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Correia de Verdier M, Ronne-Engström E, Borota L, Wikström J. Hemodynamic evaluation of intracranial arteriovenous malformations: Pre- and post-treatment 2D phase-contrast MRI measurements. Acta Radiol Open 2024; 13:20584601241269608. [PMID: 39131056 PMCID: PMC11311173 DOI: 10.1177/20584601241269608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/20/2024] [Indexed: 08/13/2024] Open
Abstract
Background Hemodynamic changes are seen in the feeding arteries of arteriovenous malformations (AVMs). Phase-contrast MRI (PC-MRI) enables the acquisition of hemodynamic information from blood vessels. There is insufficient knowledge on which flow or velocity parameter best discriminates AVMs from healthy subjects. Purpose To evaluate PC-MRI-measured flow and velocity in feeding arteries of AVMs before and, when possible, also after treatment and to compare these measurements to corresponding measurements in healthy controls. Materials and Methods Highest flow (HF), lowest flow (LF), mean flow (MF), peak systolic velocity (PSV), end-diastolic velocity (EDV), and mean velocity (MV) were measured in feeding arteries in patients with intracranial AVMs using 2D PC-MRI at 3 T. Measurements were compared to previously reported values in healthy individuals. Values in patients above the 95th percentile in the healthy cohort were categorized as pathological. Nidus volume was measured using 3D time-of-flight MR angiography. Results Ten patients with diagnosed AVMs were examined with PC-MRI. Among these, three patients also underwent follow-up PC-MRI after treatment. Pathological velocities (PSV, EDV, and MV) were seen in all five subjects with a nidus larger or equal to 5.7 cm3, whereas pathological flow values were not seen in all, that is, pathologic HF in three, pathologic LF in two, and pathologic MF in two. After treatment, there was a decrease in flow and velocity (all measured parameters). After treatment, velocities (PSV, EDV, and MV) were no longer abnormal compared to healthy controls. Conclusion Patients with a large AVM nidus show pathological velocities, but less consistent flow increases. Following treatment, velocities normalize.
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Affiliation(s)
| | | | - Ljubisa Borota
- Department of Surgical Sciences, Section of Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Johan Wikström
- Department of Surgical Sciences, Section of Neuroradiology, Uppsala University, Uppsala, Sweden
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Brunozzi D, Stone McGuire L, Hossa J, Atwal G, Charbel FT, Alaraj A. Preoperative embolization of brain arteriovenous malformation and efficacy in intraoperative blood loss reduction: a quantitative study. J Neurointerv Surg 2024; 16:541-547. [PMID: 37402571 DOI: 10.1136/jnis-2023-020142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/13/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Embolization of brain arteriovenous malformations (bAVMs) is often used as adjuvant therapy to microsurgical resection to reduce the high-risk features of bAVMs such as large size and high flow. However, the effect of preoperative embolization on surgical performance and patient outcome has shown mixed results. Heterogeneity in treatment goals, selection criteria, and unpredictable changes in bAVM hemodynamics after partial embolization may account for these uncertain findings. In this study we use an objective quantitative technique to assess the impact of preoperative embolization on intraoperative blood loss (IBL). METHODS Patients with bAVM treated with microsurgical resection only or in combination with preoperative embolization from 2012 to 2022 were retrospectively reviewed. Patients were included if quantitative magnetic resonance angiography was performed prior to any treatment. Correlation of baseline bAVM flow, volume, and IBL was evaluated between the two groups. Additionally, bAVM flow prior to and after embolization was compared. RESULTS Forty-three patients were included, 31 of whom required preoperative embolization (20 had more than one session). Mean bAVM initial flow (362.3 mL/min vs 89.6 mL/min, p=0.001) and volume (9.6 mL vs 2.8 mL, p=0.001) were significantly higher in the preoperative embolization group; flow decreased significantly after embolization (408.0 mL/min vs 139.5 mL/min, p<0.001). IBL was comparable between the two groups (258.6 mL vs 141.3 mL, p=0.17). Linear regression continued to show a significant difference in initial bAVM flow (p=0.03) but no significant difference in IBL (p=0.53). CONCLUSION Patients with larger bAVMs who underwent preoperative embolization had comparable IBL to those with smaller bAVMs undergoing only surgical treatment. Preoperative embolization of high-flow bAVMs facilitates surgical resection, reducing the risk of IBL.
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Affiliation(s)
- Denise Brunozzi
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Laura Stone McGuire
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jessica Hossa
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Gursant Atwal
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
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Samaniego EA, Dabus G, Meyers PM, Kan PT, Frösen J, Lanzino G, Welch BG, Volovici V, Gonzalez F, Fifi J, Charbel FT, Hoh BL, Khalessi A, Marks MP, Berenstein A, Pereira VM, Bain M, Colby GP, Narayanan S, Tateshima S, Siddiqui AH, Wakhloo AK, Arthur AS, Lawton MT. Most Promising Approaches to Improve Brain AVM Management: ARISE I Consensus Recommendations. Stroke 2024; 55:1449-1463. [PMID: 38648282 DOI: 10.1161/strokeaha.124.046725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/01/2024] [Indexed: 04/25/2024]
Abstract
Brain arteriovenous malformations (bAVMs) are complex, and rare arteriovenous shunts that present with a wide range of signs and symptoms, with intracerebral hemorrhage being the most severe. Despite prior societal position statements, there is no consensus on the management of these lesions. ARISE (Aneurysm/bAVM/cSDH Roundtable Discussion With Industry and Stroke Experts) was convened to discuss evidence-based approaches and enhance our understanding of these complex lesions. ARISE identified the need to develop scales to predict the risk of rupture of bAVMs, and the use of common data elements to perform prospective registries and clinical studies. Additionally, the group underscored the need for comprehensive patient management with specialized centers with expertise in cranial and spinal microsurgery, neurological endovascular surgery, and stereotactic radiosurgery. The collection of prospective multicenter data and gross specimens was deemed essential for improving bAVM characterization, genetic evaluation, and phenotyping. Finally, bAVMs should be managed within a multidisciplinary framework, with clinical studies and research conducted collaboratively across multiple centers, harnessing the collective expertise and centralization of resources.
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Affiliation(s)
- Edgar A Samaniego
- Department of Neurology, Neurosurgery and Radiology, University of Iowa (E.A.S.)
| | - Guilherme Dabus
- Department of Neurosurgery, Baptist Health, Miami, FL (G.D.)
| | - Philip M Meyers
- Department of Radiology and Neurological Surgery, Columbia University, New York (P.M.M.)
| | - Peter T Kan
- Department of Neurological Surgery, University of Texas Medical Branch Galveston (P.T.K.)
| | - Juhana Frösen
- Department of Rehabilitation, Tampere University Hospital, Finland (J.F.)
| | | | - Babu G Welch
- Departments of Neurological Surgery and Radiology; The University of Texas Southwestern, Dallas (B.G.W.)
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands (V.V.)
| | - Fernando Gonzalez
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD (F.G.)
| | - Johana Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York (J.F., A.B.)
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago (F.T.C.)
| | - Brian L Hoh
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville (B.L.H.)
| | | | - Michael P Marks
- Interventional Neuroradiology Division, Stanford University Medical Center, Palo Alto, CA (M.P.M.)
| | - Alejandro Berenstein
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York (J.F., A.B.)
| | - Victor M Pereira
- Department of Neurosurgery, St. Michael's Hospital, Toronto, Canada (V.M.P.)
| | - Mark Bain
- Department of Neurological Surgery, Cleveland Clinic, OH (M.B.)
| | - Geoffrey P Colby
- Department of Neurosurgery, University of California Los Angeles (G.P.C.)
| | - Sandra Narayanan
- Neurointerventional Program and Comprehensive Stroke Program, Pacific Neuroscience Institute, Santa Monica, CA (S.N.)
| | - Satoshi Tateshima
- Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles (S.T.)
| | - Adnan H Siddiqui
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York (A.H.S.)
| | - Ajay K Wakhloo
- Department of Radiology, Tufts University School of Medicine, Boston, MA (A.K.W.)
| | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Clinic, University of Tennessee Health Science Center, Memphis (A.S.A.)
| | - Michael T Lawton
- Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (M.T.L.)
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Shah KA, White TG, Teron I, Turpin J, Dehdashti AR, Temes RE, Black K, Woo HH. Quantitative magnetic resonance angiography as an alternative imaging technique in the assessment of cerebral vasospasm after subarachnoid hemorrhage. Interv Neuroradiol 2024; 30:271-279. [PMID: 36357992 PMCID: PMC11095350 DOI: 10.1177/15910199221138167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/25/2022] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION The major mechanism of morbidity of delayed cerebral ischemia after subarachnoid hemorrhage (SAH) is considered to be severe vasospasm. Quantitative MRA (QMRA) provides direct measurements of vessel-specific volumetric blood flow and may permit a clinically relevant assessment of the risk of ischemia secondary to cerebral vasospasm. PURPOSE To evaluate the utility of QMRA as an alternative imaging technique for the assessment of cerebral vasospasm after SAH. METHODS QMRA volumetric flow rates of the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) were compared with vessel diameters on catheter-based angiography. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of QMRA for detecting cerebral vasospasm was determined by receiver-operating characteristic curves. Spearman correlation coefficients were calculated for QMRA flow versus angiographic vessel diameter. RESULTS Sixty-six vessels (10 patients) were evaluated with QMRA and catheter-based angiography. The median percent QMRA flow of all vessels with angiographic vasospasm (55.0%, IQR 34.3-71.6%) was significantly lower than the median percent QMRA flow of vessels without vasospasm (91.4%, IQR 81.4-100.4%) (p < 0.001). Angiographic vasospasm reduced QMRA-assessed flow by 23 ± 5 (p = 0.018), 95 ± 12 (p = 0.042), and 16 ± 4 mL/min (p = 0.153) in the ACA, MCA, and PCA, respectively, compared to vessels without angiographic vasospasm. The sensitivity, specificity, PPV, and NPV of QMRA for the discrimination of cerebral vasospasm was 84%, 72%, 84%, and 72%, respectively, for angiographic vasospasm >25% and 91%, 60%, 87%, and 69%, respectively, for angiographic vasospasm >50%. The Spearman correlation indicated a significant association between QMRA flows and vessel diameters (rs = 0.71, p < 0.001). CONCLUSION Reduction in QMRA flow correlates with angiographic vessel narrowing and may be useful as a non-invasive imaging modality for the detection of cerebral vasospasm after SAH.
