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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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Ganjkhanlou MR, Shahidian A, Shahmohammadi MR. Hemodynamic Study of Cerebral Arteriovenous Malformation: Newtonian and Non-Newtonian Blood Flow. World Neurosurg 2024; 185:e317-e341. [PMID: 38320648 DOI: 10.1016/j.wneu.2024.01.159] [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: 12/26/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE Arteriovenous malformation is a disease of the vascular system that occurs mainly in the cerebral arteries and spine. Numerical simulation as a powerful method is used to investigate the Cerebral Arteriovenous Malformation hemodynamic after occlusion of the abnormality step by step by embolization. METHODS The computed tomography (CT) Angiographic imaging data of 2 patients are used and a geometric model is extracted by the Mimics software. Numerical simulation of blood flow is performed in both Newtonian and non-Newtonian models. The Navier-Stokes and continuity governing equations are solved by a finite element method using the COMSOL Multiphysics software (the commercial computational fluid dynamics (CFD) simulation software). To validate the numerical results, the real data on blood flow rate in the feeding artery and draining veins are used, as well as angiographic images at different times. RESULTS Regarding the comparison of pressure contours for different occlusions of 0, 30, 50, and 90%, by increasing the amount of occlusion in the nidus, there is an increase in the blood pressure. Regarding the comparison of the blood flow velocity in the feeding artery, draining veins, and inside the AVM nidus for Newtonian and non-Newtonian models, there is a significant difference between these 2 simulations in vessels with smaller dimensions (such as vessels inside the nidus). CONCLUSIONS By increasing the amount of nidus occlusion, the blood pressure is increased, so the blood supply process is better. According to a significant difference between the Newtonian and non-Newtonian simulations in vessels with smaller dimensions (such as vessels inside the nidus), therefore, non-Newtonian simulation should be done for different occlusions of 30, 50, and 90%.
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Affiliation(s)
| | - Azadeh Shahidian
- Department of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran.
| | - Mohammad Reza Shahmohammadi
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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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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Al-Smadi MW, Fazekas LA, Varga A, Matrai AA, Aslan S, Beqain A, Al-Khafaji MQM, Bedocs-Barath B, Novak L, Nemeth N. Minor micro-rheological alterations in the presence of an artificial saphenous arteriovenous shunt, as an arteriovenous malformation model in the rat. Clin Hemorheol Microcirc 2024; 87:27-37. [PMID: 38250764 DOI: 10.3233/ch-231825] [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] [Indexed: 01/23/2024]
Abstract
BACKGROUND Arteriovenous malformations (AVMs) are vascular anomalies characterized by abnormal shunting between arteries and veins. The progression of the AVMs and their hemodynamic and rheological relations are poorly studied, and there is a lack of a feasible experimental model. OBJECTIVE To establish a model that cause only minimal micro-rheological alterations, compared to other AV models. METHODS Sixteen female Sprague Dawley rats were randomly divided into control and AVM groups. End-to-end anastomoses were created between the saphenous veins and arteries to mimic AVM nidus. Hematological and hemorheological parameters were analyzed before surgery and on the 1st, 3rd, 5th, 7th, 9th, and 12th postoperative weeks. RESULTS Compared to sham-operated Control group the AVM group did not show important alterations in hematological parameters nor in erythrocyte aggregation and deformability. However, slightly increased aggregation and moderately decreased deformability values were found, without significant differences. The changes normalized by the 12th postoperative week. CONCLUSIONS The presented rat model of a small-caliber AVM created on saphenous vessels does not cause significant micro-rheological changes. The alterations found were most likely related to the acute phase reactions and not to the presence of a small-caliber shunt. The model seems to be suitable for further studies of AVM progression.
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Affiliation(s)
- Mohammad Walid Al-Smadi
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Kalman Laki Doctoral School, University of Debrecen, Debrecen, Hungary
| | - Laszlo Adam Fazekas
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - Adam Varga
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - Adam Attila Matrai
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - Siran Aslan
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anas Beqain
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Mustafa Qais Muhsin Al-Khafaji
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Barbara Bedocs-Barath
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - Laszlo Novak
- Department of Neurosurgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Norbert Nemeth
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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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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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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Aristova M, Pang J, Ma Y, Ma L, Berhane H, Rayz V, Markl M, Schnell S. Accelerated dual-venc 4D flow MRI with variable high-venc spatial resolution for neurovascular applications. Magn Reson Med 2022; 88:1643-1658. [PMID: 35754143 PMCID: PMC9392495 DOI: 10.1002/mrm.29306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/02/2022] [Accepted: 04/26/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Dual-velocity encoded (dual-venc or DV) 4D flow MRI achieves wide velocity dynamic range and velocity-to-noise ratio (VNR), enabling accurate neurovascular flow characterization. To reduce scan time, we present interleaved dual-venc 4D Flow with independently prescribed, prospectively undersampled spatial resolution of the high-venc (HV) acquisition: Variable Spatial Resolution Dual Venc (VSRDV). METHODS A prototype VSRDV sequence was developed based on a Cartesian acquisition with eight-point phase encoding, combining PEAK-GRAPPA acceleration with zero-filling in phase and partition directions for HV. The VSRDV approach was optimized by varying z, the zero-filling fraction of HV relative to low-venc, between 0%-80% in vitro (realistic neurovascular model with pulsatile flow) and in vivo (n = 10 volunteers). Antialiasing precision, mean and peak velocity quantification accuracy, and test-retest reproducibility were assessed relative to reference images with equal-resolution HV and low venc (z = 0%). RESULTS In vitro results for all z demonstrated an antialiasing true positive rate at least 95% for R PEAK - GRAPPA $$ {R}_{\mathrm{PEAK}-\mathrm{GRAPPA}} $$ = 2 and 5, with no linear relationship to z (p = 0.62 and 0.13, respectively). Bland-Altman analysis for z = 20%, 40%, 60%, or 80% versus z = 0% in vitro and in vivo demonstrated no bias >1% of venc in mean or peak velocity values at any R ZF $$ {R}_{\mathrm{ZF}} $$ . In vitro mean and peak velocity, and in vivo peak velocity, had limits of agreement within 15%. CONCLUSION VSRDV allows up to 34.8% scan time reduction compared to PEAK-GRAPPA accelerated DV 4D Flow MRI, enabling large spatial coverage and dynamic range while maintaining VNR and velocity measurement accuracy.
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Affiliation(s)
- Maria Aristova
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jianing Pang
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- MR R&D and CollaborationsSiemens Medical Solutions USA Inc.ChicagoILUSA
| | - Yue Ma
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of RadiologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Liliana Ma
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Haben Berhane
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Biomedical EngineeringNorthwestern University McCormick School of EngineeringEvanstonIllinoisUSA
| | - Vitaliy Rayz
- Weldon School of Biomedical EngineeringPurdue University College of EngineeringWest LafayetteIndianaUSA
| | - Michael Markl
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Biomedical EngineeringNorthwestern University McCormick School of EngineeringEvanstonIllinoisUSA
| | - Susanne Schnell
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Institut für PhysikUniversität GreifswaldGreifswaldGermany
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Challenges in Modeling Hemodynamics in Cerebral Aneurysms Related to Arteriovenous Malformations. Cardiovasc Eng Technol 2022; 13:673-684. [PMID: 35106721 DOI: 10.1007/s13239-022-00609-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/07/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE The significantly higher incidence of aneurysms in patients with arteriovenous malformations (AVMs) suggests a strong hemodynamic relationship between these lesions. The presence of an AVM alters hemodynamics in proximal vessels by drastically changing the distal resistance, thus affecting intra-aneurysmal flow. This study discusses the challenges associated with patient-specific modeling of aneurysms in the presence of AVMs. METHODS We explore how the presence of a generic distal AVM affects upstream aneurysms by examining the relationship between distal resistance and aneurysmal wall shear stress using physiologically realistic estimates for the influence of the AVM on hemodynamics. Using image-based computational models of aneurysms and surrounding vasculature, aneurysmal wall-shear stress is calculated for a range of distal resistances corresponding to the presence of AVMs of various sizes and compared with a control case representing the absence of an AVM. RESULTS In the patient cases considered, the alteration in aneurysmal wall shear stress due to the presence of an AVM is considerable, as much as 19 times the base case wall shear stress. Furthermore, the relationship between aneurysmal wall shear stress and distal resistance is shown to be highly geometry-dependent and nonlinear. In most cases, the range of physiologically realistic possibilities for AVM-related distal resistance are so large that patient-specific flow measurements are necessary for meaningful predictions of wall shear stress. CONCLUSIONS The presented work offers insight on the impact of distal AVMs on aneurysmal wall shear stress using physiologically realistic computational models. Patient-specific modeling of hemodynamics in aneurysms and associated AVMs has great potential for understanding lesion pathogenesis, surgical planning, and assessing the effect of treatment of one lesion relative to another. However, we show that modeling approaches cannot usually meaningfully quantify the impact of AVMs if based solely on imaging data from CT and X-ray angiography, currently used in clinical practice. Based on recent studies, it appears that 4D flow MRI is one promising approach to obtaining meaningful patient-specific flow boundary conditions that improve modeling fidelity.
