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Abstract：
Arterial spin labeling (ASL) has emerged as a promising noninvasive tool for the evaluation of both pediatric and adult arteriovenous malformations (AVMs). This paper reviews the advantages and challenges associated with the use of ASL in AVM assessment. An assessment of the diagnostic workup of AVMs and their variants in both adult and pediatric populations is proposed. Evaluation after treatments, whether endovascular or microsurgical, was similarly examined. ASL, with its endogenous tracer and favorable safety profile, offers functional assessment and arterial feeder identification. ASL has demonstrated strong performance in identifying feeder arteries and detecting arteriovenous shunting, although some studies report inferior performance compared with digital subtraction angiography (DSA) in delineating venous drainage. Challenges include uncertainties in sensitivity for specific AVM features. Detecting AVMs in challenging locations, such as the apical cranial convexity, is further complicated, demanding careful consideration due to the risk of underestimating total blood flow. Navigating these challenges, ASL provides a noninvasive avenue with undeniable merits, but a balanced approach considering its limitations is crucial. Larger-scale prospective studies are needed to comprehensively evaluate the diagnostic performance of ASL in AVM assessment.
摘要：
动脉自旋标记（ASL）已成为评估小儿和成人动静脉畸形（AVM）的有前途的非侵入性工具。本文回顾了与在AVM评估中使用ASL相关的优势和挑战。建议对成人和儿科人群中AVM及其变体的诊断检查进行评估。治疗后的评估，无论是血管内还是显微外科手术，进行了类似的检查。ASL,凭借其内源性示踪剂和良好的安全性，提供功能评估和动脉喂食器识别。ASL在识别供血动脉和检测动静脉分流方面表现出强大的性能，尽管一些研究报告在描绘静脉引流方面与数字减影血管造影（DSA）相比表现较差。挑战包括特定AVM特征的灵敏度的不确定性。在具有挑战性的位置检测AVM，比如顶端的颅骨凸度,更加复杂，由于低估总血流量的风险，要求仔细考虑。驾驭这些挑战，ASL提供了一种具有不可否认优点的非侵入性途径，但是考虑到其局限性，平衡的方法至关重要。需要更大规模的前瞻性研究来全面评估ASL在AVM评估中的诊断性能。