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Affiliation(s)
- Kevin A Shah
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Timothy G White
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Ina Teron
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Justin Turpin
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Richard E Temes
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Karen Black
- Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Henry H Woo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Roberts R, Hadi M, Ram C, Affan M. What the Diagnostic Neuroradiologist Needs to Know About Diseases of the Cerebral Veins. Semin Roentgenol 2024; 59:172-190. [PMID: 38880516 DOI: 10.1053/j.ro.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/10/2024] [Accepted: 02/20/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Rebecca Roberts
- Department of Neurology, University of Minnesota, Minneapolis, MN
| | - Mohiuddin Hadi
- Department of Radiology, University of Louisville, Louisville, KY
| | - Chithra Ram
- Department of Radiology, University of Louisville, Louisville, KY
| | - Muhammad Affan
- Department of Neurology, University of Minnesota, Minneapolis, MN.
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Brunozzi D, McGuire LS, Turchan WT, Hossa J, Charbel F, Koshy M, Alaraj A. Brain arteriovenous malformation flow after stereotactic radiosurgery: Role of quantitative MRA. Interv Neuroradiol 2024; 30:242-249. [PMID: 36262095 PMCID: PMC11095360 DOI: 10.1177/15910199221133174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is a current therapeutic option for treatment of arteriovenous malformations (AVMs) located in deep or eloquent brain regions. Obliteration usually occurs in a delayed fashion, with an expected latency of 3-5 years. Here, we assess how AVM flow correlates with volume before and after SRS treatment. METHODS Patients with supratentorial AVM treated with SRS at our institution between 2012-2022 were retrospectively reviewed. Patients were included if Quantitative Magnetic Resonance Angiography (QMRA) study was performed at baseline and at least at the first follow-up. Correlation between AVM flow and volume before and after treatment was evaluated. AVM flow and volume were additionally assessed for obliteration using the non-parametric receiver operating characteristic (ROC) curve. RESULTS Twelve patients with radiologic follow-up imaging were included. Eight patients presented AVM rupture, one of which occurred after radiosurgical treatment. Three patients underwent embolization prior SRS. Mean AVM initial volume was 3.8 cc (0.1-12.4 cc), mean initial flow 174 ml/min (11-604 ml/min), both variables showed progressive reduction at follow-up (range 3-57 months); and flow decreased with volume reduction (p < 0.001). Area under the ROC was 0.914 for both AVM flow and volume with obliteration (p = 0.019). CONCLUSIONS AVM flow significantly decreased after SRS treatment, reflecting volume reduction. Baseline AVM flow and volume both predicted obliteration. QMRA provides additional non-invasive information to monitor patients after radiosurgical treatment.
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Affiliation(s)
- Denise Brunozzi
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Laura Stone McGuire
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - William Tyler Turchan
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Jessica Hossa
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Fady Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Matthew Koshy
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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De Simone M, Fontanella MM, Choucha A, Schaller K, Machi P, Lanzino G, Bijlenga P, Kurz FT, Lövblad KO, De Maria L. Current and Future Applications of Arterial Spin Labeling MRI in Cerebral Arteriovenous Malformations. Biomedicines 2024; 12:753. [PMID: 38672109 PMCID: PMC11048131 DOI: 10.3390/biomedicines12040753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
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.
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Affiliation(s)
- Matteo De Simone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via S. Allende, 84081 Baronissi, Italy
| | - Marco Maria Fontanella
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy; (M.M.F.); (L.D.M.)
| | - Anis Choucha
- Department of Neurosurgery, Aix Marseille University, APHM, UH Timone, 13005 Marseille, France;
- Laboratory of Biomechanics and Application, UMRT24, Gustave Eiffel University, Aix Marseille University, 13005 Marseille, France
| | - Karl Schaller
- Division of Neurosurgery, Diagnostic Department of Clinical Neurosciences, Geneva University Hospitals (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland; (K.S.); (P.B.)
| | - Paolo Machi
- Division of Interventional Neuroradiology, Department of Radiology and Medical Informatic, Geneva University Hospitals (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland; (P.M.); (F.T.K.); (K.-O.L.)
| | - Giuseppe Lanzino
- Department of Neurosurgery and Interventional Neuroradiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA;
| | - Philippe Bijlenga
- Division of Neurosurgery, Diagnostic Department of Clinical Neurosciences, Geneva University Hospitals (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland; (K.S.); (P.B.)
| | - Felix T. Kurz
- Division of Interventional Neuroradiology, Department of Radiology and Medical Informatic, Geneva University Hospitals (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland; (P.M.); (F.T.K.); (K.-O.L.)
| | - Karl-Olof Lövblad
- Division of Interventional Neuroradiology, Department of Radiology and Medical Informatic, Geneva University Hospitals (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland; (P.M.); (F.T.K.); (K.-O.L.)
| | - Lucio De Maria
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy; (M.M.F.); (L.D.M.)
- Division of Neurosurgery, Diagnostic Department of Clinical Neurosciences, Geneva University Hospitals (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland; (K.S.); (P.B.)
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Souter J, Stone McGuire L, Choi J, Brunozzi D, Hossa J, Charbel FT, Alaraj A. Quantitative Blood Flow Reduction in Selective Embolization of Intranidal Fistula of Cerebral Arteriovenous Malformations: Case Series. Oper Neurosurg (Hagerstown) 2023; 25:499-504. [PMID: 37747350 DOI: 10.1227/ons.0000000000000876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/16/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Arteriovenous malformations (AVMs) are often associated with high-flow intranidal fistulas (INFs). Although INF embolization has been suggested to provide higher reduction of total AVM flow compared with regular pedicle embolization, this effect has not previously been quantified. The aim of this study was to characterize the effect of AVM INF embolization on total AVM flow. METHODS This study is an Institutional Review Board-approved, retrospective case series of patients from 2010 to 2022 with AVMs, both with and without INFs, who underwent quantitative magnetic resonance angiography and endovascular embolization. RESULTS Twenty patients accounted for 35 separate embolization sessions: 13 patients with INFs underwent a total 21 embolizations and 12 patients without INFs had 14 embolizations. No significant differences were found between groups on age, sex, laterality, drainage pattern, and Spetzler-Martin grade. However, AVMs with INFs were larger than the control group (12.7 vs 8.37 cm 3 , P = .049). Baseline pre-embolization AVM flow significantly differed between AVM with INF vs control groups (522 vs 320 cc/min, P = .005). Similarly, postembolization AVM flow also differed between AVM with INF and control groups (392 vs 224 cc/min, P = .008), with a larger decrease in flow per vessel per embolization session within the AVM INF group compared with controls (101.5 vs 33.2 cc/min, P < .001). Repeated measure analysis of variance showed significant differences pre-embolization and postembolization AVM flow between those with INFs vs controls ( P < .001). CONCLUSION This study represents the first to examine the effect of INF embolization on total AVM flow. AVMs with INFs showed higher baseline flow, and targeted embolization toward INFs significantly lowered AVM flow in comparison with controls without INFs. The results of this study emphasize the importance of recognizing the presence of INFs within AVMs and their embolization to reduce AVM flow as part of a multistep management paradigm.
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Affiliation(s)
- John Souter
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Laura Stone McGuire
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jason Choi
- Department of Neurosurgery, Stanford University, Stanford, California, USA
| | - Denise Brunozzi
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jessica Hossa
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
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El-Ghandour NMF. Commentary: Quantitative Blood Flow Reduction in Selective Embolization of Intranidal Fistula of Cerebral Arteriovenous Malformations: Case Series. Oper Neurosurg (Hagerstown) 2023; 25:e301-e302. [PMID: 37773325 DOI: 10.1227/ons.0000000000000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 10/01/2023] Open
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10
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Nico E, Hossa J, McGuire LS, Alaraj A. Rupture-Risk Stratifying Patients with Cerebral Arteriovenous Malformations Using Quantitative Hemodynamic Flow Measurements. World Neurosurg 2023; 179:68-76. [PMID: 37597662 DOI: 10.1016/j.wneu.2023.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023]
Abstract
Arteriovenous malformations (AVMs) are high-pressure, low-resistance arterial-venous shunts without intervening capillaries. Up to 60% of AVMs present with an intracranial hemorrhage; however, noninvasive neuroimaging has increasingly diagnosed incidental AVMs. AVM management depends on weighing the lifetime rupture risk against the risks of intervention. Although AVM rupture risk relies primarily on angioarchitectural features, measuring hemodynamic flow is gaining traction. Accurate understanding of AVM hemodynamic flow parameters will help endovascular neurosurgeons and interventional neuroradiologists stratify patients by rupture risk and select treatment plans. This review examines various neuroimaging modalities and their capabilities to quantify AVM flow, as well as the relationship between AVM flow and rupture risk. Quantitative hemodynamic studies on the relationship between AVM flow and rupture risk have not reached a clear consensus; however, the preponderance of data suggests that higher arterial inflow and lower venous outflow in the AVM nidus contribute to increased hemorrhagic risk. Future studies should consider using larger sample sizes and standardized definitions of hemodynamic parameters to reach a consensus. In the meantime, classic angioarchitectural features may be more strongly correlated with AVM rupture than the amount of blood flow.