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Mahinrad S, Tan CO, Ma Y, Aristova M, Milstead AL, Lloyd‐Jones D, Schnell S, Markl M, Sorond FA. Intracranial Blood Flow Quantification by Accelerated Dual-venc 4D Flow MRI: Comparison With Transcranial Doppler Ultrasound. J Magn Reson Imaging 2022; 56:1256-1264. [PMID: 35146822 PMCID: PMC9363520 DOI: 10.1002/jmri.28115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Dual-venc 4D flow MRI, recently introduced for the assessment of intracranial hemodynamics, may provide a promising complementary approach to well-established tools such as transcranial Doppler ultrasound (TCD) and overcome some of their disadvantages. However, data comparing intracranial flow measures from dual-venc 4D flow MRI and TCD are lacking. PURPOSE To compare cerebral blood flow velocity measures derived from dual-venc 4D flow MRI and TCD. STUDY TYPE Prospective cohort. SUBJECTS A total of 25 healthy participants (56 ± 4 years old, 44% female). FIELD STRENGTH/SEQUENCE A 3 T/dual-venc 4D flow MRI using a time-resolved three-dimensional phase-contrast sequence with three-dimensional velocity encoding. ASSESSMENT Peak velocity measurements in bilateral middle cerebral arteries (MCA) were quantified from dual-venc 4D flow MRI and TCD. The MRI data were quantified by two independent observers (S.M and Y.M.) and TCD was performed by a trained technician (A.L.M.). We assessed the agreement between 4D flow MRI and TCD measures, and the interobserver agreement of 4D flow MRI measurements. STATISTICAL TESTS Peak velocity from MRI and TCD was compared using Bland-Altman analysis and coefficient of variance. Intraclass correlation coefficient (ICC) was used to assess MRI interobserver agreement. A P value < 0.05 was considered statistically significant. RESULTS There was excellent interobserver agreement in dual-venc 4D flow MRI-based measurements of peak velocity in bilateral MCA (ICC = 0.97 and 0.96 for the left and right MCA, respectively). Dual-venc 4D flow MRI significantly underestimated peak velocity in the left and right MCA compared to TCD (bias = 0.13 [0.59, -0.33] m/sec and 0.15 [0.47, -0.17] m/sec, respectively). The coefficient of variance between dual-venc 4D flow MRI and TCD measurements was 26% for the left MCA and 22% for the right MCA. DATA CONCLUSION There was excellent interobserver agreement for the assessment of MCA peak velocity using dual-venc 4D flow MRI, and ≤20% under-estimation compared with TCD. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Simin Mahinrad
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Can Ozan Tan
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cerebrovascular Research LaboratorySpaulding Rehabilitation HospitalBostonMassachusettsUSA
- Department of RadiologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Yue Ma
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of RadiologyShengjing Hospital of China Medical UniversityChina
| | - Maria Aristova
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIllinoisUSA
| | - Andrew L. Milstead
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Donald Lloyd‐Jones
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Susanne Schnell
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Institute of Physics, Department of Medical PhysicsUniversity of GreifswaldGermany
| | - Michael Markl
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIllinoisUSA
| | - Farzaneh A. Sorond
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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Winkler E, Wu D, Gil E, McCoy D, Narsinh K, Sun Z, Mueller K, Ross J, Kim H, Weinsheimer S, Berger M, Nowakowski T, Lim D, Abla A, Cooke D. Endoluminal Biopsy for Molecular Profiling of Human Brain Vascular Malformations. Neurology 2022; 98:e1637-e1647. [PMID: 35145012 PMCID: PMC9052570 DOI: 10.1212/wnl.0000000000200109] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/11/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Ras-mitogen-activated protein kinase (MAPK) signaling abnormalities occur in most brain arteriovenous malformations (bAVMs). No means exist to molecularly profile bAVMs without open surgery, limiting precision medicine approaches to treatment. Here, we report use of endoluminal biopsy of the vessel lumen of bAVMs to characterize gene expression and blood flow-mediated transcriptional changes in living patients. METHODS Endoluminal biopsy and computational fluid dynamic modeling (CFD) were performed in adults with unruptured AVMs with cerebral angiography. Each patient underwent surgical resection and cell sampling from a contiguous arterial segment. Fluorescence-assisted cell sorting enriched endothelial cells, which were sequenced on an Illumina HiSeq 4000 sequencer. Gene expression was quantified with RNA sequencing (RNAseq). Differential gene expression, ontology, and correlative analyses were performed. Results were validated with quantitative reverse transcription PCR (RT-qPCR). RESULTS Endoluminal biopsy was successful in 4 patients without complication. Endoluminal biopsy yielded 269.0 ± 79.9 cells per biopsy (control 309.2 ± 86.6 cells, bAVM 228.8 ± 133.4 cells). RNAseq identified 106 differentially expressed genes (DEGs) in bAVMs (false discovery rate ≤0.05). DEGs were enriched for bAVM pathogenic cascades, including Ras-MAPK signaling (p < 0.05), and confirmed with RT-qPCR and a panel predictive of MAPK/extracellular signal-regulated kinase inhibitor response. Compared to patient-matched surgically excised tissues, endoluminal biopsy detected 83.3% of genes, and genome-wide expression strongly correlated (Pearson r = 0.77). Wall shear stress measured by CFD correlated with inflammatory pathway upregulation. Comparison of pre-embolization and postembolization samples confirmed flow-mediated gene expression changes. DISCUSSION Endoluminal biopsy allows molecular profiling of bAVMs in living patients. Gene expression profiles are similar to those of tissues acquired with open surgery and identify potentially targetable Ras-MAPK signaling abnormalities in bAVMs. Integration with CFD allows determination of flow-mediated transcriptomic alterations. Endoluminal biopsy may help facilitate trials of precision medicine approaches to bAVMs in humans.
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Affiliation(s)
- Ethan Winkler
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - David Wu
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Eugene Gil
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - David McCoy
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Kazim Narsinh
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Zhengda Sun
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Kerstin Mueller
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Jayden Ross
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Helen Kim
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Shantel Weinsheimer
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Mitchel Berger
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Tomasz Nowakowski
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Daniel Lim
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Adib Abla
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Daniel Cooke
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
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11
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Chen B, Tao W, Yan L, Zeng M, Song L, Huang Z, Chen F. Molecular feature of arterial remodeling in the brain arteriovenous malformation revealed by arteriovenous shunt rat model and RNA sequencing. Int Immunopharmacol 2022; 107:108653. [PMID: 35247777 DOI: 10.1016/j.intimp.2022.108653] [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: 11/24/2021] [Revised: 02/05/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Morphological research suggested the feeding artery of brain arteriovenous malformation (bAVM) had vascular remodeling under the high blood flow; however, the underlying molecular mechanisms were unclear. METHODS We constructed 32 simplified AVM rat models in four groups: the control group (n = 6), 1-week high-blood-flow group (n = 9), 3-week high-blood-flow group (n = 7) and 6-week high-blood-flow group (n = 10). The circumference, blood velocity, blood flow, pressure, and wall shear of the feeding artery were measured or calculated. The arterial wall change was observed by Masson staining. RNA sequencing (RNA-seq) of feeding arteries was performed, followed by bioinformatics analysis to detect the potential molecular mechanism for bAVM artery remodeling under the high blood flow. RESULTS We observed hemodynamic injury and vascular remodeling on the feeding artery under the high blood flow. RNA-seq showed immune/inflammation infiltration and vascular smooth muscle cell (VSMC) phenotype transformation during remodeling. Weighted gene co-expression network analysis (WGCNA) and time series analysis further identified 27 key genes and pathways involved in remodeling. Upstream miRNA and molecular drugs were predicted targeting these key genes. CONCLUSIONS We depicted molecular change of bAVM arterial remodeling via RNA-seq in high-blood-flow rat models. Twenty-seven key genes may regulate immune/inflammation infiltration and VSMC phenotype transform in bAVM arterial remodeling.
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Affiliation(s)
- Bo Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wengui Tao
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Langchao Yan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ming Zeng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Laixin Song
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Department of Neurosurgery, The Second Affiliated Hospital of Mudanjiang Medical College, Mudanjiang, Heilongjiang, China; Department of Surgery, Mudanjiang Huimin Hospital, Mudanjiang, Heilongjiang, China
| | - Zheng Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fenghua Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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12
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Abstract
Alterations in cerebral blood flow are common in several neurological diseases among the elderly including stroke, cerebral small vessel disease, vascular dementia, and Alzheimer's disease. 4D flow magnetic resonance imaging (MRI) is a relatively new technique to investigate cerebrovascular disease, and makes it possible to obtain time-resolved blood flow measurements of the entire cerebral arterial venous vasculature and can be used to derive a repertoire of hemodynamic biomarkers indicative of cerebrovascular health. The information that can be obtained from one single 4D flow MRI scan allows both the investigation of aberrant flow patterns at a focal location in the vasculature as well as estimations of brain-wide disturbances in blood flow. Such focal and global hemodynamic biomarkers show the potential of being sensitive to impending cerebrovascular disease and disease progression and can also become useful during planning and follow-up of interventions aiming to restore a normal cerebral circulation. Here, we describe 4D flow MRI approaches for analyzing the cerebral vasculature. We then survey key hemodynamic biomarkers that can be reliably assessed using the technique. Finally, we highlight cerebrovascular diseases where one or multiple hemodynamic biomarkers are of central interest.
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Affiliation(s)
- Anders Wåhlin
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
| | - Anders Eklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
| | - Jan Malm
- Department of Clinical Science and Neurosciences, Umeå University, Umeå, Sweden
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13
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Kim D, Eisenmenger L, Turski P, Johnson KM. Simultaneous 3D-TOF angiography and 4D-flow MRI with enhanced flow signal using multiple overlapping thin slab acquisition and magnetization transfer. Magn Reson Med 2021; 87:1401-1417. [PMID: 34708445 DOI: 10.1002/mrm.29060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/03/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the fusion of 3D time-of-flight principles into 4D-flow MRI to enhance vessel contrast and signal without an exogenous contrast agent, enabling simultaneous in-flow based angiograms. METHODS A 4D-flow MRI technique was developed consisting of multiple overlapping slabs with intermittent magnetization transfer preparation. The scan time penalty associated with multiple slab acquisitions was mitigated by using undersampled distributed spiral trajectories and compressed sensing reconstruction. A flow phantom was used to characterize in-flow enhancement, velocity noise improvement, and flow rate measurements against the single-slab 4D-flow MRI. In a patient-volunteer cohort (n = 15), magnitude-based angiograms were radiologically evaluated against 3D time-of-flight, and velocity measurements were compared pixel-wise against single-slab and contrast-enhanced 4D-flow MRI. RESULTS Multiple-slab acquisitions, together with magnetization transfer preparation, substantially improved vessel signal, contrast, and vessel conspicuity in magnitude angiograms. Both clinical 3D time-of-flight and the proposed technique produced equivalent vessel depictions with no statistically significant difference (p < .1). Both techniques also produced clear depictions of brain aneurysms in all patients; however, very small vessels tended to show reduced conspicuity in the proposed technique. Velocity measurements agreed with contrast-enhanced and single-slab scans with high correlations (R2 = 0.941-0.974) and agreements (slopes = 0.994-1.071). Slab boundary and magnetization transfer-related artifacts were not observed in velocity measurements, and velocity noise was reduced with in-flow enhancement over single-slab scans (phantom). CONCLUSION The vessel signal and contrast can be improved in 4D-flow MRI without exogenous contrast agents by utilizing in-flow enhancement, efficient sampling, and compressed sensing. The in-flow enhancement also enables simultaneous 3D time-of-flight angiograms useful for flow quantification and diagnosis.
