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31.07.2018 | Neuro

Evaluation of sporadic intracranial cavernous malformations for detecting associated developmental venous anomalies: added diagnostic value of C-arm contrast-enhanced cone-beam CT to routine contrast-enhanced MRI

Zeitschrift:
European Radiology
Autoren:
Burak Kocak, Osman Kizilkilic, Amalya Zeynalova, Bora Korkmazer, Naci Kocer, Civan Islak
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00330-018-5652-3) contains supplementary material, which is available to authorized users.

Abstract

Objective

Our purpose was to investigate the added diagnostic value of C-arm contrast-enhanced cone-beam CT (CE-CBCT) to routine contrast-enhanced MRI (CE-MRI) in detecting associated developmental venous anomalies (DVAs) in patients with sporadic intracranial cavernous malformations (ICMs).

Methods

Fifty-six patients (53 with single and three with double ICMs) met the inclusion criteria. All patients had routine CE-MRI scans performed at 1.5 Tesla. The imaging studies (CE-MRI and CE-CBCT) were retrospectively and independently reviewed by two observers, with consensus by a third. Group difference, intra- and interobserver agreement, and diagnostic performance of the modalities in detecting associated DVAs were calculated. Reference standard was CE-MRI.

Results

On CE-MRI and CE-CBCT, 37 (66%; of 56) and 47 patients (84%; of 56) had associated DVAs, respectively. In 10 patients (52.6%; of CE-MRI negatives [n=19]), CE-CBCT improved the diagnosis. Nine patients (16%; of 56) had no DVA on both imaging techniques. Difference in proportions of associated DVAs on CE-MRI and CE-CBCT was statistically significant, p < 0.05. Sensitivity, specificity, positive likelihood ratio, and area under the curve of CE-CBCT were 100% (95% confidence interval [CI]: 90.5-100%), 47.3% (95% CI: 24.4-71.1%), 1.9 (95%CI: 1.240-2.911), 0.737 (95%CI: 0.602-0.845), respectively. Intraobserver agreement was excellent for CE-MRI, kappa (κ) coefficient = 0.960, and CE-CBCT, κ=0.931. Interobserver agreement was substantial for CE-MRI, κ=0.803, and excellent for CE-CBCT, κ=0.810.

Conclusions

CE-CBCT is a useful imaging technique especially in patients with negative routine CE-MRI in terms of detecting associated DVAs. In nearly half of these particular patients, it reveals an associated DVA as a new diagnosis.

Key Points

• Although it is known to be the gold standard, some of the DVAs associated with ICMs are underdiagnosed with CE-MRI.
• In nearly half of the patients with negative routine CE-MRI, CE-CBCT reveals an associated DVA as a new diagnosis.
• Intra- and interobserver agreement on CE-CBCT is excellent in terms of detecting associated DVAs.

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Zusatzmaterial
Video 1 : CE-CBCT reconstruction of the patient presented in Fig. 2. Movie was made from anterior-posterior, cranial-caudal and lateral-lateral views, respectively. Please focus on the red circle which shows the associated DVA in detail. (MP4 13476 kb)
Video 2 : CE-CBCT reconstruction of the patient presented in Fig. 3. Movie was made from various viewpoints. Please focus on the red circle, which shows the associated DVA and its angioarchitecture in detail. ICM was also evident next to the DVA. (MP4 11221 kb)
Video 3 : CE-CBCT reconstruction of the patient presented in Fig. 4. Movie was made from various viewpoints. Please focus on the red ovoid shape, which shows the associated DVA and its angioarchitecture in detail. (MP4 24198 kb)
Literatur
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