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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Magnetic Resonance Perfusion Changes of Arteriovenous Malformations Treated with Stereotactic Radiosurgery
Adomas Bunevicius1, David A Joyner2, Thomas Eluvathingal Muttikkal2
1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Background:
The latency period from stereotactic radiosurgery (SRS) to obliteration of arteriovenous malformations (AVM) requires continuous imaging surveillance. Magnetic resonance (MR) perfusion is promising for noninvasive monitoring of AVMs after SRS. We studied longitudinal MR perfusion changes of brain AVMs treated with SRS.
Methods:
Consecutive patients treated for brain AVMs using SRS who had MR perfusion imaging studies performed before and at least once after SRS were studied. We estimated ipsilateral/contralateral brain hemisphere ratios of MR perfusion indexes, including regional cerebral blood flow (rCBF) and relative cerebral blood volume (rCBV), in the AVM nidus, perinidal region, and remote anterior and posterior brain regions.
Results:
Eleven patients (6 women; median age, 21 years) underwent SRS (median prescription dose, 18 Gy; range, 12-20 Gy) for brain AVMs (median Spetzler-Martin grade 2 and median volume 4.6 mL). Before the SRS, rCBV and rCBF ratios were significantly higher in the AVM nidus compared with other investigated brain regions (P < 0.001). Median time from SRS to the first and last post-SRS MR perfusion studies was 8 and 35 months, respectively. There was a statically significant decrease of rCBV (P = 0.043) and rCBF (P = 0.036) ratios in the AVM nidus, but not other brain regions, during post-SRS follow-up.
Conclusions:
There is a gradual decrease of rCBV and rCBF in the AVM nidus after SRS. MR perfusion imaging is promising for monitoring of hemodynamic changes of AVMs after SRS. Larger studies investigating clinical value of MR perfusion imaging for AVMs after SRS are warranted.
Insights
Magnetic resonance (MR) perfusion monitoring shows a decrease in blood flow and volume in arteriovenous malformations (AVMs) after stereotactic radiosurgery (SRS). This technique offers a promising, noninvasive method for tracking AVM changes post-treatment.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Arteriovenous malformations (AVMs) require continuous imaging surveillance after stereotactic radiosurgery (SRS) due to their latency period before obliteration.
- Magnetic resonance (MR) perfusion imaging presents a promising noninvasive method for monitoring AVMs post-SRS.
Purpose of the Study:
- To investigate longitudinal changes in MR perfusion parameters within brain AVMs following SRS treatment.
- To assess the utility of MR perfusion for noninvasive monitoring of hemodynamic alterations in AVMs after SRS.
Main Methods:
- Consecutive patients with brain AVMs treated with SRS underwent pre- and post-SRS MR perfusion imaging.
- Ipsilateral/contralateral hemisphere ratios of regional cerebral blood flow (rCBF) and relative cerebral blood volume (rCBV) were calculated for the AVM nidus, perinidal, and remote brain regions.
Main Results:
- Pre-SRS, AVM nidus exhibited significantly higher rCBV and rCBF ratios compared to other brain regions (P < 0.001).
- A statistically significant decrease in rCBV (P=0.043) and rCBF (P=0.036) ratios was observed in the AVM nidus during post-SRS follow-up (median 35 months).
- No significant changes in perfusion ratios were noted in other brain regions.
Conclusions:
- A gradual decrease in rCBV and rCBF occurs in the AVM nidus after SRS.
- MR perfusion imaging is a valuable tool for monitoring hemodynamic changes in AVMs post-SRS.
- Further research with larger cohorts is warranted to establish the clinical value of MR perfusion imaging for post-SRS AVM management.
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