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Affiliation(s)
- Dahan Kim
- Department of Physics, University of Wisconsin, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Patrick Turski
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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14
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Wu CX, Zang ZX, Hong T, Dong MQ, Shan Y, Zhao ZL, Hou CB, Lu J. Signal intensity ratio of draining vein on silent MR angiography as an indicator of high-flow arteriovenous shunt in brain arteriovenous malformation. Eur Radiol 2021; 31:9252-9261. [PMID: 34263361 PMCID: PMC8589750 DOI: 10.1007/s00330-021-08170-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/26/2021] [Accepted: 06/25/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate whether the signal intensity ratio (rSI) of the draining vein on silent MR angiography is correlated with arteriovenous (A-V) transit time on digital subtraction angiography (DSA), thereby identifying high-flow A-V shunt in brain arteriovenous malformation (BAVM), and to analyze whether the rSI and the characteristic of draining veins on silent MRA are associated with hemorrhage presentation. METHODS Eighty-one draining veins of 46 participants with BAVM (mean age 33.2 ± 16.9 years) who underwent silent MRA and DSA were evaluated retrospectively. The correlation between the rSI of the draining vein on silent MRA and A-V transit time on DSA was examined. The AUC-ROC was obtained to evaluate the performance of the rSI in determining the presence of high-flow A-V shunt. The characteristics of draining veins with the maximum rSI (rSImax) were further compared between the hemorrhagic and non-hemorrhagic untreated BAVM. RESULTS The rSI of each draining vein on silent MRA was significantly correlated with A-V transit time from DSA (r = -0.81, p < .001). The AUC-ROC was 0.89 for using the rSI to determine the presence of high-flow A-V shunt. A cut-off rSI value of 1.09 yielded a sensitivity of 82.4% and a specificity of 82.8%. The draining vein with rSImax and no ectasia was significantly more observed in the hemorrhagic group (p = 0.045). CONCLUSIONS The rSI of the draining vein on silent MRA is significantly correlated with A-V transit time on DSA, and it can be used as an indicator of high-flow A-V shunt in BAVM. KEY POINTS • The signal intensity ratio (rSI) of the draining vein on silent MRA significantly correlated with arteriovenous (A-V) transit time of brain arteriovenous malformation (BAVM) on digital subtraction angiography (DSA). • The area under the receiver operating characteristic curve (AUC) was 0.89 for using the rSI of draining veins to determine high-flow A-V shunt. • Draining veins with maximum rSI and no ectasia were significantly more observed in the hemorrhagic group of BAVM (p = 0.045).
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Affiliation(s)
- Chun-Xue Wu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45# Changchun Street, Xicheng District, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Zhen-Xiang Zang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45# Changchun Street, Xicheng District, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Meng-Qi Dong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yi Shan
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45# Changchun Street, Xicheng District, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Zhi-Lian Zhao
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45# Changchun Street, Xicheng District, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Cheng-Bei Hou
- Center for Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45# Changchun Street, Xicheng District, Beijing, China. .,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.
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15
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Recent progress understanding pathophysiology and genesis of brain AVM-a narrative review. Neurosurg Rev 2021; 44:3165-3175. [PMID: 33837504 PMCID: PMC8592945 DOI: 10.1007/s10143-021-01526-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023]
Abstract
Considerable progress has been made over the past years to better understand the genetic nature and pathophysiology of brain AVM. For the actual review, a PubMed search was carried out regarding the embryology, inflammation, advanced imaging, and fluid dynamical modeling of brain AVM. Whole-genome sequencing clarified the genetic origin of sporadic and familial AVM to a large degree, although some open questions remain. Advanced MRI and DSA techniques allow for better segmentation of feeding arteries, nidus, and draining veins, as well as the deduction of hemodynamic parameters such as flow and pressure in the individual AVM compartments. Nonetheless, complete modeling of the intranidal flow structure by computed fluid dynamics (CFD) is not possible so far. Substantial progress has been made towards understanding the embryology of brain AVM. In contrast to arterial aneurysms, complete modeling of the intranidal flow and a thorough understanding of the mechanical properties of the AVM nidus are still lacking at the present time.
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16
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Ozaki T, Lee H, Krings T. Characteristics of pial brain arteriovenous malformations with transdural arterial supply. Eur J Radiol 2021; 139:109670. [PMID: 33845293 DOI: 10.1016/j.ejrad.2021.109670] [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: 01/16/2021] [Revised: 03/02/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Transdural blood supply (TDBS) to pial brain arteriovenous malformations (BAVM) is uncommon and believed to be related to vascular endothelial growth factor - induced angiogenesis. The aim of this study was to define the BAVM characteristics in relation to presence and volume of TDBS. METHODS BAVMs managed at our institution between January 2006 and December 2016 who subsequently underwent complete digital subtraction angiography (DSA) were included. They were classified based on presence of TDBS as well as volume of TDBS. RESULTS Of the 641 BAVM patients managed during the recruitment period, 387 (391 BAVMs) had complete pretreatment DSAs. Forty-three (11.0 %, 10 ruptured) BAVMs exhibited TDBS. With TDBS group had a significantly greater proportion of large nidus (> 3.1 cm) than the Without TDBS group (85.1 % vs 19.5 %, p < 0.01) and were more frequently temporal (32.6 % vs 14.7 %, p < 0.01) and occipital (25.6 % vs 13.5 %, p < 0.05) in location. In unruptured BAVMs, the presence of headaches was significantly more prevalent when the malformation harboured TDBS compared to not (57.6 vs 34.8 %, p < 0.05). The annual rupture rate among unruptured BAVMs treated by conservative management was 4.7 % in the With TDBS (n = 12) group and 0% (n = 21) in BAVMs with TDBS that underwent treatment including surgery, endovascular therapy, or radiosurgery. CONCLUSION BAVMs with TDBS are more likely to be associated with a large nidus and located in the temporal and occipital lobes. Headache is more frequently associated with the presence of TDBS. Rupture rate of unruptured BAVMS with TDBS can be effectively reduced following treatment.
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Affiliation(s)
- Tomohiko Ozaki
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
| | - Hubert Lee
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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17
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Hasegawa H, Kin T, Shin M, Suzuki Y, Kawashima M, Shinya Y, Shiode T, Nakatomi H, Saito N. Possible Association Between Rupture and Intranidal Microhemodynamics in Arteriovenous Malformations: Phase-Contrast Magnetic Resonance Angiography-Based Flow Quantification. World Neurosurg 2021; 150:e427-e435. [PMID: 33737258 DOI: 10.1016/j.wneu.2021.03.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine a potential association between intranidal microhemodynamics and rupture using a phase-contrast magnetic resonance angiography (PCMRA)-based flow quantification technique in arteriovenous malformations (AVMs). METHODS We retrospectively collected data on 30 consecutive patients with AVMs (23 unruptured and 7 ruptured). Based on PCMRA data, maximal (Vmax) and mean (Vmean) intranidal velocities were calculated. Logistic regression analysis was performed to assess factors associated with previous AVM rupture. RESULTS All ruptures occurred within 6 months before PCMRA. The mean nidus volume was 4.7 mL. Eleven patients (37%) had deep draining vein(s), and 6 patients (20%) had a deep-seated nidus. The mean ± standard deviation Vmean and Vmax were 9.6 ± 2.8 cm/second and 66.7 ± 26.2 cm/second, respectively. The logistic regression analyses revealed that higher Vmax (P = 0.075, unit odds ratio [OR] = 1.05, 95% confidence interval [95% CI] = 1.00-1.10) was significantly associated with prior hemorrhage. The receiver-operating curve analyses demonstrated that a Vmean of 10.8 cm/second (area under the curve = 0.671) and Vmax of 90.2 cm/second (area under the curve = 0.764) maximized the Youden Index. A Vmax > 90 cm/second was significantly associated with AVM rupture both in the univariate (P = 0.025, OR = 9.0, 95% CI = 1.3-61.1) and multivariate (P = 0.008, OR = 51.7, 95% CI = 2.8-968.3) analyses. CONCLUSIONS Presence of faster velocities in intranidal vessels may suggest aberrant microhemodynamics and thus be associated with AVM rupture. PCMRA-based velocimetry seems to be a promising tool to predict future AVM rupture.
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Affiliation(s)
- Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
| | - Taichi Kin
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuichi Suzuki
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Mariko Kawashima
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuki Shinya
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Taketo Shiode
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
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Suzuki K, Takehara Y, Sakata M, Kawate M, Ohishi N, Sugiyama K, Akai T, Suzuki Y, Sugiyama M, Kawamura T, Morita Y, Kikuchi H, Hiramatsu Y, Yamamoto M, Nasu H, Johnson K, Wieben O, Kurachi K, Takeuchi H. Daikenchuto increases blood flow in the superior mesenteric artery in humans: A comparison study between four-dimensional phase-contrast vastly undersampled isotropic projection reconstruction magnetic resonance imaging and Doppler ultrasound. PLoS One 2021; 16:e0245878. [PMID: 33503053 PMCID: PMC7840032 DOI: 10.1371/journal.pone.0245878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022] Open
Abstract
Respiratory-gated four-dimensional phase-contrast vastly undersampled isotropic projection reconstruction (4D PC-VIPR) is magnetic resonance (MR) imaging technique that enables analysis of vascular morphology and hemodynamics in a single examination using cardiac phase resolved 3D phase-contrast magnetic resonance imaging. The present study aimed to assess the usefulness of 4D PC-VIPR for the superior mesenteric artery (SMA) flowmetry before and after flow increase was induced by the herbal medicine Daikenchuto (TJ-100) by comparing it with Doppler ultrasound (DUS) as a current standard. Twenty healthy volunteers were enrolled in this prospective single-arm study. The peak cross-sectionally averaged velocity was measured by 4D PC-VIPR, peak velocity was measured by DUS, and flow volume (FV) of SMA and aorta were measured by 4D PC-VIPR and DUS 25 min before and after the peroral administration of TJ-100. The peak cross-sectionally averaged velocity, peak velocity, and FV of SMA measured by 4D PC-VIPR and DUS significantly increased after administration of TJ-100 (4D PC-VIPR: the peak cross-sectionally averaged velocity; p = 0.004, FV; p = 0.035, DUS: the peak velocity; p = 0.003, FV; p = 0.010). Furthermore, 4D PC-VIPR can analyze multiple blood vessels simultaneously. The ratio of the SMA FV to the aorta, before and after oral administration on the 4D PC-VIPR test also increased (p = 0.015). The rate of change assessed by 4D PC-VIPR and DUS were significantly correlated (the peak cross-sectionally averaged velocity and peak velocity: r = 0.650; p = 0.005, FV: r = 0.659; p = 0.004). Retrospective 4D PC-VIPR was a useful modality for morphological and hemodynamic analysis of SMA.
