Diagnostic performance of dynamic 3D magnetic resonance angiography in daily practice for the detection of intracranial arteriovenous shunts in patients with non-traumatic intracranial hemorrhage
IntroductionIdentification of treatable causes of intracranial hemorrhage (ICH) such as intracranial arteriovenous shunt is crucial to prevent recurrence. However, diagnostic approaches vary considerably across centers, partly because of limited knowledge of the diagnostic performance of first-line...
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Frontiers Media S.A.
2023-01-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.1085806/full |
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| author | Arnaud Roumi Wagih Ben Hassen Ghazi Hmeydia Sacha Posener Johan Pallud Tarek Sharshar David Calvet Jean-Louis Mas Jean-Claude Baron Catherine Oppenheim Olivier Naggara Guillaume Turc |
| author_facet | Arnaud Roumi Wagih Ben Hassen Ghazi Hmeydia Sacha Posener Johan Pallud Tarek Sharshar David Calvet Jean-Louis Mas Jean-Claude Baron Catherine Oppenheim Olivier Naggara Guillaume Turc |
| author_sort | Arnaud Roumi |
| collection | DOAJ |
| description | IntroductionIdentification of treatable causes of intracranial hemorrhage (ICH) such as intracranial arteriovenous shunt is crucial to prevent recurrence. However, diagnostic approaches vary considerably across centers, partly because of limited knowledge of the diagnostic performance of first-line vascular imaging techniques. We assessed the diagnostic performance of dynamic three-dimensional magnetic resonance angiography (dynamic 3D MRA) in daily practice to detect intracranial arteriovenous shunts in ICH patients against subsequent digital subtraction angiography (DSA) as reference standard.MethodsWe reviewed all adult patients who underwent first-line dynamic 3D MRA and subsequent DSA for non-traumatic ICH between January 2016 and September 2021 in a tertiary center. Sensitivity, specificity, accuracy, positive and negative predictive values of dynamic 3D MRA for the detection of intracranial arteriovenous shunt were calculated with DSA as reference standard.ResultsAmong 104 included patients, 29 (27.9%) had a DSA-confirmed arteriovenous shunt [19 pial arteriovenous malformations, 10 dural arteriovenous fistulae; median onset-to-DSA: 17 (IQR: 3–88) days]. The sensitivity and specificity of dynamic 3D MRA [median onset-to-dynamic 3D MRA: 14 (3–101) h] for the detection of intracranial arteriovenous shunt were 66% (95% CI: 48–83) and 91% (95% CI: 84–97), respectively. The corresponding accuracy, positive and negative predictive values were 84% (95% CI: 77–91), 73% (95% CI: 56–90), and 87% (95% CI: 80–95), respectively.ConclusionThis study suggests that although first-line evaluation with dynamic 3D MRA may be helpful for the detection of intracranial arteriovenous shunts in patients with ICH, additional vascular imaging work-up should not be withheld if dynamic 3D MRA is negative. Comparative prospective studies are needed to determine the best imaging strategy to diagnose arteriovenous shunts after non-traumatic ICH. |
| first_indexed | 2024-04-10T20:01:12Z |
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| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-10T20:01:12Z |
| publishDate | 2023-01-01 |
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| series | Frontiers in Neurology |
| spelling | doaj.art-2ef9cf0657194ed9aaafef7706b5d4112023-01-27T05:02:59ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-01-011310.3389/fneur.2022.10858061085806Diagnostic performance of dynamic 3D magnetic resonance angiography in daily practice for the detection of intracranial arteriovenous shunts in patients with non-traumatic intracranial hemorrhageArnaud Roumi0Wagih Ben Hassen1Ghazi Hmeydia2Sacha Posener3Johan Pallud4Tarek Sharshar5David Calvet6Jean-Louis Mas7Jean-Claude Baron8Catherine Oppenheim9Olivier Naggara10Guillaume Turc11Neurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, FranceNeuroradiology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, FranceNeuroradiology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, FranceNeurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, FranceNeurosurgery Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, FranceNeuro-Intensive Care Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, FranceNeurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, FranceNeurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, FranceNeurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, FranceNeuroradiology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, FranceNeuroradiology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, FranceNeurology