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Affiliation(s)
- Elsa Nico
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Jessica Hossa
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Laura Stone McGuire
- Department of Neurosurgery, University of Illinois Hospital, Chicago, Illinois, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois Hospital, Chicago, Illinois, USA.
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11
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Lin CJ, Chen KK, Hu YS, Yang HC, Lin CF, Chang FC. Quantified flow and angioarchitecture show similar associations with hemorrhagic presentation of brain arteriovenous malformations. J Neuroradiol 2023; 50:79-85. [PMID: 35120975 DOI: 10.1016/j.neurad.2022.01.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The purpose of our study was to elucidate the impact of brain arteriovenous malformation (BAVM) flow and wall shear stress (WSS) on angioarchitecture and to evaluate their association with hemorrhagic presentations. MATERIALS AND METHODS Forty-one patients with BAVMs were evaluated by phase-contrast MR angiography. Volume flow rate and WSS were quantified. Angioarchitectural features such as location, angiogenesis, venous stenosis, venous ectasia, venous phlebitis, venous rerouting, exclusive deep vein and venous sac were evaluated by two neuroradiologists. The correlation between BAVM flow and size was evaluated with Spearman correlation coefficients. Differences of size, flow, and WSS between the hemorrhagic and non-hemorrhagic groups, the seizure and non-seizure groups, and between the different groups based on angioarchitecture were evaluated with Mann-Whitney U tests. Accuracy in predicting hemorrhage was evaluated with receiver operating characteristic curves. RESULT BAVM flow was highly correlated with volume (ρ = 0.77). Higher flow was more commonly associated with angiogenesis, venous ectasia, venous rerouting, and venous phlebitis. Flow and angioarchitecture showed similar efficacy in differentiating hemorrhagic from non-hemorrhagic BAVMs. WSS did not demonstrate differences across any clinical groups. CONCLUSION Flow quantification and angioarchitecture analysis of BAVMs showed similar efficacy as evaluated by associations with hemorrhagic presentation. High flow affects both arterial and venous angioarchitecture, reflecting the nature of low vascular resistance in BAVMs.
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Affiliation(s)
- Chung-Jung Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Ko-Kung Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yong-Sin Hu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan
| | - Huai-Che Yang
- Department of Radiology, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Fu Lin
- Department of Radiology, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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12
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Li Z, Chen Y, Chen P, Li R, Ma L, Yan D, Zhang H, Han H, Zhao Y, Zhang Y, Meng X, Jin H, Li Y, Chen X, Zhao Y. Quantitative evaluation of hemodynamics after partial embolization of brain arteriovenous malformations. J Neurointerv Surg 2022; 14:1112-1117. [PMID: 34872987 DOI: 10.1136/neurintsurg-2021-018187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/16/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND To explore the hemodynamic changes after embolization of arteriovenous malformations (AVMs) using quantitative digital subtraction angiography (QDSA). METHODS We reviewed 74 supratentorial AVMs that underwent endovascular embolization and performed a quantitative hemodynamic analysis comparing parameters in pre- and post-operative DSA in correlation with rupture. The AVMs were further divided into two subgroups based on the embolization degree: Group I: 0%-50%, Group II: 51%-100%. In the intergroup analysis, we examined the correlations between embolization degree and hemodynamic parameter changes. RESULTS A longer time to peak (TTP) of the main feeding artery (OR 11.836; 95% CI 1.388 to 100.948; P=0.024) and shorter mean transit time (MTT) of the nidus (OR 0.174; 95% CI 0.039 to 0.766; P=0.021) were associated with AVM rupture. After embolization, all MTTs were significantly prolonged (P<0.05). The full width at half maximum (FWHM) duration of the main feeding artery was significantly shortened (P<0.001), and several hemodynamic parameters of the main draining vein changed significantly (TTP: prolonged, P=0.005; FWHM: prolonged, P=0.014; inflow gradient: decreased, P=0.004; outflow gradient: decreased, P=0.042). In the subgroup analysis, several MTT parameters were significantly prolonged in both groups (P<0.05), and the MTT increase rate in Group II was greater than in Group I (P<0.05). CONCLUSIONS Embolization can significantly change the hemodynamics of AVMs, especially when an embolization degree >50% is obtained. Partial embolization may reduce the AVM rupture risk in hemodynamics perspective.
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Affiliation(s)
- Zhipeng Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Pingting Chen
- College of Energy and Power Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, China
| | - Ruinan Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Debin Yan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haibin Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Heze Han
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Zhao
- Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China
| | - Yukun Zhang
- Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China
| | - Xiangyu Meng
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Hengwei Jin
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Xiaolin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yuanli Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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13
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Koizumi S, Shojima M, Shinya Y, Ishikawa O, Hasegawa H, Miyawaki S, Nakatomi H, Saito N. Risk Factors of Brain Arteriovenous Malformation Embolization as Adjunctive Therapy: Single-Center 10-Year Experience. World Neurosurg 2022; 167:e1448-e1454. [PMID: 36130658 DOI: 10.1016/j.wneu.2022.09.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE In the multimodality treatment of complex brain arteriovenous malformations (AVMs), the role of endovascular embolization is not fully elucidated. To assess the risk of embolization, we retrospectively evaluated the outcomes of endovascular treatment for AVM, focusing on the embolization-related complications. METHODS The present study included patients with brain AVM who underwent embolization at our hospital between April 2011 and May 2021. Risk factors for peri- and postoperative complications were analyzed. RESULTS During the study period, 36 AVMs were treated during 58 embolization sessions. The goal of the embolization was preoperative in 24 (67%), pre-radiosurgical in 9 (25%), and palliative in 3 (8%) cases. The overall complication rate was 43% (25 of 58) per session and 36% (13 of 36) per patient. Ischemic and hemorrhagic complications were observed in 14 (24%) and 14 (24%) cases, respectively. n-Butyl cyanoacrylate (n-BCA) embolization was detected as the significant risk for postoperative hemorrhage in the univariate (79% vs. 36%, P = 0.012; Fisher exact test) and the multivariable analysis (odds ratio 4.90, 95% confidence interval 1.08-22.2, P = 0.039). The number of embolized feeder in a single session also tended to be higher in a hemorrhagic complication group (median 3.5 vs. 2.0, P = 0.11; Mann-Whitney U-test). CONCLUSIONS The risk of embolization in multimodality treatment for complex brain AVM was substantial. n-BCA embolization may carry a higher risk of postoperative hemorrhage. An accumulation of cases is awaited to investigate the effectiveness of minimal target embolization in the future.
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Affiliation(s)
- Satoshi Koizumi
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
| | - Masaaki Shojima
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan; Department of Neurosurgery, Teikyo University Hospital, Tokyo, Japan
| | - Yuki Shinya
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Osamu Ishikawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan; Department of Neurosurgery, Asama General Hospital, Nagano, Japan
| | - Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan; Department of Neurosurgery, Kyorin University Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
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14
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Takeda Y, Hasegawa H, Kin T, Shinya Y, Kawashima M, Furuta Y, Suzuki Y, Sekine T, Saito N. Hemodynamic changes during the obliteration process for cerebral arteriovenous malformations after radiosurgery. Neurosurg Focus 2022; 53:E7. [PMID: 35901715 DOI: 10.3171/2022.4.focus2214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/14/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The process of cerebral arteriovenous malformation (AVM) obliteration following radiosurgery is poorly understood. Authors of this retrospective study aimed to assess the changes in AVM hemodynamics after stereotactic radiosurgery (SRS) by using 3D flow magnetic resonance imaging (MRI) to elucidate the process of AVM obliteration. METHODS Twenty-four patients with AVMs treated with SRS between July 2015 and December 2017 were included in this study and classified into two groups depending on the duration of AVM obliteration: group A, obliteration within 3 years (n = 15); and group B, obliteration taking more than 3 years or no obliteration (n = 9). Blood flow (ml/min) in the largest feeding artery was measured before and after SRS by using time-averaged 3D flow MRI. The decreasing rate of blood flow in the feeding artery after SRS was calculated as the percent change from baseline blood flow. A Wilcoxon rank-sum test was used to compare the decreasing blood flow rate between the two groups at 4 and 12 months after SRS. RESULTS For the entire cohort, the mean decrease in blood flow in the feeding artery from baseline was 29% at 4 months and 71% at 12 months after SRS. In general, blood flow after SRS decreased faster in group A and slower in group B. The decreasing rates in blood flow at 4 and 12 months after SRS were significantly different between the two groups (p = 0.02 and < 0.001, respectively). CONCLUSIONS Tracking changes in AVM hemodynamics after SRS may be useful for assessing the progress of AVM obliteration and the therapeutic effects of SRS, possibly contributing to the prediction of subsequent obliteration outcome.