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Affiliation(s)
- Katsunori Suzuki
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yasuo Takehara
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University, Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Mayu Sakata
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Masanori Kawate
- Department of Radiology, Hamamatsu University Hospital, Hamamatsu, Shizuoka, Japan
| | - Naoki Ohishi
- Department of Radiology, Hamamatsu University Hospital, Hamamatsu, Shizuoka, Japan
| | - Kosuke Sugiyama
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Toshiya Akai
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yuhi Suzuki
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Masataka Sugiyama
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University, Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takafumi Kawamura
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yoshifumi Morita
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hirotoshi Kikuchi
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yoshihiro Hiramatsu
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Masayoshi Yamamoto
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hatsuko Nasu
- Department of Diagnostic Radiology & Nuclear Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kevin Johnson
- Department of Medical Physics, University of Wisconsin, Madison, WI, United States of America
- Department of Radiology, University of Wisconsin, Madison, WI, United States of America
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin, Madison, WI, United States of America
- Department of Radiology, University of Wisconsin, Madison, WI, United States of America
| | - Kiyotaka Kurachi
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- * E-mail:
| | - Hiroya Takeuchi
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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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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Youn SW, Lee J. From 2D to 4D Phase-Contrast MRI in the Neurovascular System: Will It Be a Quantum Jump or a Fancy Decoration? J Magn Reson Imaging 2020; 55:347-372. [PMID: 33236488 DOI: 10.1002/jmri.27430] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/16/2022] Open
Abstract
Considering the crosstalk between the flow and vessel wall, hemodynamic assessment of the neurovascular system may offer a well-integrated solution for both diagnosis and management by adding prognostic significance to the standard CT/MR angiography. 4D flow MRI or time-resolved 3D velocity-encoded phase-contrast MRI has long been promising for the hemodynamic evaluation of the great vessels, but challenged in clinical studies for assessing intracranial vessels with small diameter due to long scan times and low spatiotemporal resolution. Current accelerated MRI techniques, including parallel imaging with compressed sensing and radial k-space undersampling acquisitions, have decreased scan times dramatically while preserving spatial resolution. 4D flow MRI visualized and measured 3D complex flow of neurovascular diseases such as aneurysm, arteriovenous shunts, and atherosclerotic stenosis using parameters including flow volume, velocity vector, pressure gradients, and wall shear stress. In addition to the noninvasiveness of the phase contrast technique and retrospective flow measurement through the wanted windows of the analysis plane, 4D flow MRI has shown several advantages over Doppler ultrasound or computational fluid dynamics. The evaluation of the flow status and vessel wall can be performed simultaneously in the same imaging modality. This article is an overview of the recent advances in neurovascular 4D flow MRI techniques and their potential clinical applications in neurovascular disease. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Sung Won Youn
- Department of Radiology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jongmin Lee
- Department of Radiology and Biomedical Engineering, Kyungpook National University School of Medicine, Daegu, Korea
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MacDonald CJ, Hellmuth R, Priba L, Murphy E, Gandy S, Matthew S, Ross R, Houston JG. Experimental Assessment of Two Non-Contrast MRI Sequences Used for Computational Fluid Dynamics: Investigation of Consistency Between Techniques. Cardiovasc Eng Technol 2020; 11:416-430. [PMID: 32613600 PMCID: PMC7385008 DOI: 10.1007/s13239-020-00473-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/20/2020] [Indexed: 11/05/2022]
Abstract
Purpose Recent studies have noted a degree of variance between the geometries segmented by different groups from 3D medical images that are used in computational fluid dynamics (CFD) simulations of patient-specific cardiovascular systems. The aim of this study was to determine if the applied sequence of magnetic resonance imaging (MRI) also introduced observable variance in CFD results. Methods Using a series of phantoms MR images of vessels of known diameter were assessed for the time-of-flight and multi-echo data image combination sequences. Following this, patient images of arterio-venous fistulas were acquired using the same sequences. Comparisons of geometry were made using the phantom and patient images, and of wall shear stress quantities using the CFD results from the patient images. Results Phantom images showed deviations in diameter between 0 and 15% between the sequences, depending on vessel diameter. Patient images showed different geometrical features such as narrowings that were not present on both sequences. Distributions of wall shear stress (WSS) quantities differed from simulations between the geometries obtained from the sequences. Conclusion In conclusion, choosing different MRI sequences resulted in slightly different geometries of the same anatomy, which led to compounded errors in WSS quantities from CFD simulation. Electronic supplementary material The online version of this article (10.1007/s13239-020-00473-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C J MacDonald
- Imaging and Technology, University of Dundee, Dundee, UK
| | - R Hellmuth
- Vascular Flow Technologies LTD, Dundee, UK
| | - L Priba
- Medical Physics, NHS Tayside, Dundee, UK
| | - E Murphy
- Imaging and Technology, University of Dundee, Dundee, UK
| | - S Gandy
- Medical Physics, NHS Tayside, Dundee, UK
| | - S Matthew
- Imaging and Technology, University of Dundee, Dundee, UK
| | - R Ross
- Vascular Laboratory, NHS Tayside, Dundee, UK
| | - J G Houston
- Imaging and Technology, University of Dundee, Dundee, UK. .,Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK.
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Lin TM, Yang HC, Lee CC, Wu HM, Hu YS, Luo CB, Guo WY, Kao YH, Chung WY, Lin CJ. Stasis index from hemodynamic analysis using quantitative DSA correlates with hemorrhage of supratentorial arteriovenous malformation: a cross-sectional study. J Neurosurg 2020; 132:1574-1582. [PMID: 31026828 DOI: 10.3171/2019.1.jns183386] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Assessments of hemorrhage risk based on angioarchitecture have yielded inconsistent results, and quantitative hemodynamic studies have been limited to small numbers of patients. The authors examined whether cerebral hemodynamic analysis using quantitative digital subtraction angiography (QDSA) can outperform conventional DSA angioarchitecture analysis in evaluating the risk of hemorrhage associated with supratentorial arteriovenous malformations (AVMs). METHODS A cross-sectional study was performed by retrospectively reviewing adult supratentorial AVM patients who had undergone both DSA and MRI studies between 2011 and 2017. Angioarchitecture characteristics, DSA parameters, age, sex, and nidus volume were analyzed using univariate and multivariate logistic regression, and QDSA software analysis was performed on DSA images. Based on the QDSA analysis, a stasis index, defined as the inflow gradient divided by the absolute value of the outflow gradient, was determined. The receiver operating characteristic (ROC) curve was used to compare diagnostic performances of conventional DSA angioarchitecture analysis and analysis using hemodynamic parameters based on QDSA. RESULTS A total of 119 supratentorial AVM patients were included. After adjustment for age at diagnosis, sex, and nidus volume, the exclusive deep venous drainage (p < 0.01), observed through conventional angioarchitecture examination using DSA, and the stasis index of the most dominant drainage vein (p = 0.02), measured with QDSA hemodynamic analysis, were independent risk factors for hemorrhage. The areas under the ROC curves for the conventional DSA method (0.75) and QDSA hemodynamics analysis (0.73) were similar. A venous stasis index greater than 2.18 discriminated the hemorrhage group with a sensitivity of 52.6% and a specificity of 81.5%. CONCLUSIONS In QDSA, a higher stasis index of the most dominant drainage vein is an objective warning sign associated with supratentorial AVM rupture. Risk assessments of AVMs using QDSA and conventional DSA angioarchitecture were equivalent. Because QDSA is a complementary noninvasive approach without extra radiation or contrast media, comprehensive hemorrhagic risk assessment of cerebral AVMs should include both DSA angioarchitecture and QDSA analyses.
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Affiliation(s)
- Te Ming Lin
- 1Department of Radiology and
- 3School of Medicine and
| | - Huai Che Yang
- 2Neurological Institute, Department of Neurosurgery, Taipei Veterans General Hospital; and
- 3School of Medicine and
| | - Cheng Chia Lee
- 2Neurological Institute, Department of Neurosurgery, Taipei Veterans General Hospital; and
- 3School of Medicine and
| | - Hsiu Mei Wu
- 1Department of Radiology and
- 3School of Medicine and
| | - Yong Sin Hu
- 1Department of Radiology and
- 3School of Medicine and
| | - Chao Bao Luo
- 1Department of Radiology and
- 3School of Medicine and
| | - Wan Yuo Guo
- 1Department of Radiology and
- 3School of Medicine and
| | - Yi Hsuan Kao
- 4Department of Biomedical Imaging and Radiological Science, National Yang-Ming University, Taipei, Taiwan
| | - Wen Yuh Chung
- 1Department of Radiology and
- 2Neurological Institute, Department of Neurosurgery, Taipei Veterans General Hospital; and
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Soldozy S, Norat P, Yağmurlu K, Sokolowski JD, Sharifi KA, Tvrdik P, Park MS, Kalani MYS. Arteriovenous malformation presenting with epilepsy: a multimodal approach to diagnosis and treatment. Neurosurg Focus 2020; 48:E17. [DOI: 10.3171/2020.1.focus19899] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/28/2020] [Indexed: 11/06/2022]
Abstract
Arteriovenous malformation (AVM) presenting with epilepsy significantly impacts patient quality of life, and it should be considered very much a seizure disorder. Although hemorrhage prevention is the primary treatment aim of AVM surgery, seizure control should also be at the forefront of therapeutic management. Several hemodynamic and morphological characteristics of AVM have been identified to be associated with seizure presentation. This includes increased AVM flow, presence of long pial draining vein, venous outflow obstruction, and frontotemporal location, among other aspects. With the advent of high-throughput image processing and quantification methods, new radiographic attributes of AVM-related epilepsy have been identified. With respect to therapy, several treatment approaches are available, including conservative management or interventional modalities; this includes microsurgery, radiosurgery, and embolization or a combination thereof. Many studies, especially in the domain of microsurgery and radiosurgery, evaluate both techniques with respect to seizure outcomes. The advantage of microsurgery lies in superior AVM obliteration rates and swift seizure response. In addition, by incorporating electrophysiological monitoring during AVM resection, adjacent or even remote epileptogenic foci can be identified, leading to extended lesionectomy and improved seizure control. Radiosurgery, despite resulting in reduced AVM obliteration and prolonged time to seizure freedom, avoids the risks of surgery altogether and may provide seizure control through various antiepileptic mechanisms. Embolization continues to be used as an adjuvant for both microsurgery and radiosurgery. In this study, the authors review the latest imaging techniques in characterizing AVM-related epilepsy, in addition to reviewing each treatment modality.
