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Pediatric intracranial vascular malformations: evaluation of treatment results with color Doppler US. Work in
S J Westra1, J G Curran, G R Duckwiler
1Department of Radiological Sciences, University of California, Los Angeles School of Medicine 90024-1721.
Insights
Color Doppler ultrasound (US) effectively maps intracranial vascular malformations (VMs) in children. This noninvasive imaging provides crucial hemodynamic data, aiding preoperative assessment and evaluating endovascular embolization treatment success by monitoring blood flow changes.
Area of Science:
- Pediatric Neurology
- Vascular Imaging
- Interventional Radiology
Background:
- Intracranial vascular malformations (VMs) require accurate preoperative assessment and treatment evaluation.
- Traditional imaging modalities may not fully capture the complex hemodynamics of VMs.
- Noninvasive techniques are sought to complement existing diagnostic tools.
Purpose of the Study:
- To evaluate the utility of color Doppler ultrasound (US) in children with intracranial VMs.
- To assess its role in preoperative planning and post-treatment result evaluation.
- To correlate Doppler US findings with other imaging techniques and clinical outcomes.
Main Methods:
- 36 color Doppler US studies were conducted in nine pediatric patients undergoing endovascular embolization.
- Color flow imaging and spectral waveform analysis were performed on feeding arteries, nidus, draining veins, and cranial vasculature.
- Serial volume flow measurements in extracranial arteries were used to assess treatment success.
Main Results:
- Color Doppler US successfully mapped most intracranial VMs, providing detailed lesion visualization.
- Post-embolization, improved blood supply to unaffected brain areas and increased flow in non-occluded feeding vessels were observed.
- A significant decrease in total carotid artery flow correlated with successful embolization.
Conclusions:
- Color Doppler US is a valuable noninvasive tool for preoperative assessment of pediatric intracranial VMs.
- It provides essential hemodynamic information, enhancing the evaluation of endovascular embolization outcomes.
- Doppler US complements angiography by adding crucial imaging and hemodynamic data.
Abstract:
To determine the value of color Doppler ultrasound (US) in the preoperative assessment and evaluation of treatment results in children with intracranial vascular malformations (VMs), the authors performed 36 color Doppler US studies in nine children who underwent endovascular embolization. Color flow imaging with spectral waveform analysis of feeding arteries, nidus, draining veins, and uninvolved cranial vasculature was performed, and correlation was made with other imaging findings. In most VMs, color Doppler US enabled the authors to map the lesion completely. Hemodynamic changes after embolization included improvement in blood supply to uninvolved portions of the brain and increase in caliber and flow of feeding vessels that were not occluded during embolization. Serial volume flow measurements were performed with Doppler US in major extracranial arteries. Success of embolization was indicated by substantial decrease of total carotid artery flow. Color Doppler US is a noninvasive modality that adds important imaging and hemodynamic data to those provided by angiography.