Introduction Accurate diagnosis is essentially important for treatment of cerebral arteriovenous malformation (AVM). Conventional digital subtraction angiography (DSA) are limited due to the complex vessel overlapping. 4D DSA with both temporal and spatial resolution is able to reveal AVM angioarchitecture. Objective We compared the performance of 4D imaging with the conventional method for visualizing AVM. Aim To evaluate the diagnostic performance of 4D DSA and 4D prototype. Methods 37 patients were selected. The standard medical records were based on the conventional 2D and 3D DSA combination method. 2 independent experienced surgeons recorded assessments based only on 4D datasets. The evaluation results were then compared with the medical records using agreement analysis. Results Using either 4D DSA or 4D prototype, both reviewers reached a complete agreement with the medical records for Martin-Spetzler Scores and the presence of intracranial aneurysm. Assessing the number of feeding arteries, the agreement between 4D DSA and the medical records was 0.888 for both Reviewer A and B; the agreement between 4D prototype and the medical records was 0.917 for both reviewers. Determining the number of draining veins, the agreement between 4D DSA and the medical records was 0.97 for both reviewers; the agreement between 4D prototype and the medical records was 0.943 for Reviewer A and 0.941 for Reviewer B. Conclusion The diagnostic performance of both 4D DSA product and prototype software were largely equivalent to the combination method for cerebral AVM. 4D prototype further optimized the temporal resolution and image quality compared to 4D product. References Lang S, Gölitz P, Struffert T, Rösch J, Rössler K, Kowarschik M, Strother C, Doerfler A. 4D DSA for dynamic visualization of cerebral vasculature: a single-center experience in 26 cases. AJNR. American Journal of Neuroradiology 2017;38(6):1169–1176. Ognard J, Magro E, Caroff J, Ben Salem D, Andouard S, Nonent M, Gentric JC. A new time-resolved 3D angiographic technique (4D DSA): description, and assessment of its reliability in Spetzler-Martin grading of cerebral arteriovenous malformations. Journal of Neuroradiology = Journal de Neuroradiologie 2018;45(3):177–185. Disclosure Nothing to disclose