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Optimal 4DFlow MR sequence parameters for the assessment of internal carotid artery stenosis: a simulation study. Neuroradiology 2019; 61:1137-1144. [PMID: 31197413 DOI: 10.1007/s00234-019-02237-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE In patients with ICA stenosis, increased peak systolic velocity is a marker of stenosis at risk of ischemic stroke. 4DFlow MRI is a reproducible technique to evaluate velocities in ICA stenosis, although it seems to underestimate velocities as compared with Doppler ultrasonography. The purpose of our study was to confirm that velocities were underestimated on a new set of data acquired with a clinical 4DFlow sequence, and to devise optimal acquisition parameters for ICA stenosis exploration based on a numerical simulation. METHODS After review board approval, 15 healthy controls and 12 patients presenting ICA stenosis were explored with Doppler ultrasonography and 4DFlow MRI. We created a 2-dimensional simulation of ICA stenosis and its corresponding 4DFlow acquisition, and compared its mean peak systolic velocity underestimation to real MRI and Doppler. We then simulated the acquisition for voxel size ranging from 0.5 to 1.25 mm and number of phases per cardiac cycle ranging from 10 to 25. RESULTS On acquired data, 4DFlow MR underestimated peak systolic velocities (mean difference between Doppler and 4DFlow: - 35 cm/s), especially high velocities. With spatial and temporal resolutions equivalent to MR acquisition, our simulation yielded similar underestimation (mean difference: - 31 cm/s, P = 0.30). Simulations showed that 0.7-mm resolution and 20 phases per cardiac cycle would be necessary to record peak systolic velocities up to 250 cm/s. CONCLUSION Higher spatial resolution can provide accurate peak systolic velocities measurement with 4DFlow MRI, thus allowing better ICA stenosis assessment. Further studies are needed to validate the proposed parameters.
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Laminar Wall Shear Stress in Brain Arteriovenous Malformations: Systematic Review of Literature. World Neurosurg 2019; 128:e760-e767. [PMID: 31077894 DOI: 10.1016/j.wneu.2019.04.251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/28/2019] [Accepted: 04/29/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Laminar wall sheer stress (LWSS) modulates inflammatory activity of the endothelium and may be a contributing factor in many cerebrovascular pathologies. There is a lack of consensus whether significant differences in LWSS exist between feeding vessels in brain arteriovenous malformation (bAVM) and healthy vessels. A systematic review of LWSS research in bAVM was undertaken, including the methods used and the assumptions made in determining LWSS. METHODS Ovid MEDLINE, EMBASE, and Scopus electronic databases were systematically searched from inception for articles calculating LWSS in bAVM cases. LWSS values were extracted for comparison between ipsilateral bAVM feeding arteries and healthy contralateral vessels or healthy normative data. RESULTS Three retrospective cohort studies were identified, reporting on 42 adult and pediatric bAVM cases. Mean LWSS (mLWSS) in healthy vessels (contralateral vessels or normative controls) typically ranged from 1.2-2.7 Pa, while mLWSS values in untreated bAVM feeding arteries typically ranged from 1.6-3.6 Pa. All studies had mixed cohorts of ruptured and unruptured cases, obscuring the relationship between LWSS and bAVM history. CONCLUSIONS mLWSS values in healthy arteries and bAVM feeding vessels tend to be low and overlapping. Further research of high scientific and methodologic quality is necessary to improve understanding of how LWSS hemodynamics relate to bAVM formation, rupture, and treatment.
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Bouillot P, Brina O, Chnafa C, Cancelliere NM, Vargas MI, Radovanovic I, Krings T, Steinman DA, Pereira VM. Robust cerebrovascular blood velocity and flow rate estimation from 4D‐CTA. Med Phys 2019; 46:2126-2136. [DOI: 10.1002/mp.13454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/27/2019] [Accepted: 02/13/2019] [Indexed: 01/22/2023] Open
Affiliation(s)
- Pierre Bouillot
- Departement of Neuroradiology Geneva University Hospitals Geneva Switzerland
- Department of Quantum Matter Physics University of Geneva Geneva Switzerland
| | - Olivier Brina
- Departement of Neuroradiology Geneva University Hospitals Geneva Switzerland
- Division of Neuroradiology Department of Medical Imaging Toronto Western Hospital University Health Network Toronto ON Canada
| | - Christophe Chnafa
- Biomedical Simulation Laboratory Department of Mechanical & Industrial Engineering University of Toronto Toronto ON Canada
| | - Nicole M. Cancelliere
- Division of Neuroradiology Department of Medical Imaging Toronto Western Hospital University Health Network Toronto ON Canada
| | - Maria I. Vargas
- Departement of Neuroradiology Geneva University Hospitals Geneva Switzerland
| | - Ivan Radovanovic
- Division of Neurosurgery Department of Surgery Toronto Western Hospital University Health Network Toronto ON Canada
| | - Timo Krings
- Division of Neuroradiology Department of Medical Imaging Toronto Western Hospital University Health Network Toronto ON Canada
| | - David A. Steinman
- Biomedical Simulation Laboratory Department of Mechanical & Industrial Engineering University of Toronto Toronto ON Canada
| | - Vitor M. Pereira
- Departement of Neuroradiology Geneva University Hospitals Geneva Switzerland
- Division of Neuroradiology Department of Medical Imaging Toronto Western Hospital University Health Network Toronto ON Canada
- Division of Neurosurgery Department of Surgery Toronto Western Hospital University Health Network Toronto ON Canada
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ACR Appropriateness Criteria ® Cerebrovascular Disease. J Am Coll Radiol 2018; 14:S34-S61. [PMID: 28473091 DOI: 10.1016/j.jacr.2017.01.051] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 11/23/2022]
Abstract
Diseases of the cerebral vasculature represent a heterogeneous group of ischemic and hemorrhagic etiologies, which often manifest clinically as an acute neurologic deficit also known as stroke or less commonly with symptoms such as headache or seizures. Stroke is the fourth leading cause of death and is a leading cause of serious long-term disability in the United States. Eighty-seven percent of strokes are ischemic, 10% are due to intracerebral hemorrhage, and 3% are secondary to subarachnoid hemorrhage. The past two decades have seen significant developments in the screening, diagnosis, and treatment of ischemic and hemorrhagic causes of stroke with advancements in CT and MRI technology and novel treatment devices and techniques. Multiple different imaging modalities can be used in the evaluation of cerebrovascular disease. The different imaging modalities all have their own niches and their own advantages and disadvantages in the evaluation of cerebrovascular disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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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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Lin CJ, Yang HC, Chien AC, Guo WY, Wu CC, Hung SC, Chen KK, Wu HM, Luo CB, Chu WF, Hong JS, Wu CSF. In-room assessment of intravascular velocity from time-resolved rotational angiography in patients with arteriovenous malformation: a pilot study. J Neurointerv Surg 2017; 10:580-586. [DOI: 10.1136/neurintsurg-2017-013387] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/07/2017] [Accepted: 09/10/2017] [Indexed: 11/04/2022]
Abstract
BackgroundTime-resolved rotational angiography (t-RA) enables interventionists to better comprehend complex arteriovenous malformations (AVMs), thereby facilitating endovascular treatment. However, its use in evaluating hemodynamic changes has rarely been explored.ObjectiveThis study uses t-RA to estimate intravascular flow in patients with AVM to compare this with flow in the normal population.MethodsPatients with available t-RA scans were prospectively categorized into one of three groups: hemorrhagic AVM, non-hemorrhagic AVM and control. Pulsatile time–density curves (TDCs) for C1, C6 and VOIMCA were used for amplitude and velocity estimation. C1 was at the cervical internal carotid artery (ICA), 2–3 cm below the carotid canal, C6 was at the paraclinoid segment of the ICA, and VOIMCA was at the junction of the first and second segment of the middle cerebral artery (MCA). A waveform amplitude ratio was defined as (peak − trough)/trough contrast intensity. VICA was defined as the distance between C6 and C1 divided by the time required for the wave to pass, and correspondingly, the average velocity of MCA (VMCA) was defined as the distance between C6 and VOIMCA divided by the duration for the same peak to travel from C6 and VOIMCA, AVM volume was estimated by MR angiography.ResultsAmplitude ratios AC1 and AC6, and average flow velocities VICA and VMCA were significantly larger in the non-hemorrhagic group than in the control group, while the hemorrhagic AVM group was not significantly different from the controls. VICA and VMCA showed moderate to good correlations with AVM volume (r=0.51 and 0.73, respectively). VMCA (33.0±9.1) was significantly lower than VICA (41.3±13.2) in the control group, but not in the two AVM groups.ConclusionTDC waveform propagation derived from t-RA can quantify hemodynamic differences between AVM and the control group. t-RA provides both real-time anatomic and hemodynamic evaluation, and can thus potentially improve the interventional workflow.