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Affiliation(s)
| | | | | | | | | | | | | | - Tetsuro Sekine
- 3Department of Radiology, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
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15
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Behzadi F, Heiferman DM, Wozniak A, Africk B, Ballard M, Chazaro J, Zsigray B, Reynolds M, Anderson DE, Serrone JC. Comparison of transarterial n-BCA and Onyx embolization of brain arteriovenous malformations: A single-center 18-year retrospective analysis. J Cerebrovasc Endovasc Neurosurg 2022; 24:144-153. [PMID: 35526856 PMCID: PMC9260459 DOI: 10.7461/jcen.2022.e2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/02/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Brain arteriovenous malformations (AVM) are commonly treated with endovascular embolization. Due to the rapid evolution of endovascular technology and lack of consistent practice guidelines regarding AVM embolization, further study of AVM embolization outcomes is warranted. METHODS We conducted a retrospective review of AVMs embolized at a single center from 2002-2019. Patient demographics, AVM characteristics, intention of embolization, and angiographic and clinical outcome after embolization were recorded. We compared the embolization results of those treated with n-butyl cyanoacrylate (n-BCA) and Onyx. RESULTS Over an 18-year period at our institution, 30 (33%) of 92 AVMs were treated with embolization. n-BCA was used in 12 cases and Onyx in 18 cases. Eighty-seven pedicles were embolized over 47 embolization sessions. Fifty percent of AVMs treated with n-BCA underwent more than one embolization session compared to 22% when Onyx was used. The median total percent volume reduction in the n-BCA AVMs was 52% compared to 51% in Onyx AVMs. There were 2 periprocedural complications in the n-BCA cohort and none in the Onyx cohort. CONCLUSIONS In this small retrospective series, Onyx and n-BCA achieved similar occlusion results, although n-BCA required more sessions and pedicles embolized to do so.
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Affiliation(s)
- Faraz Behzadi
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | | | - Amy Wozniak
- Clinical Research Office, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Benjamin Africk
- Department of Pediatric Neurology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Matthew Ballard
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Joshua Chazaro
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Brandon Zsigray
- Department of Neurological Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Matthew Reynolds
- Department of Neurological Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Douglas E Anderson
- Department of Neurological Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Joseph C Serrone
- Department of Neurological Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
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16
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Takeda Y, Kin T, Sekine T, Hasegawa H, Suzuki Y, Uchikawa H, Koike T, Kiyofuji S, Shinya Y, Kawashima M, Saito N. Hemodynamic Analysis of Cerebral AVMs with 3D Phase-Contrast MR Imaging. AJNR Am J Neuroradiol 2021; 42:2138-2145. [PMID: 34620595 DOI: 10.3174/ajnr.a7314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/28/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The hemodynamics associated with cerebral AVMs have a significant impact on their clinical presentation. This study aimed to evaluate the hemodynamic features of AVMs using 3D phase-contrast MR imaging with dual velocity-encodings. MATERIALS AND METHODS Thirty-two patients with supratentorial AVMs who had not received any previous treatment and had undergone 3D phase-contrast MR imaging were included in this study. The nidus diameter and volume were measured for classification of AVMs (small, medium, or large). Flow parameters measured included apparent AVM inflow, AVM inflow index, apparent AVM outflow, AVM outflow index, and the apparent AVM inflow-to-outflow ratio. Correlation coefficients between the nidus volume and each flow were calculated. The flow parameters between small and other AVMs as well as between nonhemorrhagic and hemorrhagic AVMs were compared. RESULTS Patients were divided into hemorrhagic (n = 8) and nonhemorrhagic (n = 24) groups. The correlation coefficient between the nidus volume and the apparent AVM inflow and outflow was .83. The apparent AVM inflow and outflow in small AVMs were significantly smaller than in medium AVMs (P < .001 for both groups). The apparent AVM inflow-to-outflow ratio was significantly larger in the hemorrhagic AVMs than in the nonhemorrhagic AVMs (P = .02). CONCLUSIONS The apparent AVM inflow-to-outflow ratio was the only significant parameter that differed between nonhemorrhagic and hemorrhagic AVMs, suggesting that a poor drainage system may increase AVM pressure, potentially causing cerebral hemorrhage.
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Affiliation(s)
- Y Takeda
- From the Department of Neurosurgery (Y.T., T.K., H.H., H.U., T.K., S.K., Y. Shinya, M.K., N.S.)
| | - T Kin
- From the Department of Neurosurgery (Y.T., T.K., H.H., H.U., T.K., S.K., Y. Shinya, M.K., N.S.)
| | - T Sekine
- Department of Radiology (T.S.), Nippon Medical School Musashi-kosugi Hospital, Kanagawa, Japan
| | - H Hasegawa
- From the Department of Neurosurgery (Y.T., T.K., H.H., H.U., T.K., S.K., Y. Shinya, M.K., N.S.)
| | - Y Suzuki
- Radiology (Y.Suzuki), The University of Tokyo, Tokyo, Japan
| | - H Uchikawa
- From the Department of Neurosurgery (Y.T., T.K., H.H., H.U., T.K., S.K., Y. Shinya, M.K., N.S.)
| | - T Koike
- From the Department of Neurosurgery (Y.T., T.K., H.H., H.U., T.K., S.K., Y. Shinya, M.K., N.S.)
| | - S Kiyofuji
- From the Department of Neurosurgery (Y.T., T.K., H.H., H.U., T.K., S.K., Y. Shinya, M.K., N.S.)
| | - Y Shinya
- From the Department of Neurosurgery (Y.T., T.K., H.H., H.U., T.K., S.K., Y. Shinya, M.K., N.S.)
| | - M Kawashima
- From the Department of Neurosurgery (Y.T., T.K., H.H., H.U., T.K., S.K., Y. Shinya, M.K., N.S.)
| | - N Saito
- From the Department of Neurosurgery (Y.T., T.K., H.H., H.U., T.K., S.K., Y. Shinya, M.K., N.S.)
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17
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Barral M, El-Sanharawi I, Dohan A, Sebuhyan M, Guedon A, Delarue A, Boutigny A, Mohamedi N, Magnan B, Kemel S, Ketfi C, Kubis N, Bisdorff-Bresson A, Pocard M, Bonnin P. Blood Flow and Shear Stress Allow Monitoring of Progression and Prognosis of Tumor Diseases. Front Physiol 2021; 12:693052. [PMID: 34413786 PMCID: PMC8369886 DOI: 10.3389/fphys.2021.693052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
In the presence of tumor angiogenesis, blood flow must increase, leading to an elevation of blood flow velocities (BFVels) and wall shear stress (WSS) in upstream native arteries. An adaptive arterial remodeling is stimulated, whose purpose lies in the enlargement of the arterial inner diameter, aiming for normalization of BFVels and WSS. Remodeling engages delayed processes that are efficient only several weeks/months after initiation, independent from those governing expansion of the neovascular network. Therefore, during tumor expansion, there is a time interval during which elevation of BFVels and WSS could reflect disease progression. Conversely, during the period of stability, BFVels and WSS drop back to normal values due to the achievement of remodeling processes. Ovarian peritoneal carcinomatosis (OPC), pseudomyxoma peritonei (PMP), and superficial arteriovenous malformations (AVMs) are diseases characterized by the development of abnormal vascular networks developed on native ones. In OPC and PMP, preoperative blood flow in the superior mesenteric artery (SMA) correlated with the per-operative peritoneal carcinomatosis index (OPC: n = 21, R = 0.79, p < 0.0001, PMP: n = 66, R = 0.63, p < 0.0001). Moreover, 1 year after surgery, WSS in the SMA helped in distinguishing patients with PMP from those without disease progression [ROC-curve analysis, AUC = 0.978 (0.902-0.999), p < 0.0001, sensitivity: 100.0%, specificity: 93.5%, cutoff: 12.1 dynes/cm2]. Similarly, WSS in the ipsilateral afferent arteries close to the lesion distinguished stable from progressive AVM [ROC-curve analysis, AUC: 0.988, (0.919-1.000), p < 0.0001, sensitivity: 93.5%, specificity: 95.7%; cutoff: 26.5 dynes/cm2]. Blood flow volume is indicative of the tumor burden in OPC and PMP, and WSS represents an early sensitive and specific vascular marker of disease progression in PMP and AVM.
