Journal Article

Utility of ASL-MRI in detecting disease evolution including de-novo formation and post-treatment changes of intracranial dural arteriovenous fistula

Neki, Hiroaki, Oishi, Tomoya, Kamio, Yoshinobu, Kurozumi, Kazuhiko

2026

Overview

Intracranial dural arteriovenous fistula (dAVF) is a pathologic shunt between dural arteries and veins. The indication for invasive treatment of intracranial dAVF is primarily determined by the bleeding risk based on the location of the shunt and venous drainage. DSA is still the gold standard for diagnosing dAVF, but its invasive nature limits its use for early detection of disease progression or recurrence during follow-up. This study evaluates the clinical utility of noninvasive pseudo-continuous arterial spin-labeling MRI (ASL-MRI) in intracranial dAVFs, particularly its potential to detect progression, recanalization and de-novo formation. We conducted a retrospective study including patients with intracranial dAVF who were diagnosed with DSA or treated at our institution between April 2016 and December 2023. The proportion of patients was determined based on ASL-MRI signal changes in the cerebral parenchyma and venous sinuses during follow-up. If bright signal intensity was observed on ASL-MRI, repeat DSA was performed. Of the 65 patients with intracranial dAVF, 54 (83.1 %) received early therapeutic intervention immediately after diagnosis, while the remaining (n = 11; 16.9 %) followed up with MRI. Of the 11 patients, four patients transitioned to treatment, cortical ASL-MRI hyperintensity was exhibited interval augmentation. Of the 58 patients, 63 treatment procedures were performed, ASL-MRI successfully detected two cases of recurrent dangerous dAVF and three cases of de-novo dAVF. ASL-MRI is a minimally invasive diagnostic modality that is useful both before and after treatment, providing support in determining treatment timing, identifying new lesions, and conducting post-treatment follow-up assessments. ●ASL-MRI evaluated for detecting disease evolution in intracranial dAVF.●Retrospective study of 65 patients diagnosed or treated between 2016–2023.●Four of 11 MRI follow-up patients progressed and required intervention.●ASL-MRI detected 2 recurrent and 3 de-novo dAVF cases during follow-up.●ASL-MRI supports timing of treatment, new lesion detection, and monitoring.

• Publisher: Elsevier B.V,Elsevier Limited
• Subject: Adult / Aged / Central Nervous System Vascular Malformations - diagnostic imaging / Central Nervous System Vascular Malformations - surgery / Central Nervous System Vascular Malformations - therapy / de-novo formation / Decision making / Disease Progression / dural arteriovenous fistula / Embolization / Female / Fistula / Fistulae / Humans / Ischemia / Magnetic resonance imaging / Magnetic Resonance Imaging - methods / Male / Medical imaging / Middle Aged / Neurology / Neurosurgery / Parenchyma / Patients / Progression / pseudo-continuous arterial spin-labeling MRI / Radiation / Recanalization / Retrospective Studies / Sinuses / Spin Labels / Stroke / Veins & arteries