Four-dimensional digital subtraction angiography to assess cerebral arteriovenous malformations

Background and Purpose The performance of a novel prototype four-dimensional (4D) digital subtraction angiography (DSA) for cerebral arteriovenous malformation (AVM) diagnosis was evaluated and compared with that of two-dimensional (2D) and three-dimensional (3D) DSA. Methods In this retrospective study, 37 consecutive cerebral AVM patients were included. The standard diagnostic results were concluded from the 2D and 3D DSA. Two 4D DSA volumes were reconstructed for each patient by a commercial and a prototype software, then evaluated by two independent experienced neurosurgeons, who were blinded to the diagnosis and treatment process. The evaluation results were compared with the diagnostic results on Spetzler-Martin (SM) Grading Scale, number of feeding arteries, number of draining veins, and intranidal aneurysms. Results Complete agreement was achieved between 4D DSA and 2D and 3D DSA in SM Grading Scale and intracranial aneurysm identification (agreement coefficient: 1) for both reviewers. The agreement coefficients were .888 and .917 for both reviewers in feeding artery number determination using 4D DSA product and 4D DSA prototype, respectively. The agreement coefficients in draining vein number determination were all larger than .94 for both reviewers using both 4D DSA volumes. Conclusions The performance of this prototype 4D DSA in cerebral AVMs diagnosis was largely equivalent to that of 2D and 3D DSA combination. Four-dimensional DSA can be regarded as a very good complement for 2D DSA in cerebral AVM diagnosis.