Intracranial arteriovenous malformations

Ganz, Jeremy C.

doi:10.1016/bs.pbr.2021.10.027

Cited by 2 publications

(5 citation statements)

References 98 publications

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“…Particularly, AVM and DAVF with complex angioarchitecture are among the most difficult cases for target definition in SRS, for which sufficient time needs to be devoted. In this regard, this 2D/3D angiogram fusion can subserve treatment planning, including target definition, well in advance before SRS and omit the need for invasive angiography on the day of SRS, thus significantly reducing treatment time and burdens on both patients and medical professionals [1]. Elements eliminated one of the remaining advantages of frame-based SRS, that is, the integrated diagnosis of both CBCTA and limited frames of 2D-DSA, and would become a tailwind for the further implementation of frameless SRS [15,19].…”

Section: Discussionmentioning

confidence: 99%

“…Stereotactic radiosurgery (SRS) is an indispensable, definitive treatment option for patients with symptomatic arteriovenous malformation (AVM) and/or dural arteriovenous fistula (DAVF), which are not amenable to direct surgery or endovascular embolization alone [1,2]. Traditionally, the stereotactic coregistration of one or a few representative frames of orthogonally paired 2D digital subtraction angiography (2D-DSA) into a 3D setup, as well as planning images via a dedicated image localizer under rigid frame fixation to the skull, has been a standard prerequisite procedure for target delineation in SRS for intracranial AVM and DVAF.…”

mentioning

confidence: 99%

“…Traditionally, the stereotactic coregistration of one or a few representative frames of orthogonally paired 2D digital subtraction angiography (2D-DSA) into a 3D setup, as well as planning images via a dedicated image localizer under rigid frame fixation to the skull, has been a standard prerequisite procedure for target delineation in SRS for intracranial AVM and DVAF. However, the use of frame fixation for a prolonged period and performing follow-up angiography on the day of SRS impose substantial burdens on patients [1].…”

mentioning

confidence: 99%

“…Among the 3D imaging techniques for visualizing affected angioarchitectures, cone-beam computed tomography (CT) angiography (CBCTA) acquired by C-arm-based selective 3D-rotational angiography (3DRA) is recognized as the most suitable foundation for target definition in terms of spatial resolution, can visualize tiny lesions and/or fine caliber vessels, and distinguish nidus segmentation from different feeding arteries [1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. With the advent of image-guidance systems and the application of CBCTA, a frameless SRS workflow has been adopted in an increasing number of institutions implementing CyberKnife, conventional linac, and Gamma Knife, where treatment planning is usually completed by the day before SRS, thus allowing for the omission of angiography on the day of SRS [3][4][5]11,[13][14][15][16]18].…”

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confidence: 99%

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Frameless Co-Registration of Biplane 2D Digital Subtraction Angiography Whole Frames and 3D Rotational Angiography-Based Cone-Beam Computed Tomography Angiogram on Dedicated Software for Stereotactic Radiosurgery of Cranial Vascular Malformations

