Adjunctive efficacy of intra-arterial conebeam CT angiography relative to DSA in the diagnosis and surgical planning of micro-arteriovenous malformations

A. S. Al-Smadi, A. Elmokadem, A. Shaibani, M. C. Hurley, M. B. Potts, B. S. Jahromi, S. A. Ansari*

*Corresponding author for this work

Research output: Contribution to journalArticle


BACKGROUND AND PURPOSE: Micro-arteriovenous malformations are an underrecognized etiology of intracranial hemorrhage. Our study aimed to assess the adjunctive efficacy of intra-arterial conebeam CTA relative to DSA in the diagnosis and surgical planning of intracranial micro-AVMs. MATERIALS AND METHODS: We performed a retrospective study of all micro-AVMs (1-cm nidus) at our institution. Blinded neuroradiologists qualitatively graded DSA and intra-arterial conebeam CTA images for the detection of specific micro-AVM anatomic parameters (arterial feeder, micronidus, and venous drainer) and defined an overall diagnostic value. Statistical and absolute differences in the overall diagnostic values defined the relative intra-arterial conebeam CTA diagnostic values, respectively. Blinded neurosurgeons reported their treatment approach after DSA and graded the adjunctive value of intra-arterial conebeam CTA to improve or modify treatment. Intra-arterial conebeam CTA efficacy was defined as interobserver agreement in the relative intra-arterial conebeam CTA diagnostic and/or treatment-planning value scores. RESULTS: Ten patients with micro-AVMs presented with neurologic deficits and/or intracranial hemorrhages. Both neuroradiologists assigned a higher overall intra-arterial conebeam CTA diagnostic value (P .05), secondary to improved evaluation of both arterial feeders and the micronidus, with good interobserver agreement ( 0.66, P .018) in the relative intra-arterial conebeam CTA diagnostic value. Both neurosurgeons reported that integrating the intra-arterial conebeam CTA data into their treatment plan would allow more confident localization for surgical/radiation treatment (8/10; altering the treatment plan in 1 patient), with good interobserver agreement in the relative intra-arterial conebeam CTA treatment planning value ( 0.73, P .025). CONCLUSIONS: Adjunctive intra-arterial conebeam CTA techniques are more effective in the diagnostic identification and anatomic delineation of micro-AVMs, relative to DSA alone, with the potential to improve microsurgical or radiosurgery treatment planning.

Original languageEnglish (US)
Pages (from-to)1689-1695
Number of pages7
JournalAmerican Journal of Neuroradiology
Issue number9
StatePublished - Sep 1 2018


ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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