Evaluation of 4D Vascular Flow and Tissue Perfusion in Cerebral Arteriovenous Malformations: Influence of Spetzler-Martin Grade, Clinical Presentation, and AVM Risk Factors

Wu, Chia‐Ju; Ansari, Sameer A.; Honarmand, A; Vakil, Parmede; Hurley, Michael C.; Bendok, Bernard R.; Carr, James C.; Carroll, Timothy J.; Markl, Michael

doi:10.3174/ajnr.a4259

Cited by 47 publications

(35 citation statements)

References 28 publications

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“…Kim et al [25] showed that the efficacy of high-grade CAVM treatment was in relation to the lesion size, deep perforator artery, and bleeding during surgery. Besides, another study exhibited that the efficacy of CAVM treatment was related to the lesion volume, SM grade, and CAVM size, and that SM grade was an independent influencing factor [26, 27]. It has also been confirmed that CAVM size affects hemodynamic changes such as BFV and PI, that is, the increase in the size of CAVM led to the upsurge of average BFV and a decline in PI [20].…”

Section: Discussionmentioning

confidence: 94%

The Hemodynamic Changes in Patients with Cerebral Arteriovenous Malformations before and after Interventional Embolization Therapy with Glubran 2 Acrylic Glue

Chen¹,

Zhu²

2017

Eur Neurol

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The study explored hemodynamic changes in patients with cerebral arteriovenous malformations (CAVM) before and after interventional embolization therapy with Glubran 2 acrylic glue and analyzed the related factors. CAVM patients received endovascular embolization therapy with Glubran 2. Patients’ systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), blood flow velocity (BFV), and pulsatility index (PI) were measured. The location of malformed vessels, Spetzler-Martin (SM) grade, CAVM size, and type of feeding artery and venous drainage were analyzed. CAVM patients showed increased DBP, SBP, MAP, and PI and decreased average BFV compared to before therapy. CAVM patients with big CAVM size, SM grade IV/V, deep location malformed vessels, deep, and mixed venous drainage, and cortical branch and mixed artery blood-supply exhibited lower DBP, SBP, MAP, and PI but higher average BFV. Hypertensive CAVM patients showed lower DBP, SBP, MAP, average BFV, and PI before or after embolization. Hypertension, SM grade, CAVM size, malformed vessels location, venous drainage, and artery blood-supply were correlated to the hemodynamic changes of CAVM patients. Embolization with Glubran 2 acrylic glue could enhance hemodynamics in CAVM patients, and the hemodynamic changes were in correlation with the SM grade, CAVM size, and malformed vessels location.

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Section: Discussionmentioning

confidence: 94%

The Hemodynamic Changes in Patients with Cerebral Arteriovenous Malformations before and after Interventional Embolization Therapy with Glubran 2 Acrylic Glue

Chen¹,

Zhu²

2017

Eur Neurol

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“…9 205,206 . The findings showed that 4D flow MRI can assess treatment-induced changes in cerebrovascular flow distribution and were able to demonstrate significant associations between 4D flow metrics, cerebral perfusion indices, and AVM risk factors such as the Spetzler–Martin grade 206 .…”

Section: Applicationsmentioning

confidence: 99%

Advanced flow MRI: emerging techniques and applications

et al. 2016

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Magnetic resonance imaging (MRI) techniques provide non-invasive and non-ionising methods for the highly accurate anatomical depiction of the heart and vessels throughout the cardiac cycle. In addition, the intrinsic sensitivity of MRI to motion offers the unique ability to acquire spatially registered blood flow simultaneously with the morphological data, within a single measurement. In clinical routine, flow MRI is typically accomplished using methods that resolve two spatial dimensions in individual planes and encode the time-resolved velocity in one principal direction, typically oriented perpendicular to the two-dimensional (2D) section. This review describes recently developed advanced MRI flow techniques, which allow for more comprehensive evaluation of blood flow characteristics, such as real-time flow imaging, 2D multiple-venc phase contrast MRI, four-dimensional (4D) flow MRI, quantification of complex haemodynamic properties, and highly accelerated flow imaging. Emerging techniques and novel applications are explored. In addition, applications of these new techniques for the improved evaluation of cardiovascular (aorta, pulmonary arteries, congenital heart disease, atrial fibrillation, coronary arteries) as well as cerebrovascular disease (intra-cranial arteries and veins) are presented.

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“…4D flow MR imaging has the ability to provide a comprehensive evaluation of intracranial hemodynamics, which has the potential to provide guidance to clinicians in the evaluation of intracranial aneurysms [1–4], plaque [5,6], arteriovenous malformations [7,8], and cerebral veins [9,10]. Due to the small lumen diameter, intracranial MRI requires a relatively high spatial resolution resulting in long scan times even for limited coverage.…”

Section: Introductionmentioning

confidence: 99%

Highly accelerated intracranial 4D flow MRI: evaluation of healthy volunteers and patients with intracranial aneurysms

Liu

Koskas

Faraji

et al. 2017

Magn Reson Mater Phy

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Object To evaluate an accelerated 4D flow MRI method that provides a high temporal resolution in a clinically feasible acquisition time for intracranial velocity imaging. Materials and Methods Accelerated 4D flow MRI was developed by using a pseudo-random variable-density Cartesian undersampling strategy (CIRCUS) with the combination of k-t, parallel imaging and compressed sensing image reconstruction techniques (k-t SPARSE-SENSE). 4D flow data were acquired on five healthy volunteers and eight patients with intracranial aneurysms using CIRCUS (acceleration factor of R=4, termed CIRCUS4) and GRAPPA (R=2, termed GRAPPA2) as the reference method. Images with three times higher temporal resolution (R=12, CIRCUS12) were also reconstructed from the same acquisition as CIRCUS4. Qualitative and quantitative image assessment was performed on the images acquired with different methods, and complex flow patterns in the aneurysms were identified and compared. Results 4D flow MRI with CIRCUS was achieved in 5 minutes and allowed further improved temporal resolution of <30 ms. Volunteer studies showed similar qualitative and quantitative evaluation obtained with the proposed approach compared to the reference (overall image scores: GRAPPA2 3.2±0.6, CIRCUS4 3.1±0.7, and CIRCUS12 3.3±0.4; difference of the peak-velocities: −3.83±7.72 cm/s between CIRCUS4 and GRAPPA2, −1.72±8.41 cm/s between CIRCUS12 and GRAPPA2). In patients with intracranial aneurysms, the higher temporal resolution improved capturing of the flow features in intracranial aneurysms (pathline visualization scores: GRAPPA2 2.2±0.2, CIRCUS4 2.5±0.5, and CIRCUS12 2.7±0.6). Conclusion The proposed rapid 4D flow MRI with a high temporal resolution is a promising tool for evaluating intracranial aneurysms in a clinically feasible acquisition time.

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Evaluation of 4D Vascular Flow and Tissue Perfusion in Cerebral Arteriovenous Malformations: Influence of Spetzler-Martin Grade, Clinical Presentation, and AVM Risk Factors

Cited by 47 publications

References 28 publications

The Hemodynamic Changes in Patients with Cerebral Arteriovenous Malformations before and after Interventional Embolization Therapy with Glubran 2 Acrylic Glue

The Hemodynamic Changes in Patients with Cerebral Arteriovenous Malformations before and after Interventional Embolization Therapy with Glubran 2 Acrylic Glue

Advanced flow MRI: emerging techniques and applications

Highly accelerated intracranial 4D flow MRI: evaluation of healthy volunteers and patients with intracranial aneurysms

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