Department, GHU Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, FHU Neurovasc, Paris, FranceIntroductionIdentification of treatable causes of intracranial hemorrhage (ICH) such as intracranial arteriovenous shunt is crucial to prevent recurrence. However, diagnostic approaches vary considerably across centers, partly because of limited knowledge of the diagnostic performance of first-line vascular imaging techniques. We assessed the diagnostic performance of dynamic three-dimensional magnetic resonance angiography (dynamic 3D MRA) in daily practice to detect intracranial arteriovenous shunts in ICH patients against subsequent digital subtraction angiography (DSA) as reference standard.MethodsWe reviewed all adult patients who underwent first-line dynamic 3D MRA and subsequent DSA for non-traumatic ICH between January 2016 and September 2021 in a tertiary center. Sensitivity, specificity, accuracy, positive and negative predictive values of dynamic 3D MRA for the detection of intracranial arteriovenous shunt were calculated with DSA as reference standard.ResultsAmong 104 included patients, 29 (27.9%) had a DSA-confirmed arteriovenous shunt [19 pial arteriovenous malformations, 10 dural arteriovenous fistulae; median onset-to-DSA: 17 (IQR: 3–88) days]. The sensitivity and specificity of dynamic 3D MRA [median onset-to-dynamic 3D MRA: 14 (3–101) h] for the detection of intracranial arteriovenous shunt were 66% (95% CI: 48–83) and 91% (95% CI: 84–97), respectively. The corresponding accuracy, positive and negative predictive values were 84% (95% CI: 77–91), 73% (95% CI: 56–90), and 87% (95% CI: 80–95), respectively.ConclusionThis study suggests that although first-line evaluation with dynamic 3D MRA may be helpful for the detection of intracranial arteriovenous shunts in patients with ICH, additional vascular imaging work-up should not be withheld if dynamic 3D MRA is negative. Comparative prospective studies are needed to determine the best imaging strategy to diagnose arteriovenous shunts after non-traumatic ICH.https://www.frontiersin.org/articles/10.3389/fneur.2022.1085806/fulldynamic magnetic resonance angiographydigital subtraction angiographyintracerebral hemorrhagearteriovenous shuntvascular malformationsensitivity |
| spellingShingle | Arnaud Roumi Wagih Ben Hassen Ghazi Hmeydia Sacha Posener Johan Pallud Tarek Sharshar David Calvet Jean-Louis Mas Jean-Claude Baron Catherine Oppenheim Olivier Naggara Guillaume Turc Diagnostic performance of dynamic 3D magnetic resonance angiography in daily practice for the detection of intracranial arteriovenous shunts in patients with non-traumatic intracranial hemorrhage Frontiers in Neurology dynamic magnetic resonance angiography digital subtraction angiography intracerebral hemorrhage arteriovenous shunt vascular malformation sensitivity |
| title | Diagnostic performance of dynamic 3D magnetic resonance angiography in daily practice for the detection of intracranial arteriovenous shunts in patients with non-traumatic intracranial hemorrhage |
| title_full | Diagnostic performance of dynamic 3D magnetic resonance angiography in daily practice for the detection of intracranial arteriovenous shunts in patients with non-traumatic intracranial hemorrhage |
| title_fullStr | Diagnostic performance of dynamic 3D magnetic resonance angiography in daily practice for the detection of intracranial arteriovenous shunts in patients with non-traumatic intracranial hemorrhage |
| title_full_unstemmed | Diagnostic performance of dynamic 3D magnetic resonance angiography in daily practice for the detection of intracranial arteriovenous shunts in patients with non-traumatic intracranial hemorrhage |
| title_short | Diagnostic performance of dynamic 3D magnetic resonance angiography in daily practice for the detection of intracranial arteriovenous shunts in patients with non-traumatic intracranial hemorrhage |
| title_sort | diagnostic performance of dynamic 3d magnetic resonance angiography in daily practice for the detection of intracranial arteriovenous shunts in patients with non traumatic intracranial hemorrhage |
| topic | dynamic magnetic resonance angiography digital subtraction angiography intracerebral hemorrhage arteriovenous shunt vascular malformation sensitivity |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.1085806/full |
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