Digital subtraction angiography (DSA) has long been the imaging gold standard in the evaluation, treatment, and follow-up of cerebro- and spinovascular disorders. However, DSA has the disadvantages of invasiveness, contrast allergy or nephropathy, the impracticality of procedural preparation and recovery, and expense. Contrast-enhanced (CE), time-resolved (TR) magnetic resonance angiography (CE TR-MRA) is a sophisticated, relatively novel imaging modality that provides multiphasic contrast-enhanced visualization of the neurovasculature. Given the crucial role of angiography in all aspects of care for patients with complex neurovascular disorders, it is incumbent on those who care for these patients to understand the usefulness and pitfalls of novel imaging in this arena to ensure best practices, and to deliver cutting edge care to these patients in a way that minimizes cost, but does not compromise quality. CE TR-MRA has the potential to play an expanded role in the workup and follow-up across the spectrum of neurovascular disease, and this review is aimed to help neurosurgeons better understand how CE TR-MRA can be used to better manage patients in this cohort.
Keywords: AVF; AVM; AVM = arteriovenous malformation; CE = contrast enhanced; CTA = CT angiography; DAVF = dural arteriovenous fistula; DSA = digital subtraction angiography; MIP = maximum intensity projection; MRA = MR angiography; NPV = negative predictive value; PPV = positive predictive value; SM = Spetzler-Martin; TOF = time-of-flight; TR = time-resolved; aneurysm; arteriovenous fistula; arteriovenous malformation; cDAVF = cranial DAVF; sDAVF = spinal DAVF; time-resolved MRA.