MRI Arterial Spin Labeling Accurately Rules Out Vascular Causes of ICH

A prospective multicenter study across three French hospitals evaluated arterial spin labeling (ASL) MRI for detecting arteriovenous shunts (AVMs and dural arteriovenous fistulas) in 277 patients with nontraumatic intracerebral hemorrhage. ASL showed 95.8% sensitivity, 94.5% specificity, and 99.6% negative predictive value compared with digital subtraction angiography as the reference standard, with all confirmed shunts detected and three additional cases identified that were initially occult on DSA. The authors state these findings support incorporating ASL as a gatekeeper to DSA in standard MRI protocols during ICH etiologic workup, pending external validation.

Most relevant for: Adults undergoing etiologic workup for nontraumatic intracerebral hemorrhage, particularly where vascular causes such as arteriovenous malformations or dural fistulas are suspected.

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