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Arteriovenous malformations: assessment of gliotic and ischemic changes with fluid-attenuated inversion-recovery MRI
M Essig1, F Wenz, S O Schoenberg
1Department of Radiology, German Cancer Research Center, Heidelberg, Germany. M.Essig@DKFZ-Heidelberg.de
Rationale And Objectives:
To evaluate the diagnostic potential of fluid-attenuated inversion-recovery (FLAIR) MRI in the assessment of patients with cerebral arteriovenous malformations (AVMs) and to correlate the MR findings with clinical symptoms, in particular, perilesional gliosis and ischemic changes.
Methods:
Forty-five patients with cerebral AVMs were examined with FLAIR and conventional T1- and T2-weighted MRI by using identical slice parameters. Images were assessed in a two-reader study for detection and delineation of gliotic and ischemic tissue. Also, the extent of the flow void phenomenon and image artifacts were evaluated.
Results:
FLAIR MRI was rated superior to the conventional T2-weighted fast spin-echo imaging in the assessment of intralesional and perilesional gliosis. The superior delineation was a result of the suppression of cerebrospinal fluid, mild T1 weighting, and the more pronounced flow void phenomenon. There was no significant correlation between the extent of gliosis and the clinical symptoms. However, larger AVMs had more extensive signal changes.
Conclusions:
FLAIR is a valuable MRI technique to assess gliotic and ischemic changes in or close to cerebral AVMs. Because gliotic and ischemic changes are common findings and are known to be associated with epilepsy, in the assessment of these patients FLAIR is clinically useful and may guide decisions about treatment-for instance, the extent of surgical resection of the potential epileptogenic focus.
Insights
Fluid-attenuated inversion-recovery (FLAIR) MRI is superior for assessing gliosis in cerebral arteriovenous malformations (AVMs). This technique aids in evaluating potential epileptogenic foci, guiding treatment decisions for AVM patients.
Area of Science:
- Neuroradiology
- Neuroimaging
- Cerebrovascular Diseases
Background:
- Cerebral arteriovenous malformations (AVMs) pose diagnostic challenges.
- Assessing perilesional changes like gliosis is crucial for patient management.
- Conventional MRI sequences may have limitations in visualizing these changes.
Purpose of the Study:
- To determine the diagnostic utility of FLAIR MRI in evaluating cerebral AVMs.
- To correlate MRI findings with clinical symptoms, specifically gliosis and ischemia.
- To assess the role of FLAIR in identifying potential epileptogenic zones.
Main Methods:
- 45 patients with cerebral AVMs underwent FLAIR and conventional T1/T2-weighted MRI.
- Two readers evaluated images for gliotic and ischemic tissue detection and delineation.
- Flow void phenomenon and image artifacts were also assessed.
Main Results:
- FLAIR MRI demonstrated superior delineation of intralesional and perilesional gliosis compared to T2-weighted imaging.
- Cerebrospinal fluid suppression and pronounced flow void phenomenon contributed to FLAIR's effectiveness.
- Larger AVMs showed more extensive signal changes, but gliosis extent did not correlate with clinical symptoms.
Conclusions:
- FLAIR MRI is a valuable tool for assessing gliotic and ischemic changes near cerebral AVMs.
- These changes are frequently associated with epilepsy, making FLAIR clinically relevant.
- FLAIR findings can inform treatment strategies, including surgical planning for epilepsy management.