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Affiliation(s)
- Matthias Barral
- INSERM UMR1275, Université de Paris, Hôpital Lariboisière, Paris, France
| | - Imane El-Sanharawi
- AP-HP, Université de Paris, Hôpital Lariboisière, Physiologie Clinique - Explorations Fonctionnelles, Paris, France
| | - Anthony Dohan
- INSERM UMR1275, Université de Paris, Hôpital Lariboisière, Paris, France
| | - Maxime Sebuhyan
- AP-HP, Université de Paris, Hôpital Lariboisière, Physiologie Clinique - Explorations Fonctionnelles, Paris, France
| | - Alexis Guedon
- AP-HP, Université de Paris, Hôpital Lariboisière, Physiologie Clinique - Explorations Fonctionnelles, Paris, France
| | - Audrey Delarue
- AP-HP, Université de Paris, Hôpital Lariboisière, Physiologie Clinique - Explorations Fonctionnelles, Paris, France
| | - Alexandre Boutigny
- AP-HP, Université de Paris, Hôpital Lariboisière, Physiologie Clinique - Explorations Fonctionnelles, Paris, France.,INSERM UMR1148 - LVTS, Université de Paris, Hôpital Bichat, Paris, France
| | - Nassim Mohamedi
- AP-HP, Université de Paris, Hôpital Lariboisière, Physiologie Clinique - Explorations Fonctionnelles, Paris, France
| | - Benjamin Magnan
- AP-HP, Université de Paris, Hôpital Lariboisière, Physiologie Clinique - Explorations Fonctionnelles, Paris, France
| | - Salim Kemel
- AP-HP, Université de Paris, Hôpital Lariboisière, Physiologie Clinique - Explorations Fonctionnelles, Paris, France
| | - Chahinez Ketfi
- AP-HP, Université de Paris, Hôpital Lariboisière, Physiologie Clinique - Explorations Fonctionnelles, Paris, France
| | - Nathalie Kubis
- AP-HP, Université de Paris, Hôpital Lariboisière, Physiologie Clinique - Explorations Fonctionnelles, Paris, France.,INSERM UMR1148 - LVTS, Université de Paris, Hôpital Bichat, Paris, France
| | - Annouk Bisdorff-Bresson
- AP-HP, Université de Paris, Hôpital Lariboisière, Neuroradiologie, Centre Constitutif des Malformations Artério Veineuses Superficielles de l'Enfant et de l'Adulte, Paris, France
| | - Marc Pocard
- INSERM UMR1275, Université de Paris, Hôpital Lariboisière, Paris, France.,AP-HP, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Chirurgie Digestive et Cancérologique, Paris, France
| | - Philippe Bonnin
- AP-HP, Université de Paris, Hôpital Lariboisière, Physiologie Clinique - Explorations Fonctionnelles, Paris, France.,INSERM UMR1148 - LVTS, Université de Paris, Hôpital Bichat, Paris, France
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18
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Stagnant venous outflow in ruptured arteriovenous malformations revealed by delayed quantitative digital subtraction angiography. Eur J Radiol 2020; 134:109455. [PMID: 33296802 DOI: 10.1016/j.ejrad.2020.109455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To investigate the reproducibility of quantitative digital subtraction angiography (QDSA) measurements and their associations with brain arteriovenous malformation (BAVM) hemorrhage. METHODS From 2011-2019, 37 patients with BAVMs who had undergone both diagnostic and stereotactic DSA were divided into hemorrhagic and nonhemorrhagic groups. QDSA analysis was performed on the 2 DSA exams. The inter-exam reliabilities of QDSA measurements across the diagnostic and stereotactic DSA were tested using intraclass correlation coefficients (ICCs). Demographics, BAVM characteristics, and QDSA results for the hemorrhagic and nonhemorrhagic groups were compared. RESULTS Fifteen of 37 (40.5 %) patients presented with hemorrhage were associated with smaller BAVM volume and the presence of intranidal aneurysm and exclusive deep venous drainage. The median interval between the diagnostic and stereotactic DSA was 49 days and did not differ between the groups. In both groups, the inter-exam QDSA measurements were more reliable for drainage veins and transnidal time (ICCs ranged from 0.38-0.93) than for feeding arteries (ICCs ranged from 0.01-0.74). Among the venous parameters, the hemorrhagic group had lower peak density, area under the curve, inflow gradient, and outflow gradient on both DSA exams and larger full width at half maximum and stasis index on the stereotactic DSA exam than the nonhemorrhagic group. CONCLUSIONS In BAVMs, the QDSA measurements for veins are more reliable than those for arteries. QDSA analysis reflecting stagnant venous drainage is associated with BAVM hemorrhage, but may be confounded by the acute hemodynamic change after hemorrhage.
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El Sanharawi I, Barral M, Lenck S, Dillinger JG, Salvan D, Mangin G, Cogo A, Bailliart O, Levy BI, Kubis N, Bisdorff-Bresson A, Bonnin P. Wall Shear Stress in the Feeding Native Conduit Arteries of Superficial Arteriovenous Malformations of the Lower Face is a Reliable Marker of Disease Progression. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:428-438. [PMID: 30321881 DOI: 10.1055/a-0729-2728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To assess the prognostic value of the wall shear stress (WSS) measured in the feeding native arteries upstream from facial superficial arteriovenous malformations (sAVMs). Reliable prognostic criteria are needed to distinguish progressive from stable sAVMs and thus support the indication for an aggressive or a conservative management to avoid severe facial disfigurement. MATERIALS AND METHODS We prospectively included 25 patients with untreated facial sAVMs, 15 patients with surgically resected sAVMs and 15 controls. All had undergone Doppler ultrasound examination (DUS) with measurements of inner diameters, blood flow velocities, computation of blood flow and WSS of the feeding arteries. Based on the absence or presence of progression in clinical and imaging examinations 6 months after, we discriminated untreated patients as stable or progressive. RESULTS WSS in the ipsilateral external carotid artery was higher in progressive compared to stable sAVMs (15.8 ± 3.3dynes/cm² vs. 9.6 ± 2.0dynes/cm², mean±SD, p < 0.0001) with a cut-off of 11.5dynes/cm² (sensitivity: 92 %, specificity: 92 %, AUC: 0.955, [95 %CI: 0.789-0.998], p = 0.0001). WSS in the ipsilateral facial artery was also higher in progressive compared to stable sAVMs (50.7 ± 14.5dynes/cm² vs. 25.2 ± 7.1dynes/cm², p < 0.0001) with a cut-off of 34.0dynes/cm² (sensitivity: 100 %, specificity: 92 %, AUC: 0.974, [95 %CI: 0.819-1.000], p = 0.0001). The hemodynamic data of operated patients were not different from those of the control group. CONCLUSION WSS measured in the feeding arteries of an sAVM may be a simple reliable criterion to distinguish stable from progressive sAVMs. This value should be considered to guide the therapeutic strategy as well as the long-term follow-up of patients with facial sAVMs.
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Affiliation(s)
- Imane El Sanharawi
- APHP, Clinical Physiology - Functional Investigations, Lariboisiere Hospital, Paris, France
| | | | - Stéphanie Lenck
- APHP, Neuroradiology, center for arteriovenous malformations in children and adults, Lariboisiere Hospital, Paris, France
| | | | - Didier Salvan
- APHP, Otorhinolaryngology and maxillofacial surgery, Lariboisiere Hospital, Paris, France
| | | | - Adrien Cogo
- UMR965, CART, INSERM, Lariboisiere Hospital, Paris, France
| | - Olivier Bailliart
- APHP, Clinical Physiology - Functional Investigations, Lariboisiere Hospital, Paris, France
| | - Bernard I Levy
- Lariboisiere Hospital, Vessel and Blood Institut, Paris, France
| | - Nathalie Kubis
- APHP, Clinical Physiology - Functional Investigations, Lariboisiere Hospital, Paris, France
| | - Annouk Bisdorff-Bresson
- APHP, Neuroradiology, center for arteriovenous malformations in children and adults, Lariboisiere Hospital, Paris, France
| | - Philippe Bonnin
- APHP, Clinical Physiology - Functional Investigations, Lariboisiere Hospital, Paris, France
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Donzelli GF, Nelson J, McCoy D, McCulloch CE, Hetts SW, Amans MR, Dowd CF, Halbach VV, Higashida RT, Lawton MT, Kim H, Cooke DL. The effect of preoperative embolization and flow dynamics on resection of brain arteriovenous malformations. J Neurosurg 2020; 132:1836-1844. [PMID: 31100732 PMCID: PMC6858934 DOI: 10.3171/2019.2.jns182743] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Preoperative embolization of brain arteriovenous malformations (AVMs) is performed to facilitate resection, although its impact on surgical performance has not been clearly defined. The authors tested for associations between embolization and surgical performance metrics. METHODS The authors analyzed AVM cases resected by one neurosurgeon from 2006 to 2017. They tested whether cases with and without embolization differed from one another with respect to patient and AVM characteristics using t-tests for continuous variables and Fisher's exact tests for categorical variables. They used simple and multivariable regression models to test whether surgical outcomes (blood loss, resection time, surgical clip usage, and modified Rankin Scale [mRS] score) were associated with embolization. Additional regression analyses integrated the peak arterial afferent contrast normalized for the size of the region of interest (Cmax/ROI) into models as an additional predictor. RESULTS The authors included 319 patients, of whom 151 (47%) had preoperative embolization. Embolized AVMs tended to be larger (38% with diameter > 3 cm vs 19%, p = 0.001), less likely to have hemorrhaged (48% vs 63%, p = 0.013), or be diffuse (19% vs 29%, p = 0.045). Embolized AVMs were more likely to have both superficial and deep venous drainage and less likely to have exclusively deep drainage (32% vs 17% and 12% vs 23%, respectively; p = 0.002). In multivariable analysis, embolization was not a significant predictor of blood loss or mRS score changes, but did predict longer operating times (+29 minutes, 95% CI 2-56 minutes; p = 0.034) and increased clip usage (OR 2.61, 95% CI 1.45-4.71; p = 0.001). Cmax/ROI was not a significant predictor, although cases with large Cmax/ROI tended to have longer procedure times (+25 minutes per doubling of Cmax/ROI, 95% CI 0-50 minutes; p = 0.051). CONCLUSIONS In this series, preoperative embolization was associated with longer median resection times and had no association with intraoperative blood loss or mRS score changes.