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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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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: 9] [Impact Index Per Article: 1.3] [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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Vollherbst DF, Sommer CM, Ulfert C, Pfaff J, Bendszus M, Möhlenbruch MA. Liquid Embolic Agents for Endovascular Embolization: Evaluation of an Established (Onyx) and a Novel (PHIL) Embolic Agent in an In Vitro AVM Model. AJNR Am J Neuroradiol 2017; 38:1377-1382. [PMID: 28522669 DOI: 10.3174/ajnr.a5203] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/23/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Embolization plays a key role in the treatment of arteriovenous malformations. The aim of this study was to evaluate an established (Onyx) and a novel (precipitating hydrophobic injectable liquid [PHIL]) liquid embolic agent in an in vitro AVM model. MATERIALS AND METHODS An AVM model was integrated into a circuit system. The artificial nidus (subdivided into 28 honeycomb-like sections) was embolized with Onyx 18 (group Onyx; n = 8) or PHIL 25 (group PHIL; n = 8) with different pause times between the injections (30 and 60 seconds, n = 4 per study group) by using a 1.3F microcatheter. Procedure times, number of injections, embolization success (defined as the number of filled sections of the artificial nidus), volume of embolic agent, and frequency and extent of reflux and draining vein embolization were assessed. RESULTS Embolization success was comparable between Onyx and PHIL. Shorter pause times resulted in a significantly higher embolization success for PHIL (median embolization score, 28 versus 18; P = .011). Compared with Onyx, lower volumes of PHIL were required for the same extent of embolization (median volume per section of the artificial nidus, 15.5 versus 3.6 μL; P < .001). CONCLUSIONS While the embolization success was comparable for Onyx and PHIL, pause time had a considerable effect on the embolization success in an in vitro AVM model. Compared with Onyx, lower volumes of PHIL were required for the same extent of embolization.
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Affiliation(s)
- D F Vollherbst
- From the Department of Neuroradiology (D.F.V., C.U., J.P., M.B., M.A.M.)
| | - C M Sommer
- Clinic for Diagnostic and Interventional Radiology (C.M.S.), University Hospital Heidelberg, Heidelberg, Germany.,Clinic for Diagnostic and Interventional Radiology (C.M.S.), Klinikum Stuttgart, Stuttgart, Germany
| | - C Ulfert
- From the Department of Neuroradiology (D.F.V., C.U., J.P., M.B., M.A.M.)
| | - J Pfaff
- From the Department of Neuroradiology (D.F.V., C.U., J.P., M.B., M.A.M.)
| | - M Bendszus
- From the Department of Neuroradiology (D.F.V., C.U., J.P., M.B., M.A.M.)
| | - M A Möhlenbruch
- From the Department of Neuroradiology (D.F.V., C.U., J.P., M.B., M.A.M.)
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Bouillot P, Delattre BMA, Brina O, Ouared R, Farhat M, Chnafa C, Steinman DA, Lovblad KO, Pereira VM, Vargas MI. 3D phase contrast MRI: Partial volume correction for robust blood flow quantification in small intracranial vessels. Magn Reson Med 2017; 79:129-140. [PMID: 28244132 DOI: 10.1002/mrm.26637] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 11/11/2022]
Abstract
PURPOSE Recent advances in 3D-PCMRI (phase contrast MRI) sequences allow for measuring the complex hemodynamics in cerebral arteries. However, the small size of these vessels vs spatial resolution can lead to non-negligible partial volume artifacts, which must be taken into account when computing blood flow rates. For this purpose, we combined the velocity information provided by 3D-PCMRI with vessel geometry measured with 3DTOF (time of flight MRI) or 3DRA (3D rotational angiography) to correct the partial volume effects in flow rate assessments. METHODS The proposed methodology was first tested in vitro on cylindrical and patient specific vessels subject to fully controlled pulsatile flows. Both 2D- and 3D-PCMRI measurements using various spatial resolutions ranging from 20 to 1.3 voxels per vessel diameter were analyzed and compared with flowmeter baseline. Second, 3DTOF, 2D- and 3D-PCMRI measurements were performed in vivo on 35 patients harboring internal carotid artery (ICA) aneurysms indicated for endovascular treatments requiring 3DRA imaging. RESULTS The in vitro 2D- and 3D-PCMRI mean flow rates assessed with partial volume correction showed very low sensitivity to the acquisition resolution above ≈2 voxels per vessel diameter while uncorrected flow rates deviated critically when decreasing the spatial resolution. 3D-PCMRI flow rates measured in vivo in ICA agreed very well with 2D-PCMRI data and a good flow conservation was observed at the C7 bifurcation. Globally, partial volume correction led to 10-15% lower flow rates than uncorrected values as those reported in most of the published studies on intracranial flows. CONCLUSION Partial volume correction may improve the accuracy of PCMRI flow rate measurements especially in small vessels such as intracranial arteries. Magn Reson Med 79:129-140, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Pierre Bouillot
- Division of Neuroradiology, Geneva University Hospitals & Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Laboratory for Hydraulic Machines (LMH), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Bénédicte M A Delattre
- Division of Radiology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Olivier Brina
- Division of Neuroradiology, Geneva University Hospitals & Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Rafik Ouared
- Division of Neuroradiology, Geneva University Hospitals & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mohamed Farhat
- Laboratory for Hydraulic Machines (LMH), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Christophe Chnafa
- Biomedical Simulation Laboratory, Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Canada
| | - David A Steinman
- Biomedical Simulation Laboratory, Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Canada
| | - Karl-Olof Lovblad
- Division of Neuroradiology, Geneva University Hospitals & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Vitor M Pereira
- Division of Neuroradiology, Geneva University Hospitals & Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Maria I Vargas
- Division of Neuroradiology, Geneva University Hospitals & Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Heros RC. Editorial. Transdural arterial recruitment to brain arteriovenous malformations. J Neurosurg 2016; 127:47-50. [PMID: 27588587 DOI: 10.3171/2016.6.jns161361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Roberto C Heros
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida
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Bervini D, Morgan MK, Stoodley MA, Heller GZ. Transdural arterial recruitment to brain arteriovenous malformation: clinical and management implications in a prospective cohort series. J Neurosurg 2016; 127:51-58. [PMID: 27588588 DOI: 10.3171/2016.5.jns16730] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The occurrence of transdural arterial recruitment (TDAR) in association with brain arteriovenous malformation (bAVM) is uncommon, and the reason for TDAR is not understood. The aim of this cohort study was to examine patient and bAVM characteristics associated with TDAR and the implications of TDAR on management. METHODS A prospective surgical database of bAVMs was examined. Cases previously treated elsewhere or incompletely examined by digital subtraction angiography (DSA) assessment were excluded. Three studies of this cohort were performed, as follows: characteristics associated with TDAR, the relationship between TDAR and neurological deficits unassociated with hemorrhage (NDUH), and the impact of TDAR on outcome from surgery. Regression models were performed. RESULTS Of 769 patients with complete DSA who had no previous treatment, 51 (6.6%) were found to have TDAR. The presence of TDAR was associated with increasing age (p < 0.01; OR 1.05; 95% CI 1.02-1.07); presentation with NDUH (p < 0.01; OR 2.71; 95% CI 1.29-5.71); increasing size of the bAVM (p < 0.01; OR 1.57; 95% CI 1.29-1.91); and combined supply from both anterior and posterior circulations (p = 0.02; OR 2.37; 95% CI 1.17-4.78). Further analysis of TDAR cases comparing those with and without NDUH found an association of larger size (6.6 cm [2.9 SD] compared with 4.7 cm [1.8 SD]; p < 0.01) and combined supply from both anterior and posterior circulations (relative risk 2.5; 95% CI 1.0-6.2; p = 0.04) to be associated with an NDUH presentation. For the 632 patients undergoing surgery there was an increased risk of complications (where this produced a new permanent neurological deficit at 12 months represented by a modified Rankin Scale score of > 1) with the following variables: size; location in eloquent brain; deep venous drainage; increasing age; and no presentation with hemorrhage. The presence of TDAR was not associated with an increased risk of complications from surgery. CONCLUSIONS The authors found that TDAR occurs in older patients with larger bAVMs, and that TDAR is also more likely to be associated with bAVMs presenting with NDUH. The likely explanation for the presence of TDAR is a secondary recruitment arising as a consequence of shear stress, rather than a primary vascular supply present from the earliest development of the bAVM.
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Affiliation(s)
- David Bervini
- Department of Neurosurgery, Inselspital, Bern University Hospital, Bern, Switzerland; and.,Departments of 2 Clinical Medicine and
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37
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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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Schnell S, Wu C, Ansari SA. Four-dimensional MRI flow examinations in cerebral and extracerebral vessels - ready for clinical routine? Curr Opin Neurol 2016; 29:419-28. [PMID: 27262148 PMCID: PMC4939804 DOI: 10.1097/wco.0000000000000341] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To evaluate the feasibility of 4-dimensional (4D) flow MRI for the clinical assessment of cerebral and extracerebral vascular hemodynamics in patients with neurovascular disease. RECENT FINDINGS 4D flow MRI has been applied in multiple studies to qualitatively and quantitatively study intracranial aneurysm blood flow for potential risk stratification and to assess treatment efficacy of various neurovascular lesions, including intraaneurysmal and parent artery blood flow after flow diverter stent placement and staged embolizations of arteriovenous malformations and vein of Galen aneurysmal malformations. Recently, the technique has been utilized to characterize age-related changes of normal cerebral hemodynamics in healthy individuals over a broad age range. SUMMARY 4D flow MRI is a useful tool for the noninvasive, volumetric and quantitative hemodynamic assessment of neurovascular disease without the need for gadolinium contrast agents. Further improvements are warranted to overcome technical limitations before broader clinical implementation. Current developments, such as advanced acceleration techniques (parallel imaging and compressed sensing) for faster data acquisition, dual or multiple velocity encoding strategies for more accurate arterial and venous flow quantification, ultrahigh-field strengths to achieve higher spatial resolution and streamlined postprocessing workflow for more efficient and standardized flow analysis, are promising advancements in 4D flow MRI.
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Affiliation(s)
- Susanne Schnell
- Dept. of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Can Wu
- Dept. of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Dept. of Biomedical Engineering, Northwestern University, Evanston, Illinois
| | - Sameer A. Ansari
- Dept. of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Dept. of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Dept. of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Turski P, Scarano A, Hartman E, Clark Z, Schubert T, Rivera L, Wu Y, Wieben O, Johnson K. Neurovascular 4DFlow MRI (Phase Contrast MRA): emerging clinical applications. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40809-016-0019-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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40
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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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Chang W, Huang M, Chien A. Emerging techniques for evaluation of the hemodynamics of intracranial vascular pathology. Neuroradiol J 2015; 28:19-27. [PMID: 25924168 DOI: 10.15274/nrj-2014-10115] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Advances in imaging modalities have improved the assessment of intracranial hemodynamics using non-invasive techniques. This review examines new imaging modalities and clinical applications of currently available techniques, describes pathophysiology and future directions in hemodynamic analysis of intracranial stenoses, aneurysms and arteriovenous malformations and explores how hemodynamic analysis may have prognostic value in predicting clinical outcomes and assist in risk stratification. The advent of new technologies such as pseudo-continuous arterial spin labeling, accelerated magnetic resonance angiography (MRA) techniques, 4D digital subtraction angiography, and improvements in clinically available techniques such as phase-contrast MRA may change the landscape of vascular imaging and modify current clinical practice guidelines.
