Arterial-spin labeling MRI identifies residual cerebral arteriovenous malformation following stereotactic radiosurgery treatment

J Neuroradiol. 2020 Feb;47(1):13-19. doi: 10.1016/j.neurad.2018.12.004. Epub 2019 Jan 15.


Background and purpose: Brain arteriovenous malformation (AVM) treatment by stereotactic radiosurgery (SRS) is effective, but AVM obliteration following SRS may take two years or longer. MRI with arterial-spin labeling (ASL) may detect brain AVMs with high sensitivity. We determined whether brain MRI with ASL may accurately detect residual AVM following SRS treatment.

Materials and methods: We performed a retrospective cohort study of patients who underwent brain AVM evaluation by DSA between June 2010 and June 2015. Inclusion criteria were: (1) AVM treatment by SRS, (2) follow-up MRI with ASL at least 30 months after SRS, (3) DSA within 3 months of the follow-up MRI with ASL, and (4) no intervening AVM treatment between the MRI and DSA. Four neuroradiologists blindly and independently reviewed follow-up MRIs. Primary outcome measure was residual AVM indicated by abnormal venous ASL signal.

Results: 15 patients (12 females, mean age 29 years) met inclusion criteria. There were three posterior fossa AVMs and 12 supratentorial AVMs. Spetzler-Martin (SM) Grades were: SM1 (8%), SM2 (33%), SM3 (17%), SM4 (25%), and SM5 (17%). DSA demonstrated residual AVM in 10 patients. The pooled sensitivity, specificity, positive predictive value, and negative predictive value of venous ASL signal for predicting residual AVM were 100% (95% CI: 0.9-1.0), 95% (95% CI: 0.7-1.0), 98% (95% CI: 0.9-1.0), and 100% (95% CI: 0.8-1.0), respectively. High inter-reader agreement as found by Fleiss' Kappa analysis (k = 0.92; 95% CI: 0.8-1.0; P < 0.0001).

Conclusions: ASL is highly sensitive and specific in the detection of residual cerebral AVM following SRS treatment.

Keywords: ASL; AVM; Arterial-spin labeling; Digital subtraction angiography; MRI; Stereotactic radiosurgery.

MeSH terms

  • Adolescent
  • Adult
  • Brain / blood supply
  • Brain / diagnostic imaging*
  • Brain / pathology
  • Female
  • Humans
  • Intracranial Arteriovenous Malformations / diagnostic imaging*
  • Intracranial Arteriovenous Malformations / radiotherapy*
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Radiosurgery*
  • Retrospective Studies
  • Sensitivity and Specificity
  • Spin Labels
  • Treatment Outcome
  • Young Adult


  • Spin Labels