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Affiliation(s)
- Grace F. Donzelli
- UCSF School of Medicine, UCSF Medical Center, San Francisco, California
| | - Jeffrey Nelson
- Departments of Anesthesia and Perioperative Care, UCSF Medical Center, San Francisco, California
| | - David McCoy
- Departments of Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, California
| | - Charles E. McCulloch
- Departments of Biostatistics and Epidemiology, UCSF Medical Center, San Francisco, California
| | - Steven W. Hetts
- Departments of Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, California
| | - Matthew R. Amans
- Departments of Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, California
| | - Christopher F. Dowd
- Departments of Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, California
| | - Van V. Halbach
- Departments of Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, California
| | - Randall T. Higashida
- Departments of Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, California
| | - Michael T. Lawton
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Helen Kim
- Departments of Anesthesia and Perioperative Care, UCSF Medical Center, San Francisco, California
| | - Daniel L. Cooke
- Departments of Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, California
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21
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Monitoring Treatment Effectiveness in Intracranial Arteriovenous Shunt Lesions: Emerging Role of Quantitative Magnetic Resonance Venography for Intracranial Arteriovenous Shunts. World Neurosurg 2020; 135:23-27. [DOI: 10.1016/j.wneu.2019.10.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 11/23/2022]
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Brunozzi D, Hussein AE, Shakur SF, Linninger A, Hsu CY, Charbel FT, Alaraj A. Contrast Time-Density Time on Digital Subtraction Angiography Correlates With Cerebral Arteriovenous Malformation Flow Measured by Quantitative Magnetic Resonance Angiography, Angioarchitecture, and Hemorrhage. Neurosurgery 2019; 83:210-216. [PMID: 29106647 DOI: 10.1093/neuros/nyx351] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/24/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital subtraction angiography (DSA) currently provides angioarchitectural features of cerebral arteriovenous malformations (AVMs) but its role in the hemodynamic evaluation of AVMs is poorly understood. OBJECTIVE To assess contrast time-density time (TT) on DSA relative to AVM flow measured using quantitative magnetic resonance angiography (QMRA). METHODS Patients seen at our institution between 2007 and 2014 with a supratentorial AVM and DSA and QMRA obtained prior to any treatment were retrospectively reviewed. Regions of interest were selected on the draining veins at the point closest to the nidus. TT on DSA was defined as time needed for contrast to change image intensity from 10% to 100%, 100% to 10%, and 25% to 25%. TT was correlated to AVM total flow, angioarchitectural features, and hemorrhage. RESULTS Twenty-eight patients (mean age 35.6 yr) were included. Six patients presented with hemorrhage. Mean AVM volume was 11.42 mL (range 0.3-57.7 mL). Higher total AVM flow significantly correlated with shorter TT100%-10% and TT25%-25% (P = .02, .02, respectively). Presence of venous stenosis correlated significantly with shorter TT100%-10% (P = .04) and TT25%-25% (P = .04). AVMs with a single draining vein exhibited longer TT25%-25% compared to those with multiple draining veins (P = .04). Ruptured AVMs had significantly shorter TT10%-100% compared to unruptured AVMs (P = .05). CONCLUSION TT on DSA correlates with cerebral AVM flow measured using QMRA and with AVM angioarchitecture and hemorrhagic presentation. Thus, TT may be used to indirectly estimate AVM flow during angiography in real-time and may also be an indicator of important AVM characteristics associated with outflow resistance and increased rupture risk, such as venous stenosis.
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Affiliation(s)
- Denise Brunozzi
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Ahmed E Hussein
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Sophia F Shakur
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Andreas Linninger
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.,Department of Bioengineering, Univers-ity of Illinois at Chicago, Chicago, Illinois
| | - Chih-Yang Hsu
- Department of Bioengineering, Univers-ity of Illinois at Chicago, Chicago, Illinois
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.,Department of Bioengineering, Univers-ity of Illinois at Chicago, Chicago, Illinois
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23
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Brunozzi D, Theiss P, Amin-Hanjani S, Charbel FT, Mohammaden M, Andrews A, Linninger A, Alaraj A. Ratio of Arteriovenous Malformation Draining Vein to Adjacent Venous Sinus Diameter Is Associated with Increased Risk of Venous Stenosis. World Neurosurg 2019; 130:e1111-e1115. [PMID: 31323417 DOI: 10.1016/j.wneu.2019.07.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The development of venous outflow stenosis in cerebral arteriovenous malformation (AVM) is poorly understood. The location of stenosis within the AVM draining vein in relation to the adjacent venous sinus and the hypothesis that the ratio of draining vein to adjacent sinus diameter might predict the development of venous stenosis were explored. METHODS Patients with supratentorial AVMs (1997-2018) were reviewed (N = 290). AVM draining vein and adjacent venous sinus diameters, degree of draining vein stenosis, and distance from the maximal stenotic point to the junction of the adjacent draining sinus were recorded. Correlation between percentage of AVM draining vein stenosis and the ratio of AVM draining vein to venous sinus diameters was analyzed. RESULTS A total of 360 draining veins in 243 AVMs with complete angiographic data were measured. Venous stenosis (in 131 draining veins) was observed within 20 mm of the junction to the adjacent draining sinus in 85% of our sample. The ratio of draining vein to adjacent sinus diameter correlated positively with the percentage of venous stenosis (P < 0.01, r = 0.21). The ratio between 0.51-1.0 and >1.0 showed significant tighter stenosis compared with the ratio ≤0.5 (25.9% and 28.9% vs. 10.0%, respectively; P < 0.01). CONCLUSIONS AVM venous outflow stenosis is observed close to the adjacent venous sinus junction. The degree of venous stenosis is greater when the ratio of AVM draining vein/adjacent venous sinus diameter is >0.5. This may be related to more turbulent flow at the junction of the draining vein and venous sinus, especially in larger draining veins, which causes venous stenosis to develop over time.
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Affiliation(s)
- Denise Brunozzi
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Peter Theiss
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mahmoud Mohammaden
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Amanda Andrews
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andreas Linninger
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA; Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA; Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA.
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24
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Alqadi M, Brunozzi D, Linninger A, Amin-Hanjani S, Charbel FT, Alaraj A. Cerebral arteriovenous malformation venous stenosis is associated with hemodynamic changes at the draining vein-venous sinus junction. Med Hypotheses 2019; 123:86-88. [PMID: 30696602 DOI: 10.1016/j.mehy.2019.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/05/2018] [Accepted: 01/06/2019] [Indexed: 01/14/2023]
Abstract
Cerebral arteriovenous malformations (AVMs) are an uncommon vascular anomaly that carry the risk of rupture and hemorrhage. Several factors have been implicated in the propensity of an AVM to bleed. One such factor is stenosis of AVM draining veins, as impairment of the AVM venous drainage system is associated with increased risk of intracranial hemorrhage. Currently, our understanding of the pathogenesis of AVM venous outflow stenosis is limited, as there is insufficient data on the blood flow patterns and local hemodynamic parameters of these draining veins. The angioarchitecture of AVMs features a nidus lacking a high resistance capillary network. Accordingly, our previous studies on AVM arterial feeders have demonstrated an abnormally high flow volume rate along with low pulsatility and resistance indices on quantitative magnetic resonance angiography. As such, AVM vessels endure high, non-physiologic levels of flow that may partially contribute to ectasia or stenosis depending on whether wall shear stress (WSS) is high or low, respectively. We hypothesize that AVM venous outflow stenosis occurs most commonly near the junction of the draining vein and the dural venous sinus. Increased flow volume rate through the AVM circuit coupled with the variation in compliance and rigidity between the walls of the draining vein and the dural venous sinus likely create turbulence of blood flow. The resulting flow separation, low WSS, and departure from axially aligned, unidirectional flow may create atherogenic conditions that can be implicated in venous intimal hyperplasia and outflow stenosis. We have previously found there to be a significant association between intimal hyperplasia risk factors and venous outflow stenosis. Additionally, we have found a significant association between age and likelihood as well as degree of stenosis, suggesting a progressive disease process. Similar conditions have been demonstrated in the pathophysiology of stenosis of the carotid artery and dialysis arteriovenous fistulas. In both of these conditions, the use of computational fluid dynamics (CFD) has been employed to characterize the local hemodynamic features that contribute to the pathogenesis of intimal hyperplasia and stenosis. We recommend the utilization of CFD to characterize the anatomic and hemodynamic features of AVM venous outflow stenosis. An improved understanding of the possible causative features of venous outflow stenosis may impact how clinicians choose to manage the treatment of patients with AVMs.
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Affiliation(s)
- Murad Alqadi
- Department of Neurosurgery, University of Illinois at Chicago, United States
| | - Denise Brunozzi
- Department of Neurosurgery, University of Illinois at Chicago, United States
| | - Andreas Linninger
- Department of Neurosurgery, University of Illinois at Chicago, United States
| | | | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, United States
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, United States.
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25
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Morgan MK, Guilfoyle M, Kirollos R, Heller GZ. Remodeling of the Feeding Arterial System After Surgery for Resection of Brain Arteriovenous Malformations: An Observational Study. Neurosurgery 2018. [DOI: 10.1093/neuros/nyy007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michael Kerin Morgan
- Department of Clinical Medicine, Macquarie University, New South Wales, Australia
| | - Mathew Guilfoyle
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - Ramez Kirollos
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - Gillian Z Heller
- Department of Statistics, Macquarie University, New South Wales, Australia
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26
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Thakur R, Haider AS, Thomas A, Vayalumkal S, Khan U, Osumah T, Doughty K, Finn S, Layton KF. Preoperative Embolization in Tandem with Surgical Resection for Cerebral Arteriovenous Malformations. Cureus 2018; 10:e2042. [PMID: 29541563 PMCID: PMC5843387 DOI: 10.7759/cureus.2042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/08/2018] [Indexed: 11/27/2022] Open
Abstract
A number of treatment options are available for cerebral arteriovenous malformations (AVMs) including surgical resection, stereotactic radiosurgery, and endovascular embolization. Endovascular embolization may be used pre-operatively to reduce the size of large AVMs and thus reduce surgical complications. Here we present two patients who successfully underwent preoperative embolization of their AVMs and subsequent surgery. Preoperative embolization is a viable option for AVMs to reduce complications and improve patient outcomes.
