Analysis of the Role of Perfusion Parameters in Predicting Rupture of Brain Arteriovenous Malformations: a Multi-center Study

Overview

Journal Sci Rep

Specialty Science

Date 2024 Oct 27

PMID 39462139

Authors

Yue Guo

Shaosen Zhang

Shengjun Sun

Qian Zhang

Yuanren Zhai

Xiaochen Wang

Peicong Ge

Dong Zhang

Affiliations

Soon will be listed here.

Abstract

This study aimed to investigate the potential correlation between the perfusion parameters of brain arteriovenous malformations (bAVMs) as determined by multiphase CT angiography and bAVM rupture. Based on the occurrence of bAVM-related hemorrhage, 480 diagnosed bAVM patients were divided into hemorrhage (n = 220) and non-hemorrhage (n = 260) groups in this retrospective multi-center study spanning 2010 to 2020. On initial rupture CT images, the bAVM nidus and major draining vein were segmented, and time-density curves were extracted to compute perfusion parameters including mean transit time (MTT), time to peak (TTP), blood volume (BV), and blood flow (BF). To examine the potential correlation between these parameters and bAVM rupture, logistic regression was utilized to analyze multifactorial data and compare differences between the two groups. The ruptured group demonstrated a bAVM nidus characterized by an increased BF, a shorter TTP and MTT, and a higher peak density. The veins that were draining exhibited a reduced TTP, MTT, and peak density. A nidus TTP of less than 4s was identified by the multifactorial analysis as a critical risk factor for bAVM rupture. The statistical results highlight the noteworthy correlation between nidus TTP and bAVM rupture, presenting an original framework for assessing the risk of rupture.

References

Hernesniemi J, Dashti R, Juvela S, Vaart K, Niemela M, Laakso A . Natural history of brain arteriovenous malformations: a long-term follow-up study of risk of hemorrhage in 238 patients. Neurosurgery. 2008; 63(5):823-9. DOI: 10.1227/01.NEU.0000330401.82582.5E. View

Krings T, Hans F, Geibprasert S, Terbrugge K . Partial "targeted" embolisation of brain arteriovenous malformations. Eur Radiol. 2010; 20(11):2723-31. PMC: 2948167. DOI: 10.1007/s00330-010-1834-3. View

Rutledge W, Ko N, Lawton M, Kim H . Hemorrhage rates and risk factors in the natural history course of brain arteriovenous malformations. Transl Stroke Res. 2014; 5(5):538-42. PMC: 4139097. DOI: 10.1007/s12975-014-0351-0. View

Kim H, Sidney S, McCulloch C, Poon K, Singh V, Johnston S . Racial/Ethnic differences in longitudinal risk of intracranial hemorrhage in brain arteriovenous malformation patients. Stroke. 2007; 38(9):2430-7. DOI: 10.1161/STROKEAHA.107.485573. View

Katyal A, Calic Z, Killingsworth M, Bhaskar S . Diagnostic and prognostic utility of computed tomography perfusion imaging in posterior circulation acute ischemic stroke: A systematic review and meta-analysis. Eur J Neurol. 2021; 28(8):2657-2668. DOI: 10.1111/ene.14934. View

Stefani M, Ribeiro D, Mohr J . Grades of brain arteriovenous malformations and risk of hemorrhage and death. Ann Clin Transl Neurol. 2019; 6(3):508-514. PMC: 6414495. DOI: 10.1002/acn3.723. View

Szurowska E, Nowicki T, Izycka-Swieszewska E, Wypych J, Drobinska-Jurowiecka A, Markiet K . Is hepatotropic contrast enhanced MR a more effective method in differential diagnosis of hemangioma than multi-phase CT and unenhanced MR?. BMC Gastroenterol. 2011; 11:43. PMC: 3110140. DOI: 10.1186/1471-230X-11-43. View

Defeudis A, De Mattia C, Rizzetto F, Calderoni F, Mazzetti S, Torresin A . Standardization of CT radiomics features for multi-center analysis: impact of software settings and parameters. Phys Med Biol. 2020; 65(19):195012. DOI: 10.1088/1361-6560/ab9f61. View

Ding D, Chen C, Starke R, Kano H, Lee J, Mathieu D . Risk of Brain Arteriovenous Malformation Hemorrhage Before and After Stereotactic Radiosurgery. Stroke. 2019; 50(6):1384-1391. DOI: 10.1161/STROKEAHA.118.024230. View

10.

Byrne D, Sugrue G, Stanley E, Walsh J, Murphy S, Kavanagh E . Improved Detection of Anterior Circulation Occlusions: The "Delayed Vessel Sign" on Multiphase CT Angiography. AJNR Am J Neuroradiol. 2017; 38(10):1911-1916. PMC: 7963625. DOI: 10.3174/ajnr.A5317. View

11.

Vagal A, Wintermark M, Nael K, Bivard A, Parsons M, Grossman A . Automated CT perfusion imaging for acute ischemic stroke: Pearls and pitfalls for real-world use. Neurology. 2019; 93(20):888-898. DOI: 10.1212/WNL.0000000000008481. View

12.

Hashimoto T, Young W, Prohovnik I, Gupta D, Ostapkovich N, Ornstein E . Increased cerebral blood flow after brain arteriovenous malformation resection is substantially independent of changes in cardiac output. J Neurosurg Anesthesiol. 2002; 14(3):204-8. DOI: 10.1097/00008506-200207000-00005. View

13.

Abraham A, Pedregosa F, Eickenberg M, Gervais P, Mueller A, Kossaifi J . Machine learning for neuroimaging with scikit-learn. Front Neuroinform. 2014; 8:14. PMC: 3930868. DOI: 10.3389/fninf.2014.00014. View

14.

Guo Y, Saunders T, Su H, Kim H, Akkoc D, Saloner D . Silent intralesional microhemorrhage as a risk factor for brain arteriovenous malformation rupture. Stroke. 2012; 43(5):1240-6. PMC: 3335931. DOI: 10.1161/STROKEAHA.111.647263. View

15.

Lawton M, Rutledge W, Kim H, Stapf C, Whitehead K, Li D . Brain arteriovenous malformations. Nat Rev Dis Primers. 2016; 1:15008. DOI: 10.1038/nrdp.2015.8. View

16.

Miles K, Hayball M, Dixon A . Colour perfusion imaging: a new application of computed tomography. Lancet. 1991; 337(8742):643-5. DOI: 10.1016/0140-6736(91)92455-b. View

17.

Elshafeey N, Kotrotsou A, Hassan A, Elshafei N, Hassan I, Ahmed S . Multicenter study demonstrates radiomic features derived from magnetic resonance perfusion images identify pseudoprogression in glioblastoma. Nat Commun. 2019; 10(1):3170. PMC: 6639324. DOI: 10.1038/s41467-019-11007-0. View

18.

Valavanis A, YASARGIL M . The endovascular treatment of brain arteriovenous malformations. Adv Tech Stand Neurosurg. 1999; 24:131-214. DOI: 10.1007/978-3-7091-6504-1_4. 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.

Redekop G, terBrugge K, Montanera W, Willinsky R . Arterial aneurysms associated with cerebral arteriovenous malformations: classification, incidence, and risk of hemorrhage. J Neurosurg. 1998; 89(4):539-46. DOI: 10.3171/jns.1998.89.4.0539. View