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European Radiology

, Volume 29, Issue 2, pp 783–791 | Cite as

Evaluation of sporadic intracranial cavernous malformations for detecting associated developmental venous anomalies: added diagnostic value of C-arm contrast-enhanced cone-beam CT to routine contrast-enhanced MRI

  • Burak Kocak
  • Osman Kizilkilic
  • Amalya Zeynalova
  • Bora Korkmazer
  • Naci Kocer
  • Civan IslakEmail author
Neuro
  • 89 Downloads

Abstract

Objective

Our purpose was to investigate the added diagnostic value of C-arm contrast-enhanced cone-beam CT (CE-CBCT) to routine contrast-enhanced MRI (CE-MRI) in detecting associated developmental venous anomalies (DVAs) in patients with sporadic intracranial cavernous malformations (ICMs).

Methods

Fifty-six patients (53 with single and three with double ICMs) met the inclusion criteria. All patients had routine CE-MRI scans performed at 1.5 Tesla. The imaging studies (CE-MRI and CE-CBCT) were retrospectively and independently reviewed by two observers, with consensus by a third. Group difference, intra- and interobserver agreement, and diagnostic performance of the modalities in detecting associated DVAs were calculated. Reference standard was CE-MRI.

Results

On CE-MRI and CE-CBCT, 37 (66%; of 56) and 47 patients (84%; of 56) had associated DVAs, respectively. In 10 patients (52.6%; of CE-MRI negatives [n=19]), CE-CBCT improved the diagnosis. Nine patients (16%; of 56) had no DVA on both imaging techniques. Difference in proportions of associated DVAs on CE-MRI and CE-CBCT was statistically significant, p < 0.05. Sensitivity, specificity, positive likelihood ratio, and area under the curve of CE-CBCT were 100% (95% confidence interval [CI]: 90.5-100%), 47.3% (95% CI: 24.4-71.1%), 1.9 (95%CI: 1.240-2.911), 0.737 (95%CI: 0.602-0.845), respectively. Intraobserver agreement was excellent for CE-MRI, kappa (κ) coefficient = 0.960, and CE-CBCT, κ=0.931. Interobserver agreement was substantial for CE-MRI, κ=0.803, and excellent for CE-CBCT, κ=0.810.

Conclusions

CE-CBCT is a useful imaging technique especially in patients with negative routine CE-MRI in terms of detecting associated DVAs. In nearly half of these particular patients, it reveals an associated DVA as a new diagnosis.

Key Points

• Although it is known to be the gold standard, some of the DVAs associated with ICMs are underdiagnosed with CE-MRI.

• In nearly half of the patients with negative routine CE-MRI, CE-CBCT reveals an associated DVA as a new diagnosis.

• Intra- and interobserver agreement on CE-CBCT is excellent in terms of detecting associated DVAs.

Keywords

Cavernous haemangioma Cone-beam computed tomography Magnetic resonance imaging Central nervous system venous angioma 

Abbreviations

CBCT

C-arm cone-beam computed tomography

CE-CBCT

C-arm contrast-enhanced cone-beam computed tomography

CE-MRI

Contrast-enhanced magnetic resonance imaging

DSA

Digital subtraction angiography

DVA

Developmental venous anomaly

FOV

Field of view

GRE

Gradient -echo

ICM

Intracranial cavernous malformation

MRI

Magnetic resonance imaging

NLR

Negative likelihood ratio

SWI

Susceptibility-weighted imaging

Notes

Acknowledgements

A partial abstract of this study (maximum 250 words) has been submitted to ECR (European Congress of Radiology) 2018, accepted and presented as oral presentation (control number: 1976; presentation number: B-0687).

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Civan Islak.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Burak Kocak) has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in authors’ previous publication Kocak B, Kizilkilic O, Oz B, Bakkaloglu DV, Isler C, Kocer N, Islak C. Ultra-high-resolution C-arm flat-detector CT angiography evaluation reveals 3-fold higher association rate for sporadic intracranial cavernous malformations and developmental venous anomalies: a retrospective study in consecutive 58 patients with 60 cavernous malformations. Eur Radiol. 2017 Jun;27(6):2629-2639. doi: 10.1007/s00330-016-4595-9. Epub 2016 Sep 21.

Methodology

• retrospective

• diagnostic study

• performed at one institution

Supplementary material

330_2018_5652_MOESM1_ESM.mp4 (13.2 mb)
Video 1 : CE-CBCT reconstruction of the patient presented in Fig. 2. Movie was made from anterior-posterior, cranial-caudal and lateral-lateral views, respectively. Please focus on the red circle which shows the associated DVA in detail. (MP4 13476 kb)
330_2018_5652_MOESM2_ESM.mp4 (11 mb)
Video 2 : CE-CBCT reconstruction of the patient presented in Fig. 3. Movie was made from various viewpoints. Please focus on the red circle, which shows the associated DVA and its angioarchitecture in detail. ICM was also evident next to the DVA. (MP4 11221 kb)
330_2018_5652_MOESM3_ESM.mp4 (23.6 mb)
Video 3 : CE-CBCT reconstruction of the patient presented in Fig. 4. Movie was made from various viewpoints. Please focus on the red ovoid shape, which shows the associated DVA and its angioarchitecture in detail. (MP4 24198 kb)

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Burak Kocak
    • 1
  • Osman Kizilkilic
    • 2
  • Amalya Zeynalova
    • 2
  • Bora Korkmazer
    • 3
  • Naci Kocer
    • 2
  • Civan Islak
    • 2
    Email author
  1. 1.Department of RadiologyIstanbul Training and Research HospitalIstanbulTurkey
  2. 2.Department of RadiologyIstanbul University, Cerrahpasa Medical FacultyIstanbulTurkey
  3. 3.Department of RadiologyCanakkale Mehmet Akif Ersoy State HospitalCanakkaleTurkey

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