Current and Future Applications of Arterial Spin Labeling MRI in Cerebral Arteriovenous Malformations
Matteo De Simone,
Marco Maria Fontanella,
Anis Choucha,
Karl Schaller,
Paolo Machi,
Giuseppe Lanzino,
Philippe Bijlenga,
Felix T. Kurz,
Karl-Olof Lövblad,
Lucio De Maria
Affiliations
Matteo De Simone
Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via S. Allende, 84081 Baronissi, Italy
Marco Maria Fontanella
Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy
Anis Choucha
Department of Neurosurgery, Aix Marseille University, APHM, UH Timone, 13005 Marseille, France
Karl Schaller
Division of Neurosurgery, Diagnostic Department of Clinical Neurosciences, Geneva University Hospitals (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
Paolo Machi
Division of Interventional Neuroradiology, Department of Radiology and Medical Informatic, Geneva University Hospitals (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
Giuseppe Lanzino
Department of Neurosurgery and Interventional Neuroradiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
Philippe Bijlenga
Division of Neurosurgery, Diagnostic Department of Clinical Neurosciences, Geneva University Hospitals (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
Felix T. Kurz
Division of Interventional Neuroradiology, Department of Radiology and Medical Informatic, Geneva University Hospitals (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
Karl-Olof Lövblad
Division of Interventional Neuroradiology, Department of Radiology and Medical Informatic, Geneva University Hospitals (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
Lucio De Maria
Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy
Arterial spin labeling (ASL) has emerged as a promising noninvasive tool for the evaluation of both pediatric and adult arteriovenous malformations (AVMs). This paper reviews the advantages and challenges associated with the use of ASL in AVM assessment. An assessment of the diagnostic workup of AVMs and their variants in both adult and pediatric populations is proposed. Evaluation after treatments, whether endovascular or microsurgical, was similarly examined. ASL, with its endogenous tracer and favorable safety profile, offers functional assessment and arterial feeder identification. ASL has demonstrated strong performance in identifying feeder arteries and detecting arteriovenous shunting, although some studies report inferior performance compared with digital subtraction angiography (DSA) in delineating venous drainage. Challenges include uncertainties in sensitivity for specific AVM features. Detecting AVMs in challenging locations, such as the apical cranial convexity, is further complicated, demanding careful consideration due to the risk of underestimating total blood flow. Navigating these challenges, ASL provides a noninvasive avenue with undeniable merits, but a balanced approach considering its limitations is crucial. Larger-scale prospective studies are needed to comprehensively evaluate the diagnostic performance of ASL in AVM assessment.
