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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

Published on: October 20, 2017

Ferumoxytol-enhanced MRI to Image Inflammation within Human Brain Arteriovenous Malformations: A Pilot Investigation

David M Hasan1, Matthew Amans, Tarik Tihan

  • 1Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, IA.

Translational Stroke Research
|September 25, 2012
PubMed

Insights

Macrophages in brain arteriovenous malformations (bAVMs) may drive rupture. Ferumoxytol-enhanced MRI shows potential for imaging these inflammatory cells, offering a new biomarker for bAVM rupture risk.

Area of Science:

  • Neuroimaging
  • Vascular Biology
  • Immunology

Background:

  • Brain arteriovenous malformations (bAVMs) exhibit inflammation, including macrophages, even in untreated lesions.
  • Macrophages are implicated in bAVM progression and may indicate rupture risk.

Purpose of the Study:

  • To assess the feasibility of imaging macrophages within bAVMs using ferumoxytol-enhanced MRI.
  • To explore ferumoxytol-enhanced MRI as a potential biomarker for bAVM inflammation.

Main Methods:

  • Four patients with diagnosed bAVMs underwent ferumoxytol-enhanced MRI using iron-sensitive imaging (T2*-GE-MRI).
  • Imaging was performed at baseline and 1 or 5 days post-ferumoxytol infusion (5mg/kg).
  • Histopathological correlation (CD68 staining) was performed on one resected specimen.

Main Results:

  • Imaging at 5 days post-infusion showed reduced intravascular ferumoxytol and signal loss in the bAVM nidus, suggesting tracer localization.
  • One patient showed prominent CD68 staining in the vascular wall upon resection, correlating with imaging findings.
  • Early imaging (1 day) was limited by residual intravascular ferumoxytol.

Conclusions:

  • Ferumoxytol-enhanced MRI is a feasible technique for visualizing inflammatory cells, specifically macrophages, within bAVMs.
  • This imaging approach holds promise for developing a non-invasive biomarker to assess bAVM inflammatory burden and rupture risk.

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