Comparative study of non-contrast silent and time-of-flight magnetic resonance angiographic sequences in the evaluation of intracranial dural arteriovenous fistula

• Published in: Clinical radiology 2024-03, Vol.79 (3), p.e393-e400
• Main Authors: Prasad Balasubramanian, A., Kumar Kannath, S., Thomas, B., Enakshy Rajan, J., Kesavadas, C.
• Format: Article
• Language: English
• Subjects: Angiography, Digital Subtraction; Central Nervous System Vascular Malformations - diagnostic imaging; Humans; Magnetic Resonance Angiography; Magnetic Resonance Spectroscopy; Veins
• ISSN: 0009-9260; 1365-229X; 1365-229X
• DOI: 10.1016/j.crad.2023.11.019

To compare the performance of two non-contrast magnetic resonance angiography (MRA) sequences, silent MRA and time of flight (TOF) MRA, in the evaluation of intracranial dural arteriovenous fistula (DAVF). Forty consecutive patients with DAVF were enrolled and evaluated prospectively using silent MRA, TOF MRA, and digital subtraction angiography (DSA). The location, Cognard classification, arterial feeders, and venous drainage were evaluated. The therapeutic strategy and possible route were predicted on both silent and TOF MRA and these were compared with DSA during subsequent endovascular treatment. Sensitivity and accuracy of silent and TOF MRA for localisation (96.4% versus 96% and 96% versus 95%, respectively) and classification (96% versus 94% and 96% versus 93.5%, respectively) were high. Silent MRA showed higher sensitivity than TOF MRA for arterial feeders and draining veins (87% versus 79% and 81.6% versus 67%). This improved to a sensitivity of 96.4% and 89% when prominent feeders were considered. The sensitivity and accuracy were 92.6% and 85.8% for immediate draining veins. Both silent and TOF MRA were accurate for therapeutic planning (96% versus 85%), although silent MRA was more accurate. Silent MRA can more reliably evaluate the various angioarchtectural components of DAVF compared to TOF MRA. •Both Silent MRA and TOF MRA are accurate for dural fistula localisation.•Silent MRA is better for arterial and venous features assessment of fistula.•Treatment planning is aided by both sequences, though silent MRA is more accurate.