CTA Neck There is no relevant literature to support the use of CTA neck in the surveillance of high-flow intracranial vascular malformations. CTA neck may be useful for potential treatment planning, but preference will be individual or site specific. CTV Head There is no relevant literature to support the use of CTV head in the surveillance of high-flow intracranial vascular malformations. CVD-Aneurysm, Vascular Malformation, and SAH MRA Head MRA head is frequently used in surveillance of known high-flow vascular malformations. In the setting of AVM, time-of-flight and contrast-enhanced MRA offer good diagnostic accuracy but lack temporal resolution for hemodynamics and information regarding the small angioarchitecture [88]. Multiple 4-D MRA techniques are available to provide temporal resolution with trade-off in spatial resolution. Although 4-D MRA demonstrates good agreement with DSA [89-91], MRA has limited sensitivity for small nidus (<1 cm) or complete resolution after treatment [88,92]. For AVF, time-of-flight MRA demonstrates excellent intermodality agreement with DSA regarding the location of the fistula site and good agreement regarding the arterial feeding vessels and venous drainage [93]. Time-of-flight and contrast-enhanced MRA demonstrated slightly lower negative predictive values in the evaluation of signs of cortical venous reflux when compared with CTA [94]. There is good to excellent correlation of 4-D MRA techniques to DSA demonstrated in multiple studies [95-97]. MRA Neck There is no relevant literature to support the use of MRA neck in the surveillance of high-flow intracranial vascular malformations. MRA neck may be useful for potential treatment planning, but preference will be individual or site specific. MRI Head Perfusion MRI head perfusion demonstrates variable perfusion abnormalities in the evaluation of hemodynamic physiology of AVM [83].
Cerebrovascular Diseases Aneurysm Vascular Malformation and Subarachnoid Hemorrhage PCAs. CTA Neck There is no relevant literature to support the use of CTA neck in the surveillance of high-flow intracranial vascular malformations. CTA neck may be useful for potential treatment planning, but preference will be individual or site specific. CTV Head There is no relevant literature to support the use of CTV head in the surveillance of high-flow intracranial vascular malformations. CVD-Aneurysm, Vascular Malformation, and SAH MRA Head MRA head is frequently used in surveillance of known high-flow vascular malformations. In the setting of AVM, time-of-flight and contrast-enhanced MRA offer good diagnostic accuracy but lack temporal resolution for hemodynamics and information regarding the small angioarchitecture [88]. Multiple 4-D MRA techniques are available to provide temporal resolution with trade-off in spatial resolution. Although 4-D MRA demonstrates good agreement with DSA [89-91], MRA has limited sensitivity for small nidus (<1 cm) or complete resolution after treatment [88,92]. For AVF, time-of-flight MRA demonstrates excellent intermodality agreement with DSA regarding the location of the fistula site and good agreement regarding the arterial feeding vessels and venous drainage [93]. Time-of-flight and contrast-enhanced MRA demonstrated slightly lower negative predictive values in the evaluation of signs of cortical venous reflux when compared with CTA [94]. There is good to excellent correlation of 4-D MRA techniques to DSA demonstrated in multiple studies [95-97]. MRA Neck There is no relevant literature to support the use of MRA neck in the surveillance of high-flow intracranial vascular malformations. MRA neck may be useful for potential treatment planning, but preference will be individual or site specific. MRI Head Perfusion MRI head perfusion demonstrates variable perfusion abnormalities in the evaluation of hemodynamic physiology of AVM [83].