Hemodynamic Evaluation of Intracranial Arteriovenous Malformations: Pre- and Post-treatment 2D Phase-contrast MRI Measurements

Overview

Journal Acta Radiol Open

Specialty Radiology

Date 2024 Aug 12

PMID 39131056

Authors

Maria Correia de Verdier

Elisabeth Ronne-Engstrom

Ljubisa Borota

Johan Wikstrom

Affiliations

Soon will be listed here.

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 cm, 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.

References

Shakur S, Amin-Hanjani S, Abouelleil M, Aletich V, Charbel F, Alaraj A . Changes in pulsatility and resistance indices of cerebral arteriovenous malformation feeder arteries after embolization and surgery. Neurol Res. 2016; 39(1):7-12. DOI: 10.1080/01616412.2016.1258970. View

Jo K, Kim J, Hong S, Lee J . Hemodynamic changes in arteriovenous malformations after radiosurgery: transcranial Doppler evaluation. World Neurosurg. 2011; 77(2):316-21. DOI: 10.1016/j.wneu.2011.06.061. View

Schuster L, Schenk E, Giesel F, Hauser T, Gerigk L, Zabel-Du-Bois A . Changes in AVM angio-architecture and hemodynamics after stereotactic radiosurgery assessed by dynamic MRA and phase contrast flow assessments: a prospective follow-up study. Eur Radiol. 2010; 21(6):1267-76. DOI: 10.1007/s00330-010-2031-0. View

Marks M, Pelc N, ROSS M, Enzmann D . Determination of cerebral blood flow with a phase-contrast cine MR imaging technique: evaluation of normal subjects and patients with arteriovenous malformations. Radiology. 1992; 182(2):467-76. DOI: 10.1148/radiology.182.2.1732966. View

Dempsey R, Moftakhar R, Pozniak M . Intraoperative Doppler to measure cerebrovascular resistance as a guide to complete resection of arteriovenous malformations. Neurosurgery. 2004; 55(1):155-60. DOI: 10.1227/01.neu.0000126879.95006.46. View

Wu C, Ansari S, Honarmand A, Vakil P, Hurley M, Bendok B . 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(6):1142-9. PMC: 8013038. DOI: 10.3174/ajnr.A4259. View

Li C, Hsiao A, Hattangadi-Gluth J, Handwerker J, Farid N . Early Hemodynamic Response Assessment of Stereotactic Radiosurgery for a Cerebral Arteriovenous Malformation Using 4D Flow MRI. AJNR Am J Neuroradiol. 2018; 39(4):678-681. PMC: 7410784. DOI: 10.3174/ajnr.A5535. View

Lv X, Wu Z, Li Y . Arteriovenous malformation in the brain: a theoretical study explaining the behavior of liquid embolic agents during endovascular treatment. Neuroradiol J. 2013; 26(6):661-8. PMC: 4202870. DOI: 10.1177/197140091302600609. View

Mast H, Mohr J, Thompson J, Osipov A, Trocio S, Mayer S . Transcranial Doppler ultrasonography in cerebral arteriovenous malformations. Diagnostic sensitivity and association of flow velocity with spontaneous hemorrhage and focal neurological deficit. Stroke. 1995; 26(6):1024-7. DOI: 10.1161/01.str.26.6.1024. View

10.

Nico E, Hossa J, McGuire L, Alaraj A . Rupture-Risk Stratifying Patients with Cerebral Arteriovenous Malformations Using Quantitative Hemodynamic Flow Measurements. World Neurosurg. 2023; 179:68-76. DOI: 10.1016/j.wneu.2023.08.047. View

11.

Kaspera W, Ladzinski P, Larysz P, Majchrzak H, Hebda A, Kopera M . Transcranial color-coded Doppler assessment of cerebral arteriovenous malformation hemodynamics in patients treated surgically or with staged embolization. Clin Neurol Neurosurg. 2013; 116:46-53. DOI: 10.1016/j.clineuro.2013.11.001. View

12.

Shtraus N, Schifter D, Corn B, Maimon S, Alani S, Frolov V . Radiosurgical treatment planning of AVM following embolization with Onyx: possible dosage error in treatment planning can be averted. J Neurooncol. 2010; 98(2):271-6. DOI: 10.1007/s11060-010-0177-x. View

13.

Alaraj A, Amin-Hanjani S, Shakur S, Aletich V, Ivanov A, Carlson A . Quantitative assessment of changes in cerebral arteriovenous malformation hemodynamics after embolization. Stroke. 2015; 46(4):942-7. DOI: 10.1161/STROKEAHA.114.008569. View

14.

Chang W, Loecher M, Wu Y, Niemann D, Ciske B, Aagaard-Kienitz B . Hemodynamic changes in patients with arteriovenous malformations assessed using high-resolution 3D radial phase-contrast MR angiography. AJNR Am J Neuroradiol. 2012; 33(8):1565-72. PMC: 6278605. DOI: 10.3174/ajnr.A3010. View

15.

Uggowitzer M, Kugler C, Riccabona M, Klein G, Leber K, Simbrunner J . Cerebral arteriovenous malformations: diagnostic value of echo-enhanced transcranial Doppler sonography compared with angiography. AJNR Am J Neuroradiol. 1999; 20(1):101-6. View

16.

GOSLING R, King D . Arterial assessment by Doppler-shift ultrasound. Proc R Soc Med. 1974; 67(6 Pt 1):447-9. PMC: 1645777. View

17.

Gross B, Du R . Natural history of cerebral arteriovenous malformations: a meta-analysis. J Neurosurg. 2012; 118(2):437-43. DOI: 10.3171/2012.10.JNS121280. View

18.

Mohr J, Parides M, Stapf C, Moquete E, Moy C, Overbey J . Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet. 2013; 383(9917):614-21. PMC: 4119885. DOI: 10.1016/S0140-6736(13)62302-8. View

19.

Kim H, Salman R, McCulloch C, Stapf C, Young W . Untreated brain arteriovenous malformation: patient-level meta-analysis of hemorrhage predictors. Neurology. 2014; 83(7):590-7. PMC: 4141996. DOI: 10.1212/WNL.0000000000000688. View

20.

Petty G, Massaro A, Tatemichi T, Mohr J, Hilal S, STEIN B . Transcranial Doppler ultrasonographic changes after treatment for arteriovenous malformations. Stroke. 1990; 21(2):260-6. DOI: 10.1161/01.str.21.2.260. View