3. Service de neuroradiologie interventionnelle, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France. 4. Service d'imagerie médicale, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France; Inserm UMR 1101, laboratoire de traitement de l'information médicale (LaTIM), 5, avenue Foch, 29200 Brest cedex, France. 5. SIEMENS S.A.S. Division Healthcare, service application, 40, avenue des Fruitiers, 93200 Saint-Denis, France. 6. Service d'imagerie médicale, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France; Groupe d'étude de la thrombose occidentale, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France.
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.
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.
Authors: Jay F Yu; Leland Pung; Hataka Minami; Kerstin Mueller; Rajkamal Khangura; Robert Darflinger; Steven W Hetts; Daniel L Cooke Journal: Interv Neuroradiol Date: 2020-09-26 Impact factor: 1.610