Correlating brain arteriovenous malformations location with clinical and angio-architectural characteristics: A...

Brain arteriovenous malformations (bAVMs) are potentially aggressive neurological diseases.

Our aim was to assess the applicability of voxel-based lesion symptom mapping (VLSM) to bAVMs and extend the approach to correlate bAVM location with hitherto unknown aspects of the disease. This single-center retrospective study of all adult patients managed between 1998 and 2022 with an available pretreatment MRI scan 3D contrast-enhanced T1-weighted fast spoiled gradient-recalled acquisition, a nidus size> 5 mm and no recent hemorrhage. Spatial normalization and semiautomated nidus segmentation were performed. Validatory tests correlating location with epilepsy and headache were conducted with univariate analyses and the VLSM pipeline. Exploratory VLSM analyses were performed.

One hundred and sixty-four patients with 168 bAVMs were included (mean age 38, 29-52[IQR]; 85 men). Statistical analyses on categorical location variables confirmed bAVMs revealed by seizure were positively correlated with temporal lobe location (p = 0.028) while headache was correlated with occipital lobe location (p = 0.027). VLSM analyses failed to reproduce these results as positive controls. Exploratory analyses demonstrated a significant correlation between proximal flow-related aneurysms (13/155 bAVMs, 8.39 %) and central gyri location (z > 4.03, p < 0.05). This result was confirmed by univariate and multivariate analyses.

In comparison to statistical analyses based on bAVM location as a categorical variable, VLSM offers high spatial resolution at the cost of decreased sensitivity.

Employing VLSM to correlate location and clinical and angioarchitectural characteristics requires large datasets to achieve sufficient statistical power. Proximal flow-related aneurysms might be correlated with bAVM central gyri location.