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Affiliation(s)
| | | | | | | | - Umair Khan
- School of Medicine, St. George's University
| | | | - Kyle Doughty
- Department of Neurosurgery, Baylor University Medical Center
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27
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Fennell VS, Martirosyan NL, Atwal GS, Kalani MYS, Ponce FA, Lemole GM, Dumont TM, Spetzler RF. Hemodynamics Associated With Intracerebral Arteriovenous Malformations: The Effects of Treatment Modalities. Neurosurgery 2017; 83:611-621. [DOI: 10.1093/neuros/nyx560] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 10/13/2017] [Indexed: 12/22/2022] Open
Abstract
Abstract
The understanding of the physiology of cerebral arteriovenous malformations (AVMs) continues to expand. Knowledge of the hemodynamics of blood flow associated with AVMs is also progressing as imaging and treatment modalities advance. The authors present a comprehensive literature review that reveals the physical hemodynamics of AVMs, and the effect that various treatment modalities have on AVM hemodynamics and the surrounding cortex and vasculature. The authors discuss feeding arteries, flow through the nidus, venous outflow, and the relative effects of radiosurgical monotherapy, endovascular embolization alone, and combined microsurgical treatments. The hemodynamics associated with intracranial AVMs is complex and likely changes over time with changes in the physical morphology and angioarchitecture of the lesions. Hemodynamic change may be even more of a factor as it pertains to the vast array of single and multimodal treatment options available. An understanding of AVM hemodynamics associated with differing treatment modalities can affect treatment strategies and should be considered for optimal clinical outcomes.
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Affiliation(s)
- Vernard S Fennell
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Nikolay L Martirosyan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
- Division of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Gursant S Atwal
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - M Yashar S Kalani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - G Michael Lemole
- Division of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Travis M Dumont
- Division of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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28
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Chen QY, Zhu XR, Zhang Y. The Hemodynamic Changes in Patients with Cerebral Arteriovenous Malformations before and after Interventional Embolization Therapy with Glubran 2 Acrylic Glue. Eur Neurol 2017; 78:169-175. [PMID: 28848195 DOI: 10.1159/000478727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/14/2017] [Indexed: 11/19/2022]
Abstract
The study explored hemodynamic changes in patients with cerebral arteriovenous malformations (CAVM) before and -after interventional embolization therapy with Glubran 2 acrylic glue and analyzed the related factors. CAVM patients received endovascular embolization therapy with Glubran 2. Patients' systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), blood flow velocity (BFV), and pulsatility index (PI) were measured. The location of malformed vessels, Spetzler-Martin (SM) grade, CAVM size, and type of feeding artery and venous drainage were analyzed. CAVM patients showed increased DBP, SBP, MAP, and PI and decreased average BFV compared to before therapy. CAVM patients with big CAVM size, SM grade IV/V, deep location malformed vessels, deep, and mixed venous drainage, and cortical branch and mixed artery blood-supply exhibited lower DBP, SBP, MAP, and PI but higher average BFV. Hypertensive CAVM patients showed lower DBP, SBP, MAP, average BFV, and PI before or after embolization. Hypertension, SM grade, CAVM size, malformed vessels location, venous drainage, and artery blood-supply were correlated to the hemodynamic changes of CAVM patients. Embolization with Glubran 2 acrylic glue could enhance hemodynamics in CAVM patients, and the hemodynamic changes were in correlation with the SM grade, CAVM size, and malformed vessels location.
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29
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Critical review of brain AVM surgery, surgical results and natural history in 2017. Acta Neurochir (Wien) 2017; 159:1457-1478. [PMID: 28555270 DOI: 10.1007/s00701-017-3217-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND An understanding of the present standing of surgery, surgical results and the role in altering the future morbidity and mortality of untreated brain arteriovenous malformations (bAVMs) is appropriate considering the myriad alternative management pathways (including radiosurgery, embolization or some combination of treatments), varying risks and selection biases that have contributed to confusion regarding management. The purpose of this review is to clarify the link between the incidence of adverse outcomes that are reported from a management pathway of either surgery or no intervention with the projected risks of surgery or no intervention. METHODS A critical review of the literature was performed on the outcomes of surgery and non-intervention for bAVM. An analysis of the biases and how these may have influenced the outcomes was included to attempt to identify reasonable estimates of risks. RESULTS In the absence of treatment, the cumulative risk of future hemorrhage is approximately 16% and 29% at 10 and 20 years after diagnosis of bAVM without hemorrhage and 35% and 45% at 10 and 20 years when presenting with hemorrhage (annualized, this risk would be approximately 1.8% for unruptured bAVMs and 4.7% for 8 years for bAVMs presenting with hemorrhage followed by the unruptured bAVM rate). The cumulative outcome of these hemorrhages depends upon whether the patient remains untreated and is allowed to have a further hemorrhage or is treated at this time. Overall, approximately 42% will develop a new permanent neurological deficit or death from a hemorrhagic event. The presence of an associated proximal intracranial aneurysm (APIA) and restriction of venous outflow may increase the risk for subsequent hemorrhage. Other risks for increased risk of hemorrhage (age, pregnancy, female) were examined, and their purported association with hemorrhage is difficult to support. Both the Spetzler-Martin grading system (and its compaction into the Spetzler-Ponce tiers) and Lawton-Young supplementary grading system are excellent in predicting the risk of surgery. The 8-year risk of unfavorable outcome from surgery (complication leading to a permanent new neurological deficit with a modified Rankin Scale score of greater than one, residual bAVM or recurrence) is dependent on bAVM size, the presence of deep venous drainage (DVD) and location in critical brain (eloquent location). For patients with bAVMs who have neither a DVD nor eloquent location, the 8-year risk for an unfavorable outcome increases with size (increasing from 1 cm to 6 cm) from 1% to 9%. For patients with bAVM who have either a DVD or eloquent location (but not both), the 8-year risk for an unfavorable outcome increases with the size (increasing from 1 cm to 6 cm) from 4% to 35%. For patients with bAVM who have both a DVD and eloquent location, the 8-year risk for unfavorable outcome increases with size (increasing from 1 cm to 3 cm) from 12% to 38%. CONCLUSION Patients with a Spetzler-Ponce A bAVM expecting a good quality of life for the next 8 years are likely to do better with surgery in expert centers than remaining untreated. Ongoing research is urgently required on the outcome of management pathways for bAVM.
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30
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Rivera R, Sordo JG, Echeverria D, Badilla L, Pinto C, Merino-Osorio C. Quantitative evaluation of arteriovenous malformation hemodynamic changes after endovascular treatment using parametric color coding: A case series study. Interv Neuroradiol 2017; 23:650-655. [PMID: 28764614 DOI: 10.1177/1591019917721867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Brain arteriovenous malformations (AVMs) are complex vascular lesions. Endovascular treatment results are usually measured by calculating the volume reduction of the lesions. Nevertheless, vascular flow quantification seems a more physiologically accurate way of measuring endovascular results. We evaluated the use of parametric color coding (PCC) with digital subtraction angiography (DSA), in order to determine the feasibility of PCC to detect and measure the impact of AVM endovascular treatment-induced changes using real-time hemodynamic parameters. Methods and results Supratentorial brain AVM treatment was evaluated in 29 patients over the course of 38 sessions. Using regions of interest (ROIs) at the carotid siphon, arterial feeder, drainage vein and venous sinus, we found significant increase in time to peak (TTP) values at the arterial feeder, drainage vein and venous sinus. We compared TTP in four different embolization volume groups: I (0-25%), II (26-50%), III (51-75%) and IV (76-100%). We found significant differences between groups and a moderate correlation between embolization percentages, as well as an increase in TTP at the main vein ROI; but not in the arterial side or sinus. Conclusions Brain AVM endovascular treatment results can be quantified in vivo with PCC. PCC is capable of detecting hemodynamic changes after brain AVM endovascular treatment, that may reflect flow drop, and it is correlated with volume embolization.
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Affiliation(s)
- Rodrigo Rivera
- 1 Neuroradiology Department, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile
| | - Juan G Sordo
- 1 Neuroradiology Department, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile
| | - Daniel Echeverria
- 1 Neuroradiology Department, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile
| | - Lautaro Badilla
- 1 Neuroradiology Department, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile
| | - Camila Pinto
- 1 Neuroradiology Department, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile
| | - Catalina Merino-Osorio
- 2 Physical Therapy School, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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31
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Zhang M, Connolly ID, Teo MK, Yang G, Dodd R, Marks M, Zuccarello M, Steinberg GK. Management of Arteriovenous Malformations Associated with Developmental Venous Anomalies: A Literature Review and Report of 2 Cases. World Neurosurg 2017; 106:563-569. [PMID: 28735125 DOI: 10.1016/j.wneu.2017.07.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Classification of cerebrovascular malformations has revealed intermediary lesions that warrant further review owing to their unusual presentation and management. We present 2 cases of arteriovenous malformation (AVM) associated with a developmental venous anomaly (DVA), and discuss the efficacy of previously published management strategies. METHODS Two cases of AVMs associated with DVA were identified, and a literature search for published cases between 1980 and 2016 was conducted. Patient demographic data and clinical features were documented. RESULTS In case 1, a 29-year-old female presenting with parenchymal hemorrhage and left homonymous hemianopia was found to have a right parieto-occipital AVM fed from the anterior cerebral, middle cerebral, and posterior cerebral arteries, with major venous drainage to the superior sagittal sinus. In case 2, imaging in a 34-year-old female evaluated for night tremors and incontinence revealed a left parietal AVM with venous drainage to the superior sagittal sinus. Including our 2 cases, 22 cases of coexisting AVMs and DVAs have been reported in the literature. At presentation, 68% had radiographic evidence of hemorrhage. Stereotactic radiosurgery was performed in 7 cases, embolization in 6 cases, surgical resection in 4 cases, and multimodal therapy in 5 cases. Radiography at follow-up demonstrated successful AVM obliteration in 67% of cases (12 of 18). CONCLUSIONS Patients with coexisting AVMs and DVAs tend to have a hemorrhagic presentation. Contrary to traditional AVM management, in these cases it is important to preserve the draining vein via the DVA to ensure a safe, sustained circulatory outflow of the associated brain parenchyma while achieving safe AVM obliteration.
