Alvaro Rojas-Villabona1,2, Magdalena Sokolska3, Thomas Solbach4, Joan Grieve5, Marilena Rega6, Francisco Torrealdea7, Francesca Benedetta Pizzini8, Enrico De Vita9, Yuriko Suzuki10, Matthias J P Van Osch10, Emma Biondetti11, Karin Shmueli11, David Atkinson7, Mary Murphy5, Ian Paddick1, Xavier Golay12, Neil Kitchen5, Hans Rolf Jäger4,12. 1. The Gamma Knife Centre at Queen Square, National Hospital for Neurology and Neurosurgery, London, UK. 2. Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK. 3. Medical Physics and Biomedical Engineering, University College London Hospitals, London, UK. 4. The Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK. 5. Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK. 6. Institute of Nuclear Medicine, University College London Hospitals, London, UK. 7. Centre for Medical Imaging, University College London, London, UK. 8. Division of Radiology, Department of Diagnostic and Public Health, Verona University, Verona, Italy. 9. School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK. 10. C. J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands. 11. MRI Group, Department of Medical Physics and Biomedical Engineering, University College London, London, UK. 12. Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK.
Abstract
PURPOSE: Intra-arterial Digital Subtraction Angiography (DSA) is the gold standard technique for radiosurgery target delineation in brain Arterio-Venous Malformations (AVMs). This study aims to evaluate whether a combination of three Magnetic Resonance Angiography sequences (triple-MRA) could be used for delineation of brain AVMs for Gamma Knife Radiosurgery (GKR). METHODS: Fifteen patients undergoing DSA for GKR targeting of brain AVMs also underwent triple-MRA: 4D Arterial Spin Labelling based angiography (ASL-MRA), Contrast-Enhanced Time-Resolved MRA (CE-MRA) and High Definition post-contrast Time-Of-Flight angiography (HD-TOF). The arterial phase of the AVM nidus was delineated on triple-MRA by an interventional neuroradiologist and a consultant neurosurgeon (triple-MRA volume). Triple-MRA volumes were compared to AVM targets delineated by the clinical team for delivery of GKR using the current planning paradigm, i.e., stereotactic DSA and volumetric MRI (DSA volume). Difference in size, degree of inclusion (DI) and concordance index (CcI) between DSA and triple-MRA volumes are reported. RESULTS: AVM target volumes delineated on triple-MRA were on average 9.8% smaller than DSA volumes (95%CI:5.6-13.9%; SD:7.14%; p = .003). DI of DSA volume in triple-MRA volume was on average 73.5% (95%CI:71.2-76; range: 65-80%). The mean percentage of triple-MRA volume not included on DSA volume was 18% (95%CI:14.7-21.3; range: 7-30%). CONCLUSION: The technical feasibility of using triple-MRA for visualisation and delineation of brain AVMs for GKR planning has been demonstrated. Tighter and more precise delineation of AVM target volumes could be achieved by using triple-MRA for radiosurgery targeting. However, further research is required to ascertain the impact this may have in obliteration rates and side effects.
PURPOSE: Intra-arterial Digital Subtraction Angiography (DSA) is the gold standard technique for radiosurgery target delineation in brain Arterio-Venous Malformations (AVMs). This study aims to evaluate whether a combination of three Magnetic Resonance Angiography sequences (triple-MRA) could be used for delineation of brain AVMs for Gamma Knife Radiosurgery (GKR). METHODS: Fifteen patients undergoing DSA for GKR targeting of brain AVMs also underwent triple-MRA: 4D Arterial Spin Labelling based angiography (ASL-MRA), Contrast-Enhanced Time-Resolved MRA (CE-MRA) and High Definition post-contrast Time-Of-Flight angiography (HD-TOF). The arterial phase of the AVM nidus was delineated on triple-MRA by an interventional neuroradiologist and a consultant neurosurgeon (triple-MRA volume). Triple-MRA volumes were compared to AVM targets delineated by the clinical team for delivery of GKR using the current planning paradigm, i.e., stereotactic DSA and volumetric MRI (DSA volume). Difference in size, degree of inclusion (DI) and concordance index (CcI) between DSA and triple-MRA volumes are reported. RESULTS: AVM target volumes delineated on triple-MRA were on average 9.8% smaller than DSA volumes (95%CI:5.6-13.9%; SD:7.14%; p = .003). DI of DSA volume in triple-MRA volume was on average 73.5% (95%CI:71.2-76; range: 65-80%). The mean percentage of triple-MRA volume not included on DSA volume was 18% (95%CI:14.7-21.3; range: 7-30%). CONCLUSION: The technical feasibility of using triple-MRA for visualisation and delineation of brain AVMs for GKR planning has been demonstrated. Tighter and more precise delineation of AVM target volumes could be achieved by using triple-MRA for radiosurgery targeting. However, further research is required to ascertain the impact this may have in obliteration rates and side effects.
Authors: Luis Hernandez-Garcia; Verónica Aramendía-Vidaurreta; Divya S Bolar; Weiying Dai; Maria A Fernández-Seara; Jia Guo; Ananth J Madhuranthakam; Henk Mutsaerts; Jan Petr; Qin Qin; Jonas Schollenberger; Yuriko Suzuki; Manuel Taso; David L Thomas; Matthias J P van Osch; Joseph Woods; Moss Y Zhao; Lirong Yan; Ze Wang; Li Zhao; Thomas W Okell Journal: Magn Reson Med Date: 2022-08-19 Impact factor: 3.737