The following is a summary of “Comparative study of non-contrast silent and time-of-flight magnetic resonance angiographic sequences in the evaluation of intracranial dural arteriovenous fistula,” published in the December 2023 issue of Neurology by Balasubramanian et al.
In evaluating intracranial dural arteriovenous fistulas (dAVF), the accuracy of assessing angioarchitecture components is pivotal for therapeutic decisions. This study aimed to compare the efficacy of two non-contrast magnetic resonance angiographic sequences, silent MRA and time-of-flight (TOF) MRA, in assessing dAVF. Forty consecutive patients diagnosed with dAVF underwent prospective evaluation using both silent MRA and TOF MRA alongside digital subtraction angiography (DSA).
The analysis encompassed dAVF location, Cognard classification, arterial feeders, venous drainage, and treatment planning. Both silent and TOF MRAs demonstrated high sensitivity and accuracy in localizing (96.4% vs. 96% and 96% vs. 95%, respectively) and classifying dAVF (96% vs. 94% and 96% vs. 93.5%, respectively). Silent MRA exhibited higher sensitivity than TOF MRA for arterial feeders and draining veins (87% vs. 79% and 81.6% vs. 67%, respectively), with further improvement (96.4% and 89%) considering prominent feeders. Sensitivity and accuracy for immediate draining veins were 92.6% and 85.8%. Both silent and TOF MRAs were accurate for therapeutic planning (96% vs. 85%), with silent MRA showing slightly better accuracy. The study concluded that silent MRA can reliably assess various angioarchitectural components of dAVF compared to TOF MRA, supporting its potential utility in clinical practice.
Source: sciencedirect.com/science/article/abs/pii/S0009926023005731