Hemodynamic and radiomic parameters of the nidus predict multiple-stage embolizations in brain arteriovenous...

Embolization can be an effective treatment modality for some patients with brain arteriovenous malformations (AVMs). Since no specific criteria predictive of the degree of occlusion after a single-stage embolization have been established, this study aimed to analyze the AVM draining vein and nidus from the hemodynamic and radiomic point of view, in search for parameters associated with the need for a multiple-stage embolization, thereby identifying patients less suitable for endovascular treatment. We retrospectively analyzed 29 patients who underwent a curative embolization of a brain AVM, among which 18 required a multiple-stage embolization. Using manually selected Regions of Interest (ROIs) of the AVMs nidus on digital subtraction angiography (DSA) images, we calculated hemodynamic descriptors including time to peak (TTP), inflow and outflow gradients, full width at half maximum (FWHM), stasis index and radiomics descriptors such as energy, entropy, homogeneity and contrast. Lesions with lower value of FWHM (1.788 ± 1.524 vs. 2.637 ± 1.471; p = 0.037) and higher value of energy (11.796 ± 1.757 vs. 5.763 ± 1.893; p = 0.006) were more likely to necessitate a multiple-stage treatment. In multivariate logistic regression analysis, higher energy (OR: 1.524; 95%CI: 1.106-2.744; p = 0.039) remained independently associated with incomplete occlusion after a single-stage embolization.