Quantification of hemodynamics of cerebral arteriovenous malformations after stereotactic radiosurgery using 4D flow magnetic resonance imaging.

Published on Jun 1, 2021in Journal of Magnetic Resonance Imaging4.813
· DOI :10.1002/JMRI.27490
Shanmukha Srinivas2
Estimated H-index: 2
(UCSD: University of California, San Diego),
Tara Retson8
Estimated H-index: 8
(UCSD: University of California, San Diego)
+ 3 AuthorsNikdokht Farid19
Estimated H-index: 19
(UCSD: University of California, San Diego)
Sources
Abstract
Stereotactic radiosurgery (SRS) is used to treat cerebral arteriovenous malformations (AVMs). However, early evaluation of efficacy is difficult as structural magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) often does not demonstrate appreciable changes within the first 6 months. The aim of this study was to evaluate the use of four-dimensional (4D) flow MRI to quantify hemodynamic changes after SRS as early as 2 months. This was a retrospective observational study, which included 14 patients with both pre-SRS and post-SRS imaging obtained at multiple time points from 1 to 27 months after SRS. A 3T MRI Scanner was used to obtain T2 single-shot fast spin echo, time-of-flight MRA, and postcontrast 4D flow with three-dimensional velocity encoding between 150 and 200 cm/s. Post-hoc two-dimensional cross-sectional flow was measured for the dominant feeding artery, the draining vein, and the corresponding contralateral artery as a control. Measurements were performed by two independent observers, and reproducibility was assessed. Wilcoxon signed-rank tests were used to compare differences in flow, circumference, and pulsatility between the feeding artery and the contralateral artery both before and after SRS; and differences in nidus size and flow and circumference of the feeding artery and draining vein before and after SRS. Arterial flow (L/min) decreased in the primary feeding artery (mean: 0.1 ± 0.07 vs. 0.3 ± 0.2; p < 0.05) and normalized in comparison to the contralateral artery (mean: 0.1 ± 0.07 vs. 0.1 ± 0.07; p = 0.068). Flow decreased in the draining vein (mean: 0.1 ± 0.2 vs. 0.2 ± 0.2; p < 0.05), and the circumference of the draining vein also decreased (mean: 16.1 ± 8.3 vs. 15.7 ± 6.7; p < 0.05). AVM volume decreased after SRS (mean: 45.3 ± 84.8 vs. 38.1 ± 78.7; p < 0.05). However, circumference (mm) of the primary feeding artery remained similar after SRS (mean: 15.7 ± 2.7 vs. 16.1 ± 3.1; p = 0.600). 4D flow may be able to demonstrate early hemodynamic changes in AVMs treated with radiosurgery, and these changes appear to be more pronounced and occur earlier than the structural changes on standard MRI/MRA. Level of Evidence: 4 Technical Efficacy Stage: 1.
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References40
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#1Maria Aristova (NU: Northwestern University)H-Index: 4
#2Alireza Vali (NU: Northwestern University)H-Index: 12
Last. Susanne Schnell (NU: Northwestern University)H-Index: 28
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BACKGROUND: Cerebral arteriovenous malformations (AVMs) are pathological connections between arteries and veins. Dual-venc 4D flow MRI, an extended 4D flow MRI method with improved velocity dynamic range, provides time-resolved 3D cerebral hemodynamics. PURPOSE: To optimize dual-venc 4D flow imaging parameters for AVM; to assess the relationship between spatial resolution, acceleration, and flow quantification accuracy; and to introduce and apply the flow distribution network graph (FDNG) paradi...
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#1Sonali Shaligram (UCSF: University of California, San Francisco)H-Index: 7
#2Ethan A. Winkler (UCSF: University of California, San Francisco)H-Index: 30
Last. Hua Su (UCSF: University of California, San Francisco)H-Index: 59
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Author(s): Shaligram, Sonali S; Winkler, Ethan; Cooke, Daniel; Su, Hua | Abstract: Patients with brain arteriovenous malformation (bAVM) are at risk of intracranial hemorrhage (ICH). Overall, bAVM accounts for 25% of hemorrhagic strokes in adults l50 years of age. The treatment of unruptured bAVMs has become controversial, because the natural history of these patients may be less morbid than invasive therapies. Available treatments include observation, surgical resection, endovascular embolizati...
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#3Jingliang Cheng (Zhengzhou University)H-Index: 2
#8Yang Fan (GE Healthcare)H-Index: 8
Last. Bing Wu (GE Healthcare)H-Index: 13
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BACKGROUND: 4D flow MRI shows great potential in neurovascular disorders such as stenosis, atherosclerotic disease, aneurysms, and vascular malformations. Its widespread application in the neurovascular system requires evidence of good test-retest multicenter reproducibility. PURPOSE: To assess the multicenter reproducibility, test-retest reliability and interobserver dependence of 4D flow MRI in measurements of cerebral blood flow/velocity in main intracranial vessels. STUDY TYPE: Prospective s...