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Affiliation(s)
- Michael Zhang
- Department of Neurosurgery and Stanford Stroke Center, Stanford University Medical Center, Stanford, California, USA
| | - Ian D Connolly
- Department of Neurosurgery and Stanford Stroke Center, Stanford University Medical Center, Stanford, California, USA
| | - Mario K Teo
- Department of Neurosurgery and Stanford Stroke Center, Stanford University Medical Center, Stanford, California, USA; Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, North Bristol University Hospital, Bristol, UK
| | - George Yang
- Department of Neurosurgery, Mayfield Brain & Spine, Cincinnati, Ohio, USA
| | - Robert Dodd
- Department of Neurosurgery and Stanford Stroke Center, Stanford University Medical Center, Stanford, California, USA
| | - Michael Marks
- Department of Neurosurgery and Stanford Stroke Center, Stanford University Medical Center, Stanford, California, USA
| | - Mario Zuccarello
- Department of Neurosurgery, Mayfield Brain & Spine, Cincinnati, Ohio, USA
| | - Gary K Steinberg
- Department of Neurosurgery and Stanford Stroke Center, Stanford University Medical Center, Stanford, California, USA.
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32
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Shakur SF, Brunozzi D, Hussein AE, Linninger A, Hsu CY, Charbel FT, Alaraj A. Validation of cerebral arteriovenous malformation hemodynamics assessed by DSA using quantitative magnetic resonance angiography: preliminary study. J Neurointerv Surg 2017; 10:156-161. [PMID: 28235955 DOI: 10.1136/neurintsurg-2017-012991] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/01/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND The hemodynamic evaluation of cerebral arteriovenous malformations (AVMs) using DSA has not been validated against true flow measurements. OBJECTIVE To validate AVM hemodynamics assessed by DSA using quantitative magnetic resonance angiography (QMRA). MATERIALS AND METHODS Patients seen at our institution between 2007 and 2016 with a supratentorial AVM and DSA and QMRA obtained before any treatment were retrospectively reviewed. DSA assessment of AVM flow comprised AVM arterial-to-venous time (A-Vt) and iFlow transit time. A-Vt was defined as the difference between peak contrast intensity in the cavernous internal carotid artery and peak contrast intensity in the draining vein. iFlow transit times were determined using syngo iFlow software. A-Vt and iFlow transit times were correlated with total AVM flow measured using QMRA and AVM angioarchitectural and clinical features. RESULTS 33 patients (mean age 33 years) were included. Nine patients presented with hemorrhage. Mean AVM volume was 9.8 mL (range 0.3-57.7 mL). Both A-Vt (r=-0.47, p=0.01) and iFlow (r=-0.44, p=0.01) correlated significantly with total AVM flow. iFlow transit time was significantly shorter in patients who presented with seizure but A-Vt and iFlow did not vary with other AVM angioarchitectural features such as venous stenosis or hemorrhagic presentation. CONCLUSIONS A-Vt and iFlow transit times on DSA correlate with cerebral AVM flow measured using QMRA. Thus, these parameters may be used to indirectly estimate AVM flow before and after embolization during angiography in real time.
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Affiliation(s)
- Sophia F Shakur
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Denise Brunozzi
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ahmed E Hussein
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andreas Linninger
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Chih-Yang Hsu
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
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Shakur SF, Amin-Hanjani S, Abouelleil M, Aletich VA, Charbel FT, Alaraj A. Changes in pulsatility and resistance indices of cerebral arteriovenous malformation feeder arteries after embolization and surgery. Neurol Res 2016; 39:7-12. [DOI: 10.1080/01616412.2016.1258970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sophia F. Shakur
- Department of Neurosurgery, University of Illinois at Chicago , Chicago, IL, USA
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, University of Illinois at Chicago , Chicago, IL, USA
| | - Mohamed Abouelleil
- Department of Neurosurgery, University of Illinois at Chicago , Chicago, IL, USA
| | - Victor A. Aletich
- Department of Neurosurgery, University of Illinois at Chicago , Chicago, IL, USA
| | - Fady T. Charbel
- Department of Neurosurgery, University of Illinois at Chicago , Chicago, IL, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago , Chicago, IL, USA
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Wu C, Schoeneman SE, Kuhn R, Honarmand AR, Schnell S, Ansari SA, Carr J, Markl M, Shaibani A. Complex Alterations of Intracranial 4-Dimensional Hemodynamics in Vein of Galen Aneurysmal Malformations During Staged Endovascular Embolization. Oper Neurosurg (Hagerstown) 2016; 12:239-249. [PMID: 29506111 DOI: 10.1227/neu.0000000000001137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/01/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vein of Galen aneurysmal malformations (VGAMs) are rare congenital cerebral arteriovenous shunts often treated by staged endovascular embolization early in life. Treatment-induced changes in intracranial hemodynamics and their impact on the clinical management of VGAM patients remain unclear. OBJECTIVE To evaluate hemodynamic alterations in the cerebral arterial and venous network in pediatric patients with VGAMs during staged embolizations. METHODS Serial 4-dimensional flow magnetic resonance imaging (21 scans) was performed in 6 VGAM patients (3 female; mean age, 2.1 ± 4.0 years) undergoing staged embolization. Time-integrated pathlines were used to visualize 3-dimensional blood flow changes in intracranial arterial and venous systems. Total cerebral arterial inflow (flow in bilateral internal carotid arteries plus basilar artery), arteriovenous shunt flow, and blood flow in other major cerebral arteries (middle cerebral artery; posterior cerebral artery) were quantified for all patients. RESULTS Intracranial 3-dimensional blood flow visualization demonstrated marked reduction of arteriovenous shunting and distinct hemodynamic alterations after embolization. From baseline to endpoint embolization, total cerebral arterial inflow dropped by 40.2% (from 22.70 ± 6.54 mL/s to 13.57 ± 4.87 mL/s), corresponding to arteriovenous shunt flow reduction of 73.5% (from 9.69 ± 6.16 mL/s to 2.57 ± 3.79 mL/s). In addition, the ipsilateral posterior cerebral artery/middle cerebral artery flow ratio decreased by 86.9% (from 4.20 ± 6.28 to 0.55 ± 0.23). CONCLUSION Hemodynamic alterations in VGAMs after embolization can be visualized and quantified using 4-dimensional flow magnetic resonance imaging. Cerebral arterial inflow and arteriovenous shunt flow reduction and complex flow redistribution after embolization illustrate the potential of 4-dimensional flow magnetic resonance imaging to better evaluate the efficacy of interventions and monitor treatment effects.
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Affiliation(s)
- Can Wu
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois.,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Samantha E Schoeneman
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ryan Kuhn
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Amir R Honarmand
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Susanne Schnell
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sameer A Ansari
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael Markl
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois.,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ali Shaibani
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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35
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Shakur SF, Liesse K, Amin-Hanjani S, Carlson AP, Aletich VA, Charbel FT, Alaraj A. Relationship of Cerebral Arteriovenous Malformation Hemodynamics to Clinical Presentation, Angioarchitectural Features, and Hemorrhage. Neurosurgery 2016; 63 Suppl 1:136-140. [DOI: 10.1227/neu.0000000000001285] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sophia F. Shakur
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Kelly Liesse
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Andrew P. Carlson
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Victor A. Aletich
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Fady T. Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
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36
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Shakur SF, Valyi-Nagy T, Amin-Hanjani S, Ya’qoub L, Aletich VA, Charbel FT, Alaraj A. Effects of nidus microarchitecture on cerebral arteriovenous malformation hemodynamics. J Clin Neurosci 2016; 26:70-4. [DOI: 10.1016/j.jocn.2015.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 10/11/2015] [Indexed: 10/22/2022]
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37
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Advanced flow MRI: emerging techniques and applications. Clin Radiol 2016; 71:779-95. [PMID: 26944696 DOI: 10.1016/j.crad.2016.01.011] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/10/2015] [Accepted: 01/10/2016] [Indexed: 12/12/2022]
Abstract
Magnetic resonance imaging (MRI) techniques provide non-invasive and non-ionising methods for the highly accurate anatomical depiction of the heart and vessels throughout the cardiac cycle. In addition, the intrinsic sensitivity of MRI to motion offers the unique ability to acquire spatially registered blood flow simultaneously with the morphological data, within a single measurement. In clinical routine, flow MRI is typically accomplished using methods that resolve two spatial dimensions in individual planes and encode the time-resolved velocity in one principal direction, typically oriented perpendicular to the two-dimensional (2D) section. This review describes recently developed advanced MRI flow techniques, which allow for more comprehensive evaluation of blood flow characteristics, such as real-time flow imaging, 2D multiple-venc phase contrast MRI, four-dimensional (4D) flow MRI, quantification of complex haemodynamic properties, and highly accelerated flow imaging. Emerging techniques and novel applications are explored. In addition, applications of these new techniques for the improved evaluation of cardiovascular (aorta, pulmonary arteries, congenital heart disease, atrial fibrillation, coronary arteries) as well as cerebrovascular disease (intra-cranial arteries and veins) are presented.
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