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Journal Article Meta-Analysis Systematic Review Epublish 2 citations

PubMed: 39190141 DOI: 10.1007/s10143-024-02659-8

Diagnostic accuracy of arterial spin labeling MR imaging in detecting cerebral arteriovenous malformations: a systematic review and meta-analysis.

Neurosurg Rev 47(1):492

Authors: Hana Hallak, Salwa Aljarayhi, Hussam Abou-Al-Shaar, Michael Martini, Charlotte Michealcheck, Turki Elarjani, Othman Bin-Alamer, Anant Naik, Homoud Aldahash, Waleed Brinjikji, Michael Lawton, Naif Alotaibi

Affiliations

  • Department of Neurological Surgery, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.
  • Department of Neurological Surgery, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.
  • Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
  • Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
  • Department of Neurological Surgery, University of Miami, Miami, FL, USA.
  • Department of Neurological Surgery, Barrow Neurologic Institute, Phoenix, AZ, USA.
  • Department of Neurologic Surgery, King Fahad Medical City, Riyadh, Saudi Arabia.

Abstract

Diagnostic accuracy of arteriovenous malformations (AVMs) is imperative for delineating management. The current standard is digital subtraction angiography (DSA). Arterial spin labeling (ASL) is an understudied noninvasive, non-contrast technique that allows angioarchitecture visualization and additionally quantifies cortical and AVM cerebral blood flow and hemodynamics. This meta-analysis aims to compare ASL and DSA imaging in detecting and characterizing cerebral AVMs. EMBASE, Medline, Scopus, and Cochrane databases were queried from inception to July 2022 for reports of AVMs evaluated by DSA and ASL imaging. Fourteen studies with 278 patients evaluated using DSA and ASL imaging prior to intervention were included; pCASL in 11 studies (n = 239, 85.37%) and PASL in three studies (n = 41, 14.64%). The overall AVM detection rate on ASL was 99% (CI 97-100%); subgroup analysis revealed no difference between pCASL vs. PASL (99%; CI 96-100% vs. 100%; CI 95-100% respectively, p = 0.42). The correlation value comparing ASL and DSA nidus size was 0.99. DSA and ASL intermodality agreement Cohen's k factor for Spetzler Martin Grading (SMG) was reported at a median of 0.98 (IQR 0.73-0.1), with a 1.0 agreement on SMG classification. A median of 25 arteries were detected by DSA (IQR 14.5-27), vs. 25 by ASL (IQR 14.5-27.5) at a median 0.92 k factor. ASL provides angioarchitectural visualization noninferior to DSA and additionally quantifies CBF. Our study suggests that ASL should be considered in the detection of AVMs, especially in patients with contrast contraindications or apprehension towards an invasive assessment.

MeSH

Arteriovenous Malformations, Neurosurgery

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