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Affiliation(s)
| | | | - Aichi Chien
- UCLA Department of Radiology; Los Angeles, CA, USA
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42
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Combined DSA and 4D Flow Demonstrate Overt Alterations of Vascular Geometry and Hemodynamics in an Unusually Complex Cerebral AVM. Clin Neuroradiol 2015; 26:471-475. [PMID: 26475127 DOI: 10.1007/s00062-015-0477-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/03/2015] [Indexed: 01/06/2023]
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Kang CK, Park CA, Lee DS, Lee YB, Park CW, Kim YB, Cho ZH. Velocity measurement of microvessels using phase-contrast magnetic resonance angiography at 7 Tesla MRI. Magn Reson Med 2015; 75:1640-6. [PMID: 25980462 DOI: 10.1002/mrm.25600] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 12/10/2014] [Accepted: 12/12/2014] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of this study was to measure the velocity and direction of blood flow in microvessels, such as lenticulostriate arteries (LSAs), using PC MRA. METHODS Eleven healthy subjects were scanned with 7 Tesla (T) MRI. Three velocity encoding (VENC) values of 15, 50, and 100 cm/s were tested for detecting the flow velocity in LSAs. The flow directions in Circle of Willis (CoW) were also examined with images obtained by the proposed method. Three subjects were also scanned with 3T MRI to determine the possibility of velocity measurement in LSAs. Difference between 3T and 7T was quantitatively analyzed in terms of signal-to-noise ratio and velocities in vessels and static tissues. RESULTS In 7T MRI, use of VENC = 15 cm/s provided great visualization and velocity measurements in small and slow flowing vessels, such as the LSAs. The mean of peak velocities in LSAs was 9.61 ± 1.78 cm/s. The results obtained with low VENC also clearly depicted the directions of flow in CoW, especially in posterior communicating arteries. However, 3T MRI could not detect the velocity of blood flow in LSAs. CONCLUSION This study demonstrated the potential for measuring the velocity and direction of blood flow in the targeted microvessels using an appropriate VENC and 7T MRI.
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Affiliation(s)
- Chang-Ki Kang
- Neuroscience Research Institute, Gachon University, Incheon, Korea.,Department of Radiological Science, Gachon University, Incheon, Korea
| | - Chan-A Park
- Bioimaging Research Team, Korea Basic Science Institute, Chungcheongbuk-do, Korea
| | - David Soobin Lee
- Department of Biomedical Engineering and Center for Imaging Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yeong-Bae Lee
- Department of Neurology, Gachon University Gil Hospital, Gachon University, Incheon, Korea
| | - Cheol-Wan Park
- Neuroscience Research Institute, Gachon University, Incheon, Korea
| | - Young-Bo Kim
- Neuroscience Research Institute, Gachon University, Incheon, Korea.,Department of Neurosurgery, Gachon University Gil Hospital, Gachon University, Incheon, Korea
| | - Zang-Hee Cho
- Department of Radiological Sciences, University of California, Irvine, California, USA
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Interest of HYPR flow dynamic MRA for characterization of cerebral arteriovenous malformations: comparison with TRICKS MRA and catheter DSA. Eur Radiol 2015; 25:3230-7. [DOI: 10.1007/s00330-015-3745-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 03/04/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
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45
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Wu C, Ansari SA, Honarmand AR, Vakil P, Hurley MC, Bendok BR, Carr J, Carroll TJ, Markl M. Evaluation of 4D vascular flow and tissue perfusion in cerebral arteriovenous malformations: influence of Spetzler-Martin grade, clinical presentation, and AVM risk factors. AJNR Am J Neuroradiol 2015; 36:1142-9. [PMID: 25721076 DOI: 10.3174/ajnr.a4259] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 12/11/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The role of intracranial hemodynamics in the pathophysiology and risk stratification of brain AVMs remains poorly understood. The purpose of this study was to assess the influence of Spetzler-Martin grade, clinical history, and risk factors on vascular flow and tissue perfusion in cerebral AVMs. MATERIALS AND METHODS 4D flow and perfusion MR imaging was performed in 17 patients with AVMs. Peak velocity and blood flow were quantified in AVM feeding and contralateral arteries, draining veins, and the straight sinus. Regional perfusion ratios (CBF, CBV, and MTT) were calculated between affected and nonaffected hemispheres. RESULTS Regarding flow parameters, high-grade AVMs (Spetzler-Martin grade of >2) demonstrated significantly increased peak velocity and blood flow in the major feeding arteries (P < .001 and P = .004) and straight sinus (P = .003 and P = .012) and increased venous draining flow (P = .001). The Spetzler-Martin grade significantly correlated with cumulative feeding artery flow (r = 0.85, P < .001) and draining vein flow (r = 0.80, P < .001). Regarding perfusion parameters, perinidal CBF and CBV ratios were significantly lower (P < .001) compared with the remote ratios and correlated negatively with cumulative feeding artery flow (r = -0.60, P = .014 and r = -0.55, P = .026) and draining vein flow (r = -0.60, P = .013 and r = -0.56, P = .025). Multiple regression analysis revealed no significant association of AVM flow or perfusion parameters with clinical presentation (rupture and seizure history) and AVM risk factors. CONCLUSIONS Macrovascular flow was significantly associated with increasing Spetzler-Martin grade and correlated with perinidal microvascular perfusion in cerebral AVMs. Future longitudinal studies are needed to evaluate the potential of comprehensive cerebral flow and perfusion MR imaging for AVM risk stratification.
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Affiliation(s)
- C Wu
- From the Department of Biomedical Engineering (C.W., T.J.C., M.M.), McCormick School of Engineering, Northwestern University, Evanston, Illinois Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.)
| | - S A Ansari
- Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.) Neurological Surgery (S.A.A., M.C.H., B.R.B.) Neurology (S.A.A.)
| | - A R Honarmand
- Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.)
| | - P Vakil
- Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.)
| | - M C Hurley
- Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.) Neurological Surgery (S.A.A., M.C.H., B.R.B.)
| | - B R Bendok
- Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.) Neurological Surgery (S.A.A., M.C.H., B.R.B.) Otolaryngology (B.R.B.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - J Carr
- Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.)
| | - T J Carroll
- From the Department of Biomedical Engineering (C.W., T.J.C., M.M.), McCormick School of Engineering, Northwestern University, Evanston, Illinois Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.)
| | - M Markl
- From the Department of Biomedical Engineering (C.W., T.J.C., M.M.), McCormick School of Engineering, Northwestern University, Evanston, Illinois Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.)
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Chang W, Wu Y, Johnson K, Loecher M, Wieben O, Edjlali M, Oppenheim C, Roca P, Hald J, Aagaard-Kienitz B, Niemann D, Mistretta C, Turski P. Fast contrast-enhanced 4D MRA and 4D flow MRI using constrained reconstruction (HYPRFlow): potential applications for brain arteriovenous malformations. AJNR Am J Neuroradiol 2015; 36:1049-55. [PMID: 25698624 DOI: 10.3174/ajnr.a4245] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 09/29/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE HYPRFlow is a novel imaging strategy that provides fast, high-resolution contrast-enhanced time-resolved images and measurement of the velocity of the entire cerebrovascular system. Our hypothesis was that the images obtained with this strategy are of adequate diagnostic image quality to delineate the major components of AVMs. MATERIALS AND METHODS HYPRFlow and 3D TOF scans were obtained in 21 patients with AVMs with correlative DSA examinations in 14 patients. The examinations were scored for image quality and graded by using the Spetzler-Martin criteria. Mean arterial transit time and overlap integrals were calculated from the dynamic image data. Volume flow rates in normal arteries and AVM feeding arteries were measured from the phase contrast data. RESULTS HYPRFlow was equivalent to 3D-TOF in delineating normal arterial anatomy, arterial feeders, and nidus size and was concordant with DSA for AVM grading and venous drainage in 13 of the 14 examinations. Mean arterial transit time on the AVM side was 0.49 seconds, and on the normal contralateral side, 2.53 seconds with P < .001. Across all 21 subjects, the mean arterial volume flow rate in the M1 segment ipsilateral to the AVM was 4.07 ± 3.04 mL/s; on the contralateral M1 segment, it was 2.09 ± 0.64 mL/s. The mean volume flow rate in the largest feeding artery to the AVM was 3.86 ± 2.74 mL/s. CONCLUSIONS HYPRFlow provides an alternative approach to the MRA evaluation of AVMs, with the advantages of increased coverage, 0.75-second temporal resolution, 0.68-mm isotropic spatial resolution, and quantitative measurement of flow in 6 minutes.
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Affiliation(s)
- W Chang
- From the Department of Radiology (W.C.), University of California, Los Angeles, Los Angeles, California
| | - Y Wu
- Medical Physics (Y.W., K.J., M.L., O.W., C.M.), University of Wisconsin School of Medicine, Madison, Wisconsin
| | - K Johnson
- Medical Physics (Y.W., K.J., M.L., O.W., C.M.), University of Wisconsin School of Medicine, Madison, Wisconsin
| | - M Loecher
- Medical Physics (Y.W., K.J., M.L., O.W., C.M.), University of Wisconsin School of Medicine, Madison, Wisconsin
| | - O Wieben
- Medical Physics (Y.W., K.J., M.L., O.W., C.M.), University of Wisconsin School of Medicine, Madison, Wisconsin
| | - M Edjlali
- Department of Radiology (M.E., C.O., P.R.), Université Paris-Descartes, Paris, France
| | - C Oppenheim
- Department of Radiology (M.E., C.O., P.R.), Université Paris-Descartes, Paris, France
| | - P Roca
- Department of Radiology (M.E., C.O., P.R.), Université Paris-Descartes, Paris, France
| | - J Hald
- Department of Radiology (J.H.), Rikshospitalet, Oslo, Norway
| | | | | | - C Mistretta
- Medical Physics (Y.W., K.J., M.L., O.W., C.M.), University of Wisconsin School of Medicine, Madison, Wisconsin
| | - P Turski
- Departments of Radiology (B.A.-K., P.T.)
