ArticleQuantitative imaging in medicine and surgery2024
Hemodynamic relationship with angioarchitecture of cerebral arteriovenous malformation and changes after embolization: a pilot study by 4D flow MR.
Article in Quantitative imaging in medicine and surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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6 authors.
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Abstract
Background: The hemodynamics of cerebral arteriovenous malformation (cAVM) is difficult to evaluate with conventional imaging or clinical grading. The aim of this study is to: (I) investigate the association between the angioarchitecture and hemodynamic parameters in cAVM based on 4-dimentional flow magnetic resonance (4D flow MR); (II) quantify flow changes during follow-up after embolization and explore the potential of flow-guided staged embolization. Methods: Twenty-one patients with digital subtraction angiography (DSA)-diagnosed cAVM were prospectively enrolled in a tertiary hospital consecutively from April 2022 to January 2024 for a cohort study. Lesion angioarchitecture at baseline was assessed by DSA. 4D flow MR was performed to assess hemodynamics. Flow-derived parameters included velocity, flow, time averaged wall shear stress (WSS) of the main feeding artery, and inflow-to-outflow ratio. Hemodynamic metrics were compared between groups with different angioarchitecture and rupture status. Seven patients had a post embolization follow-up 4D flow MR scan with a median interval of 8.9 months. Results: Among multiple angioarchitectural features, supply by a single feeding artery (6/7 in the ruptured group and 0/14 in the unruptured group, P<0.001) and intra nidal aneurysm (7/7 in the ruptured group and 5/14 in the unruptured group, P=0.007) were significantly associated with lesion rupture. The ruptured cAVM showed lower total flow of feeding arteries (2.09±3.15 Conclusions: cAVM lesions tend to have heterogeneous hemodynamics even with similar angioarchitecture. This could be captured and quantified on an individual basis using 4D flow MR. Flow analysis by MR offers the potential to guide a second embolization.
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