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#1Tora Dunås (Umeå University)H-Index: 5
#2Madelene Holmgren (Umeå University)H-Index: 3
Last. Anders Eklund (Umeå University)H-Index: 39
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Background: Accelerated 4D flow MRI allows for high‐resolution velocity measurements with whole‐brain coverage. Such scans are increasingly used to calculate flow rates of individual arteries in th ...
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#1Vafa Alakbarzade (St George’s University Hospitals NHS Foundation Trust)H-Index: 5
#2Anthony C Pereira (St George’s University Hospitals NHS Foundation Trust)H-Index: 11
Catheter-based angiography is an important but invasive procedure in vascular neurology. It is used mainly for diagnosis and for planning treatment in patients with a suspected underlying vascular abnormality. It is often performed as a semiurgent, planned investigation or linked to an interventional procedure. Cerebral angiography provides high-resolution, three-dimensional, pathoanatomical data about the cerebral vasculature and also allows real-time analysis of blood flow. Contrast injections...
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#1C.Q. Li (UCSD: University of California, San Diego)H-Index: 1
#2Albert Hsiao (UCSD: University of California, San Diego)H-Index: 20
Last. Nikdokht Farid (UCSD: University of California, San Diego)H-Index: 19
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SUMMARY: Brain AVMs treated with stereotactic radiosurgery typically demonstrate a minimum latency period of 1–3 years between treatment and nidus obliteration. Assessment of treatment response is usually limited to evaluation of AVM nidus structural changes using conventional MR imaging and MRA techniques. This report describes the use of 4D Flow MRI to also measure radiation-induced hemodynamic changes in a Spetzler-Martin grade III AVM, which were detectable as early as 6 months after treatme...
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#1Chang Kyu Park (Kyung Hee University)H-Index: 9
#2Seok Keun Choi (Kyung Hee University)H-Index: 8
Last. Young Jin Lim (Kyung Hee University)H-Index: 14
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Purpose Gamma knife radiosurgery (GKRS) is an established treatment modality for brain arteriovenous malformation (AVM), but there have been few published studies examining the relationship between clinical features of AVM and successful obliteration with GKRS in pediatric patients. In the current study, we investigate the outcomes of GKRS for pediatric patients with brain AVM and analyze the variables that influence obliteration.
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#1Philip Gilbo (Hofstra University)H-Index: 5
#2Isabella Zhang (Hofstra University)H-Index: 7
Last. Jonathan P.S. Knisely (Hofstra University)H-Index: 32
view all 3 authors...
Over the past half-century since Lars Leksell first utilized radiation to address deep and difficult to treat lesions of the central nervous system (CNS), intracranial stereotactic ra-diosurgery (SRS) has become an increasingly valued tool in the hands of neurosurgeons and radiation oncologists. Following developments in medical imaging and radiation technology, radiosurgery has evolved from its first application in movement disorders to widespread use for a varied range of malignant and benign ...
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#1Sophia F. Shakur (UIC: University of Illinois at Chicago)H-Index: 12
#2Sepideh Amin-Hanjani (UIC: University of Illinois at Chicago)H-Index: 36
Last. Ali Alaraj (UIC: University of Illinois at Chicago)H-Index: 24
view all 6 authors...
AbstractObjectives: Embolization reduces flow in cerebral arteriovenous malformations (AVMs) before surgical resection, but changes in pulsatility and resistance indices (PI, RI) are unknown. Here, we measure PI, RI in AVM arterial feeders before and after embolization/surgery.Methods: Records of patients who underwent AVM embolization and surgical resection at our institution between 2007 and 2014 and had PI, RI, and flows obtained using quantitative magnetic resonance angiography were retrospe...
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#1Robert M. Starke (UVA: University of Virginia)H-Index: 72
#2Hideyuki Kano (University of Pittsburgh)H-Index: 57
Last. Jason P. Sheehan (UVA: University of Virginia)H-Index: 77
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OBJECTIVE In this multicenter study, the authors reviewed the results following Gamma Knife radiosurgery (GKRS) of cerebral arteriovenous malformations (AVMs), determined predictors of outcome, and assessed predictive value of commonly used grading scales based upon this large cohort with long-term follow-up. METHODS Data from a cohort of 2236 patients undergoing GKRS for cerebral AVMs were compiled from the International Gamma Knife Research Foundation. Favorable outcome was defined as AVM obli...
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