Can angiogenesis be reliably determined on digital subtraction angiography in cerebral arteriovenous malformations?

Suparna Das ^1,2, Helen Raffalli-Ebezant ¹, Paul R Kasher ³

⁰Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK.

British Journal of Neurosurgery +

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November 8, 2024

View abstract on PubMed

Summary

Angiogenesis, or new blood vessel formation, is present in 38.2% of cerebral arteriovenous malformations (cAVMs). This finding, visualized on digital subtraction angiograms (DSAs), correlates with venous hypertension indicators.

Area Of Science

Neurovascular Imaging
Vascular Malformations
Angiogenesis Research

Background

Angiogenesis is implicated in cerebral arteriovenous malformation (cAVM) development, yet its angiographic features are poorly understood.
Digital subtraction angiography (DSA) is a key imaging modality for cAVMs, but detailed descriptions of angiogenesis are lacking.

Purpose Of The Study

To determine the frequency of angiogenesis in cAVMs visualized by DSA.
To assess the reliability of diagnosing angiogenesis on DSA through intra- and inter-observer agreement.
To identify angioarchitectural features associated with angiogenesis in cAVMs.

Main Methods

Retrospective analysis of DSA data from 100 patients (102 cAVMs).
Evaluation of cAVM angioarchitecture, including angiogenesis, by experienced observers.
Statistical analysis, including univariate analysis and inter-/intra-observer agreement (Kappa statistic).

Main Results

Angiogenesis was detected in 38.2% of cAVMs.
Intra-observer agreement for angiogenesis diagnosis was generally strong, while inter-observer agreement was moderate.
Significant associations were found between angiogenesis and venous reflux, venous congestion, arterial ectasia, and artery: vein ratio.

Conclusions

Perinidal angiogenesis is visually identifiable on angiograms with moderate reliability.
The presence of angiogenesis in cAVMs may be linked to angioarchitectural features indicative of venous hypertension.

Keywords:

Cerebral arteriovenous malformation angioarchitecture angiogenesis angiogram observer agreement