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Title: Delineation of brain AVMs on MR-Angiography for the purpose of stereotactic radiosurgery

Abstract

Purpose: To assess the dosimetric consequences of brain arteriovenous malformation (bAVM) delineation on magnetic resonance angiography (MRA) for the purpose of stereotactic radiosurgery. Methods and Materials: Three observers contoured a bAVM in 20 patients, using digital subtraction angiography (V{sub DSA}) and three-dimensional time-of-flight MRA (V{sub MRA}). Displacement between contours was calculated. Agreement and differences between observers and imaging modalities were assessed. A standardized treatment plan with dynamic conformal arcs was generated and dosimetric coverage of all contours and the volume of normal brain tissue within the high dose region was determined. Results: The generalized reliability coefficient was 'fair' for target volume (0.79), but 'poor' for displacement (0.35). V{sub MRA} was larger than V{sub DSA} (5.0 vs. 4.0 mL, p = 0.001). No difference in displacement was found (2.8 vs. 2.5 mm, p = 0.156). Dosimetric coverage of V{sub MRA} was 62.9% (95% CI, 56.9-68.8) when V{sub DSA} was used as planning target volume, and coverage of V{sub DSA} was 83.5% (95% CI, 78.1-88.8) when V{sub MRA} was used for planning (p < 0.001). The mean volume of normal brain within the 80% isodose was larger when the bAVM was delineated on MRA (0.7 vs. 1.0 mL (p = 0.02) formore » targets {<=}3 mL and 3.7 vs. 7.0 mL (p = 0.01) for targets >3 mL). Conclusions: Brain arteriovenous malformations delineated on MRA are larger and more randomly displaced. However, for bAVMs {<=}3 mL, the difference in volume of normal brain tissue within the high-dose region does not seem to be clinically relevant. Therefore, MRA-images might be used as the sole imaging modality for the radiosurgical treatment of bAVMs {<=}3 mL when the bAVM is located in a noneloquent position.« less

Authors:
 [1];  [2];  [3];  [4];  [5];  [4];  [2];  [3]
  1. Department of Neurosurgery, VU University Medical Center, Amsterdam (Netherlands). E-mail: dr.buis@vumc.nl
  2. Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands)
  3. Department of Neurosurgery, VU University Medical Center, Amsterdam (Netherlands)
  4. Department of Radiology, VU University Medical Center, Amsterdam (Netherlands)
  5. Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam (Netherlands)
Publication Date:
OSTI Identifier:
20850329
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 67; Journal Issue: 1; Other Information: DOI: 10.1016/j.ijrobp.2006.08.075; PII: S0360-3016(06)02836-7; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; BLOOD VESSELS; BRAIN; IMAGES; MALFORMATIONS; NMR IMAGING; PATIENTS; PLANNING; RADIATION DOSES; RADIOTHERAPY; RELIABILITY; SURGERY; TIME-OF-FLIGHT METHOD

Citation Formats

Buis, Dennis R., Lagerwaard, Frank J., Dirven, Clemens M.F., Barkhof, Frederik, Knol, Dirk L., Berg, Rene van den, Slotman, Ben J., and Vandertop, W. Peter. Delineation of brain AVMs on MR-Angiography for the purpose of stereotactic radiosurgery. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.08.075.
Buis, Dennis R., Lagerwaard, Frank J., Dirven, Clemens M.F., Barkhof, Frederik, Knol, Dirk L., Berg, Rene van den, Slotman, Ben J., & Vandertop, W. Peter. Delineation of brain AVMs on MR-Angiography for the purpose of stereotactic radiosurgery. United States. doi:10.1016/j.ijrobp.2006.08.075.
Buis, Dennis R., Lagerwaard, Frank J., Dirven, Clemens M.F., Barkhof, Frederik, Knol, Dirk L., Berg, Rene van den, Slotman, Ben J., and Vandertop, W. Peter. Mon . "Delineation of brain AVMs on MR-Angiography for the purpose of stereotactic radiosurgery". United States. doi:10.1016/j.ijrobp.2006.08.075.
@article{osti_20850329,
title = {Delineation of brain AVMs on MR-Angiography for the purpose of stereotactic radiosurgery},
author = {Buis, Dennis R. and Lagerwaard, Frank J. and Dirven, Clemens M.F. and Barkhof, Frederik and Knol, Dirk L. and Berg, Rene van den and Slotman, Ben J. and Vandertop, W. Peter},
abstractNote = {Purpose: To assess the dosimetric consequences of brain arteriovenous malformation (bAVM) delineation on magnetic resonance angiography (MRA) for the purpose of stereotactic radiosurgery. Methods and Materials: Three observers contoured a bAVM in 20 patients, using digital subtraction angiography (V{sub DSA}) and three-dimensional time-of-flight MRA (V{sub MRA}). Displacement between contours was calculated. Agreement and differences between observers and imaging modalities were assessed. A standardized treatment plan with dynamic conformal arcs was generated and dosimetric coverage of all contours and the volume of normal brain tissue within the high dose region was determined. Results: The generalized reliability coefficient was 'fair' for target volume (0.79), but 'poor' for displacement (0.35). V{sub MRA} was larger than V{sub DSA} (5.0 vs. 4.0 mL, p = 0.001). No difference in displacement was found (2.8 vs. 2.5 mm, p = 0.156). Dosimetric coverage of V{sub MRA} was 62.9% (95% CI, 56.9-68.8) when V{sub DSA} was used as planning target volume, and coverage of V{sub DSA} was 83.5% (95% CI, 78.1-88.8) when V{sub MRA} was used for planning (p < 0.001). The mean volume of normal brain within the 80% isodose was larger when the bAVM was delineated on MRA (0.7 vs. 1.0 mL (p = 0.02) for targets {<=}3 mL and 3.7 vs. 7.0 mL (p = 0.01) for targets >3 mL). Conclusions: Brain arteriovenous malformations delineated on MRA are larger and more randomly displaced. However, for bAVMs {<=}3 mL, the difference in volume of normal brain tissue within the high-dose region does not seem to be clinically relevant. Therefore, MRA-images might be used as the sole imaging modality for the radiosurgical treatment of bAVMs {<=}3 mL when the bAVM is located in a noneloquent position.},
doi = {10.1016/j.ijrobp.2006.08.075},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 67,
place = {United States},
year = {Mon Jan 01 00:00:00 EST 2007},
month = {Mon Jan 01 00:00:00 EST 2007}
}