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Bendok BR, El Tecle NE, El Ahmadieh TY, Koht A, Gallagher TA, Carroll TJ, Markl M, Sabbagha R, Sabbagha A, Cella D, Nowinski C, Dewald JPA, Meade TJ, Samson D, Batjer HH. Advances and innovations in brain arteriovenous malformation surgery. Neurosurgery 2014; 74 Suppl 1:S60-73. [PMID: 24402494 DOI: 10.1227/neu.0000000000000230] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Arteriovenous malformations (AVMs) of the brain are very complex and intriguing pathologies. Since their initial description by Luschka and Virchow in the middle of the 19th century, multiple advances and innovations have revolutionized their management and surgical treatment. Here, we review the historical landmarks in the surgical treatment of AVMs and then illustrate the most recent and futuristic technologies aiming to improve outcomes in AVM surgeries. In particular, we examine potential advances in patient selection, imaging, surgical technique, neuroanesthesia, and postoperative neuro-rehabilitation and quantitative assessments. Finally, we illustrate how concurrent advances in radiosurgery and endovascular techniques might present new opportunities to treat AVMs more safely from a surgical perspective.
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Affiliation(s)
- Bernard R Bendok
- Northwestern Memorial Hospital, Departments of *Neurological Surgery, ‡Radiology, §Otolaryngology, and ¶Anesthesiology, Chicago, Illinois; ‖Northwestern University, McCormick School of Engineering, Department of Biomedical Engineering, Evanston, Illinois; Northwestern University, #Neuropsychology Institute, **Department of Medical Social Sciences, ‡‡Department of Physical Therapy and Human Movement Sciences, and §§Department of Chemistry, Chicago, Illinois; ¶¶University of Texas Southwestern, Department of Neurological Surgery, Dallas, Texas
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48
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Raoult H, Bannier E, Maurel P, Neyton C, Ferré JC, Schmitt P, Barillot C, Gauvrit JY. Hemodynamic Quantification in Brain Arteriovenous Malformations With Time-Resolved Spin-Labeled Magnetic Resonance Angiography. Stroke 2014; 45:2461-4. [DOI: 10.1161/strokeaha.114.006080] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hélène Raoult
- From the CHU Rennes, Department of Neuroradiology, Rennes, France (H.R., J.-C.F., J.-Y.G.); Unité VISAGES U746 INSERM-INRIA, IRISA UMR CNRS 6074, University of Rennes, Rennes, France (H.R., E.B., P.M., C.N., J.-C.F., C.B., J.-Y.G); and MR Application & Workflow Development, Siemens AG, Healthcare Sector, Erlangen, Germany (P.S.)
| | - Elise Bannier
- From the CHU Rennes, Department of Neuroradiology, Rennes, France (H.R., J.-C.F., J.-Y.G.); Unité VISAGES U746 INSERM-INRIA, IRISA UMR CNRS 6074, University of Rennes, Rennes, France (H.R., E.B., P.M., C.N., J.-C.F., C.B., J.-Y.G); and MR Application & Workflow Development, Siemens AG, Healthcare Sector, Erlangen, Germany (P.S.)
| | - Pierre Maurel
- From the CHU Rennes, Department of Neuroradiology, Rennes, France (H.R., J.-C.F., J.-Y.G.); Unité VISAGES U746 INSERM-INRIA, IRISA UMR CNRS 6074, University of Rennes, Rennes, France (H.R., E.B., P.M., C.N., J.-C.F., C.B., J.-Y.G); and MR Application & Workflow Development, Siemens AG, Healthcare Sector, Erlangen, Germany (P.S.)
| | - Clément Neyton
- From the CHU Rennes, Department of Neuroradiology, Rennes, France (H.R., J.-C.F., J.-Y.G.); Unité VISAGES U746 INSERM-INRIA, IRISA UMR CNRS 6074, University of Rennes, Rennes, France (H.R., E.B., P.M., C.N., J.-C.F., C.B., J.-Y.G); and MR Application & Workflow Development, Siemens AG, Healthcare Sector, Erlangen, Germany (P.S.)
| | - Jean-Christophe Ferré
- From the CHU Rennes, Department of Neuroradiology, Rennes, France (H.R., J.-C.F., J.-Y.G.); Unité VISAGES U746 INSERM-INRIA, IRISA UMR CNRS 6074, University of Rennes, Rennes, France (H.R., E.B., P.M., C.N., J.-C.F., C.B., J.-Y.G); and MR Application & Workflow Development, Siemens AG, Healthcare Sector, Erlangen, Germany (P.S.)
| | - Peter Schmitt
- From the CHU Rennes, Department of Neuroradiology, Rennes, France (H.R., J.-C.F., J.-Y.G.); Unité VISAGES U746 INSERM-INRIA, IRISA UMR CNRS 6074, University of Rennes, Rennes, France (H.R., E.B., P.M., C.N., J.-C.F., C.B., J.-Y.G); and MR Application & Workflow Development, Siemens AG, Healthcare Sector, Erlangen, Germany (P.S.)
| | - Christian Barillot
- From the CHU Rennes, Department of Neuroradiology, Rennes, France (H.R., J.-C.F., J.-Y.G.); Unité VISAGES U746 INSERM-INRIA, IRISA UMR CNRS 6074, University of Rennes, Rennes, France (H.R., E.B., P.M., C.N., J.-C.F., C.B., J.-Y.G); and MR Application & Workflow Development, Siemens AG, Healthcare Sector, Erlangen, Germany (P.S.)
| | - Jean-Yves Gauvrit
- From the CHU Rennes, Department of Neuroradiology, Rennes, France (H.R., J.-C.F., J.-Y.G.); Unité VISAGES U746 INSERM-INRIA, IRISA UMR CNRS 6074, University of Rennes, Rennes, France (H.R., E.B., P.M., C.N., J.-C.F., C.B., J.-Y.G); and MR Application & Workflow Development, Siemens AG, Healthcare Sector, Erlangen, Germany (P.S.)
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Edjlali M, Roca P, Gentric JC, Trystram D, Rodriguez-Régent C, Nataf F, Chrétien F, Wieben O, Turski P, Meder JF, Naggara O, Oppenheim C. Advanced technologies applied to physiopathological analysis of central nervous system aneurysms and vascular malformations. Diagn Interv Imaging 2014; 95:1187-93. [PMID: 24933269 DOI: 10.1016/j.diii.2014.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While depiction and definition of morphological and architectural characteristics of CNS vascular disorders remains the first step of an MR analysis, emerging imaging techniques offer new functional information that might help to characterize rupture risk of CNS vascular disorders. Two main orientations are suggested by recent studies: inflammation of the vessel wall and analysis of physical constraints of blood flow using 4D flow imaging (shear parietal). This paper will focus on radiological application of 4D flow imaging and inflammation imaging, in the characterization of potential prognostic markers of CNS vascular disorders. We will review the basic technical considerations of 4D flow MRA, inflammation imaging and discuss their applications in CNS vascular disorders: aneurysms, arteriovenous malformation, dural arteriovenous fistulas. We will illustrate their potential in the development of individual rupture risk criteria in brain vascular disorders.
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Affiliation(s)
- M Edjlali
- Département de neuroradiologie, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
| | - P Roca
- Département de neuroradiologie, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - J-C Gentric
- Département de neuroradiologie, hôpital universitaire de Montréal, Québec, Canada
| | - D Trystram
- Département de neuroradiologie, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - C Rodriguez-Régent
- Département de neuroradiologie, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - F Nataf
- Département de neurochirurgie, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - F Chrétien
- Département d'anatomopathologie, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - O Wieben
- Département de physique médicale (O.W.) et de radiologie (P.T.), université du Wisconsin, Madison, Wisconsin, United States
| | - P Turski
- Département de physique médicale (O.W.) et de radiologie (P.T.), université du Wisconsin, Madison, Wisconsin, United States
| | - J-F Meder
- Département de neuroradiologie, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - O Naggara
- Département de neuroradiologie, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Département de neuroradiologie (O.N.), hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - C Oppenheim
- Département de neuroradiologie, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
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Ferreira R, Santos T, Amar A, Tahara SM, Chen TC, Giannotta SL, Hofman FM. MicroRNA-18a improves human cerebral arteriovenous malformation endothelial cell function. Stroke 2013; 45:293-7. [PMID: 24203843 DOI: 10.1161/strokeaha.113.003578] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral arteriovenous malformation (AVM) is a vascular disease that disrupts normal blood flow and leads to serious neurological impairment or death. Aberrant functions of AVM-derived brain endothelial cells (AVM-BECs) are a disease hallmark. Our aim was to use microRNA-18a (miR-18a) as a therapeutic agent to improve AVM-BEC function. METHODS Human AVM-BECs were tested for growth factor production and proliferation under different shear flow conditions and evaluated for tubule formation. Thrombospondin-1, inhibitor of DNA-binding protein 1, and vascular endothelial growth factor (VEGF) isotype mRNA levels were quantified by quantitative real-time polymerase chain reaction. Thrombospondin-1, VEGF-A, and VEGF-D protein expression was measured using enzyme-linked immunosorbent assay. Proliferation and tubule formation were evaluated using bromodeoxyuridine incorporation and growth factor-reduced Matrigel assays, respectively. RESULTS miR-18a increased thrombospondin-1 production but decreased inhibitor of DNA-binding protein 1, a transcriptional repressor of thrombospondin-1. miR-18a reduced VEGF-A and VEGF-D levels, both overexpressed in untreated AVM-BECs. This is the first study reporting VEGF-D overexpression in AVM. These effects were most prominent under arterial shear flow conditions. miR-18a also reduced AVM-BEC proliferation, improved tubule formation, and was effectively internalized by AVM-BECs in the absence of extraneous transfection reagents. CONCLUSIONS We report VEGF-D overexpression in AVM and the capacity of miR-18a to induce AVM-BECs to function more normally. This highlights the clinical potential of microRNA as a treatment for AVM and other vascular diseases.
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Affiliation(s)
- Raquel Ferreira
- From the Department of Neurological Surgery (R.F., A.A., T.C.C., S.L.G., F.M.H.), Department of Pathology (T.S., T.C.C., F.M.H.), and Department of Molecular Microbiology and Immunology (S.M.T.), Keck School of Medicine, University of Southern California, Los Angeles, CA
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