Accuracy of four-dimensional CT angiography in detection and characterisation of arteriovenous malformations and dural arteriovenous fistulas

Neuroradiol J. 2015 Aug;28(4):376-84. doi: 10.1177/1971400915604526. Epub 2015 Oct 1.


A retrospective review was made to assess the accuracy of four dimensional CT angiogram (4D-CTA) in diagnosis of arteriovenous malformations (AVM) and dural arteriovenous fistulas (DAVF), with catheter-based digital-subtraction angiogram (DSA) being gold standard. 33 pairs of investigations (DSA and 4D-CTA) were performed primarily for suspicion of AVM/DAVF. Based on blinded reports, sensitivity and specificity for detection of AVM/DAVF were 77% (95% CI: 46-95%) and 100% (95% CI: 83-100%) respectively. Positive predictive value was 100% (95% CI: 69-100%) and negative predictive value 87% (95% CI: 66-97%). 4D-CTA is a practical minimally-invasive technique for evaluating cerebrovascular pathologies. There is good agreement between the findings of 4D-CTA and DSA despite the differences in temporal and spatial resolutions. 4D-CTA may obviate the need for DSA in a subgroup of patients who would otherwise have undergone this invasive investigation, which carries a risk of important complications.

Keywords: Four-dimensional CT angiogram; arteriovenous malformation; digital subtraction angiography; dural arteriovenous fistula.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Angiography, Digital Subtraction
  • Central Nervous System Vascular Malformations / diagnostic imaging*
  • Cerebral Angiography / methods*
  • Contrast Media
  • Female
  • Four-Dimensional Computed Tomography / methods*
  • Humans
  • Intracranial Arteriovenous Malformations / diagnostic imaging*
  • Iohexol / analogs & derivatives
  • Male
  • Middle Aged
  • Radiographic Image Interpretation, Computer-Assisted
  • Retrospective Studies
  • Sensitivity and Specificity


  • Contrast Media
  • Iohexol
  • iopromide