Diagnostic performance of susceptibility-weighted imaging for cerebral arteriovenous malformation assessment: An institutional diagnostic accuracy study with structured literature review.

BACKGROUND

Brain arteriovenous malformations (AVMs) are complex vascular lesions requiring accurate preoperative imaging for microsurgical planning. While digital subtraction angiography (DSA) remains the gold standard, noninvasive techniques such as susceptibility-weighted imaging (SWI) may improve structural characterization. This study aimed to evaluate the diagnostic performance and clinical utility of SWI in the morphological assessment of AVMs, particularly in the preoperative setting.

METHODS

A systematic literature review following PRISMA guidelines was performed to identify studies evaluating susceptibility-based MRI in comparison with digital subtraction angiography (DSA) in cerebral AVMs. The review identified two diagnostic accuracy studies and one physiologic QSM study, and was therefore combined with an institutional cohort analysis of 21 patients. The analysis focused primarily on the detection and characterization of venous drainage patterns using SWI magnitude and phase images, while observations regarding nidus conspicuity were qualitative and descriptive. Sensitivity and specificity were calculated for the institutional cohort as exploratory diagnostic metrics.

RESULTS

The systematic review identified two diagnostic accuracy studies (n = 28; published 2010-2012 at 1.5 T) and one physiologic QSM study (n = 14). Literature-based detection rates for draining veins on SWI magnitude images ranged from 77.8% to 85.7%, although reporting formats were heterogeneous. In our contemporary institutional cohort (n = 21), SWI demonstrated a sensitivity of 91.7% (95% CI: 61.5%-99.8%) and a specificity of 77.8% (95% CI: 40.0%-97.2%) for detecting arterialized venous drainage. While SWI improved venous conspicuity and qualitatively enhanced nidus visualization, it demonstrated limited utility for detailed identification of individual feeding arteries compared with DSA. Phase imaging differentiated microhemorrhage from calcification, while magnitude hyperintensity reflected altered oxygenation dynamics in arterialized veins.

CONCLUSIONS

SWI may enhance the morphological evaluation of AVMs and provide clinically relevant adjunctive information for preoperative planning. Although SWI does not replace DSA, it may represent a useful component of multimodal AVM imaging assessment; however, further prospective validation is required.