In-Room Direct Nidal Flow Measurement by Digital Subtraction Angiography to Estimate Hemorrhage Risk in Brain...

Area of Science:

• Medical Imaging
• Interventional Radiology
• Neurovascular Diseases

Background:

• Noninvasive flow measurement in brain arteriovenous malformations (BAVMs) using digital subtraction angiography (DSA) presents significant challenges.
• Estimating blood volume flow rate within the BAVM nidus is crucial for understanding disease presentation and progression.

Purpose of the Study:

• To devise and validate a method for estimating the blood volume flow rate of the BAVM nidus using DSA.
• To assess the association between the estimated nidus flow index and angioarchitecture features, particularly in patients with a history of hemorrhage.

Main Methods:

• A retrospective analysis of 24 patients with BAVMs, including 10 controls and 14 with hemorrhage, who underwent DSA and magnetic resonance (MR) imaging.
• Nidus volume was determined from MR data, while flow velocities and volume flow rates were estimated from DSA.
• The BAVM nidus flow index was calculated by summing feeding artery flow rates from DSA and normalizing by nidus volume, with comparisons made to phase-contrast MR estimations.

Main Results:

• The nidus flow index derived from DSA was significantly higher in the hemorrhagic BAVM group compared to the control group (P=0.0272).
• Phase-contrast MR-derived flow index and nidus volume did not show significant differences between groups.
• Classification accuracy for identifying BAVM patients improved when the DSA-derived nidus flow index was incorporated with angioarchitecture data.

Conclusions:

• The BAVM nidus flow index can be directly estimated noninvasively from DSA, offering a feasible method for peritherapeutic hemodynamic assessment.
• This DSA-derived nidus flow index shows potential association with hemorrhagic presentation in BAVMs.