Color mapping of 4D-CTA for the detection of cranial arteriovenous shunts

M. Meijs, S.A. Pegge, K. Murayama, H.D. Boogaarts, M. Prokop, P.W. Willems, R. Manniesing and F.J. Meijer

American Journal of Neuroradiology

DOI PMID

Abstract

Four-dimensional CT angiography (4D-CTA) is increasingly used in clinical practice for the assessment of different neurovascular disorders. Optimized processing of 4D-CTA is crucial for diagnostic interpretation because of the large amount of data that is generated. A color-mapping method of 4D-CTA is presented for improved and enhanced visualization of the cerebral vasculature hemodynamics. This method was applied to detect cranial AVFs. All patients who underwent both 4D-CTA and DSA in our hospital in the period 2011-2018 for the clinical suspicion of a cranial AVF or caroticocavernous fistula (CCF) were retrospectively collected. Temporal information in the cerebral vasculature was visualized using a patient-specific color-scale. All color-maps were evaluated by three observers for the presence or absence of an AVF or CCF. The presence or absence of cortical venous reflux was evaluated as a secondary outcome measure. In total 31 patients were included, 21 patients with and 10 without an AVF. Arterialization of venous structures in AVFs was accurately visualized using color-mapping. There was high sensitivity (86-100%) and moderate-to-high specificity (70-100%) for the detection of AVFs on color-mapping 4D-CTA, even without the availability of dynamic subtraction rendering. The diagnostic performance of the three observers in the detection of cortical venous reflux was variable (sensitivity 43-88%, specificity 60-80%). Arterialization of venous structures can be visualized using color mapping of 4D-CTA and proves to be accurate for the detection of cranial AVFs. This makes color-mapping a promising visualization technique for assessing temporal hemodynamics in 4D-CTA.

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