Changes in AVM angio-architecture and hemodynamics after stereotactic radiosurgery assessed by dynamic MRA and phase contrast flow assessments

ObjectivesAssessment of changes in the hemodynamics of Arteriovenous malformations (AVM) induced by radiosurgery by MR Phase contrast (PC) measurements of the internal carotid arteries (ICA).Methods65 patients shortly after or before stereotactic radiosurgery underwent MRI including morphological series, MR-Angiography (Time-of-flight, dynamic MRA) and bilateral ECG triggered MR phase contrast (PC) measurements of the ICA. Follow-up was performed in 34 patients. The observation period was up to 4 years.ResultsOver all subjects, a significant relationship between mean arterial blood flow in the ICA on the side of the lesion and AVM volume was revealed (p = 0,0002). In large (>10 ccm) and medium-sized AVMs, (>3, 5 ≤10 ccm) the blood flow was significantly increased on the side of the AVM (p = 0,0004; p = 0,047), whereas in lesions <3, 5 ccm, no significant rise of the mean blood flow was detectable. At follow-up, the mean blood flow in the ipsilateral artery was not increased anymore compared to the contralateral ICA (p = 0,11). These changes correlated with a significant reduction of the average AVM volume (p = 0, 0026).ConclusionsThe AVM angioarchitecture has significant impact on the blood flow in feeding arteries. A significant reduction of the shunt volume by successful radiotherapy leads to normalization of the hemodynamics.

[1]  L R Schad,et al.  Cerebral arteriovenous malformations: improved nidus demarcation by means of dynamic tagging MR-angiography. , 1996, Magnetic Resonance Imaging.

[2]  W. Schlegel,et al.  Stereotactic linac-based radiosurgery in the treatment of cerebral arteriovenous malformations located deep, involving corpus callosum, motor cortex, or brainstem. , 2006, International journal of radiation oncology, biology, physics.

[3]  D. Eberhard,et al.  Histopathology of arteriovenous malformations after gamma knife radiosurgery. , 1997, Journal of neurosurgery.

[4]  A. Brawanski,et al.  Ultrasonic blood flow volume assessment in the extracranial internal carotid artery in arteriovenous malformations , 2005, Neurological research.

[5]  M. Essig,et al.  Assessment of neuropsychological changes in patients with arteriovenous malformation (AVM) after radiosurgery. , 1998, International journal of radiation oncology, biology, physics.

[6]  R. Coffey,et al.  Patient Outcomes after Arteriovenous Malformation Radiosurgical Management: Results Based on a 5- to 14-year Follow-up Study , 2003, Neurosurgery.

[7]  J. Meyer,et al.  CEREBRAL CIRCULATION TIME IN CEREBRAL VASCULAR DISEASE MEASURED BY SERIAL ANGIOGRAPHY. , 1963, The American journal of roentgenology, radium therapy, and nuclear medicine.

[8]  W. Feindel,et al.  Red cerebral veins and the cerebral steal syndrome. Evidence from fluorescein angiography and microregional blood flow by radioisotopes during excision of an angioma. , 1971, Journal of neurosurgery.

[9]  M. Bock,et al.  Assessment of hemodynamic changes in patients with renal artery stenosis by means of the cine MR phase-contrast technique , 1997, Der Radiologe.

[10]  K. Schwab,et al.  The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment. , 1990, Journal of neurosurgery.

[11]  W. Young,et al.  The influence of hemodynamic and anatomic factors on hemorrhage from cerebral arteriovenous malformations. , 1994, Neurosurgery.

[12]  W. Yuh,et al.  Cerebral arteriovenous malformations: morphologic evaluation by ultrashort 3D gadolinium-enhanced MR angiography , 2002, European Radiology.

[13]  C L Dumoulin,et al.  Phase contrast MR angiography techniques. , 1995, Magnetic resonance imaging clinics of North America.

[14]  R R Edelman,et al.  Signal targeting with alternating radiofrequency (STAR) sequences: Application to MR angiography , 1994, Magnetic resonance in medicine.

[15]  H. Nornes,et al.  Hemodynamic aspects of cerebral arteriovenous malformations. , 1980, Journal of neurosurgery.

[16]  L Dade Lunsford,et al.  An analysis of the dose-response for arteriovenous malformation radiosurgery and other factors affecting obliteration. , 2002, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[17]  S. Schoenberg,et al.  Arteriovenous Malformations: Assessment of Gliotic and Ischemic Changes with Fluid-Attenuated Inversion-Recovery MRI , 2000, Investigative radiology.

[18]  F J Bova,et al.  Linear accelerator radiosurgery for arteriovenous malformations: the relationship of size to outcome. , 1995, Journal of neurosurgery.

[19]  W. R. Hudgins.  Management of unruptured intracranial arteriovenous malformations: a decision analysis. , 1993, Neurosurgery.

[20]  K. J. Lee,et al.  Stereotactic radiosurgery for brain arteriovenous malformations: quantitative MR assessment of nidal response at 1 year and angiographic factors predicting early obliteration , 2006, Neuroradiology.

[21]  H. Steinmetz,et al.  Cerebral hemodynamics in angioma patients: an intraoperative study. , 1987, Journal of neurosurgery.

[22]  E. Bartels,et al.  Möglichkeiten und Grenzen der transkraniellen Farbduplexsonographie bei der Darstellung intrakranieller arteriovenöser Malformationen , 2006 .

[23]  R. Ackerman,et al.  Arteriovenous malformation hemodynamics: a transcranial Doppler study. , 1993, Neurosurgery.

[24]  S. Yeh,et al.  Early irradiation effects observed on magnetic resonance imaging and angiography, and positron emission tomography for arteriovenous malformations treated by Gamma Knife radiosurgery. , 1995, Stereotactic and functional neurosurgery.

[25]  C. Meier,et al.  Cardiovascular flow measurement with phase-contrast MR imaging: basic facts and implementation. , 2002, Radiographics : a review publication of the Radiological Society of North America, Inc.

[26]  S Rudin,et al.  A novel approach to flow quantification in brain arteriovenous malformations prior to enbucrilate embolization: use of insoluble contrast (Ethiodol droplet) angiography. , 1998, Journal of neurosurgery.

[27]  W. Young,et al.  The effects of intracranial arteriovenous malformations on cerebral hemodynamics. , 1996, Neurosurgery clinics of North America.

[28]  S. Schoenberg,et al.  OBLITERATION DYNAMICS IN CEREBRAL ARTERIOVENOUS MALFORMATIONS AFTER CYBERKNIFE RADIOSURGERY: QUANTIFICATION WITH SEQUENTIAL NIDUS VOLUMETRY AND 3‐TESLA 3‐DIMENSIONAL TIME‐OF‐FLIGHT MAGNETIC RESONANCE ANGIOGRAPHY , 2009, Neurosurgery.

[29]  F. Ponce,et al.  Intention-to-treat analysis of Spetzler-Martin grades IV and V arteriovenous malformations: natural history and treatment paradigm. , 2003, Journal of neurosurgery.

[30]  L. Symon,et al.  The management of cerebral arteriovenous malformations , 2005, Acta Neurochirurgica.

[31]  W. Guo,et al.  The Impact of Arteriovenous Malformation Radiosurgery on the Brain: From Morphology and Perfusion to Neurocognition , 2006, Stereotactic and Functional Neurosurgery.