Ohtakara¹,

Izumi²,

Tanahashi³

et al. 2022

Cureus

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Purpose: Given its high spatial resolution and vasculature selectivity, the cone-beam computed tomography (CT) angiography (CBCTA) image acquired by selective 3D rotational angiography (3DRA) is the most suitable 3D image for the target definition of stereotactic radiosurgery (SRS) for intracranial arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs). Furthermore, the relatively low temporal resolution of 3DRA-based CBCTA can be complemented by the stereotactic co-registration of orthogonally paired 2D dynamic digital subtraction angiography (2D-DSA). The integration of 2D-DSA, which is usually limited to one or a few frames for each projection, into CBCTA and/or planning CT can be achieved only by catheter-directed angiography on the day of SRS via a dedicated image localizer under rigid frame fixation to the skull, which imposes substantial burdens on patients. This study aimed to demonstrate a novel, convenient, and significantly less invasive method for the frameless co-registration of biplane 2D-DSA whole frames and CBCTA on commercially available dedicated software, namely, Brainlab ® Elements (Brainlab AG, Munich, Germany), and present its prerequisite for successful image fusion.Technical Report: Elements have afforded the following functionality: A 3D vasculature image is automatically extracted as a floating image from any 3D image series containing vascular details and then subsequently co-registered manually and automatically to a selected frame pair of 2D-DSA with a sixdegree-of-freedom rigid registration. As a preclinical feasibility study, two anonymous image datasets from patients harboring cerebral AVM and transverse-sigmoid (TS) DAVF were used to verify the accuracy and practicality of Elements for the frameless co-registration of 2D/3D vascular images, particularly on the assumption of clinical workflow for the target delineation of SRS planning. The use of ordinary unsubtracted CBCTA resulted in the insufficient extraction of abutting vessels or vessels that are in close proximity to bony structures, particularly in the case of TS-DAVF, where the fistulous pouch and the affected venous sinuses were adjacent to the cranial bone. By contrast, the amount and selectivity of vasculatures and the accuracy of subsequent image fusion were significantly improved from the subtracted CBCTA. The integration of CBCTA into dynamic 2D-DSA allowed the simultaneous review of both image information by sharing any concerning point and 2D or 3D structures under a common 3D coordinate.Conclusions: Elements enable the clinically useful frameless co-registration of biplane 2D-DSA whole frames into CBCTA, for which the routine acquisition of both subtracted and unsubtracted CBCTA axial images for ordinary diagnostic purposes is an indispensable prerequisite for successful image fusion and further widespread application. This frameless integration of the 2D/3D angiogram would dramatically enhance both the frame-based and frameless SRS workflow and circumstances by allowing users to forward SRS p...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Frameless Co-Registration of Biplane 2D Digital Subtraction Angiography Whole Frames and 3D Rotational Angiography-Based Cone-Beam Computed Tomography Angiogram on Dedicated Software for Stereotactic Radiosurgery of Cranial Vascular Malformations

Ohtakara¹,

Izumi²,

Tanahashi³

et al. 2022

Cureus

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“…Intracranial vascular lesions encompass a broad spectrum of entities which differ in hemodynamic physiology, structure and prognosis [ 1 – 3 ]. They have been increasingly seen in clinical practice primarily because of new developments in imaging technology [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

The dural angioleiomyoma harbors frequent GJA4 mutation and a distinct DNA methylation profile

Tauziède‐Espariat

Pierre²,

Wassef³

et al. 2022

acta neuropathol commun

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The International Society for the Study of Vascular Anomalies (ISSVA) has defined four vascular lesions in the central nervous system (CNS): arteriovenous malformations, cavernous angiomas (also known as cerebral cavernous malformations), venous malformations, and telangiectasias. From a retrospective central radiological and histopathological review of 202 CNS vascular lesions, we identified three cases of unclassified vascular lesions. Interestingly, they shared the same radiological and histopathological features evoking the cavernous subtype of angioleiomyomas described in the soft tissue. We grouped them together with four additional similar cases from our clinicopathological network and performed combined molecular analyses. In addition, cases were compared with a cohort of 5 soft tissue angioleiomyomas. Three out 6 CNS lesions presented the same p.Gly41Cys GJA4 mutation recently reported in hepatic hemangiomas and cutaneous venous malformations and found in 4/5 soft tissue angioleiomyomas of our cohort with available data. Most DNA methylation profiles were not classifiable using the CNS brain tumor (version 12.5), and sarcoma (version 12.2) classifiers. However, using unsupervised t-SNE analysis and hierarchical clustering analysis, 5 of the 6 lesions grouped together and formed a distinct epigenetic group, separated from the clusters of soft tissue angioleiomyomas, other vascular tumors, inflammatory myofibroblastic tumors and meningiomas. Our extensive literature review identified several cases similar to these lesions, with a wide variety of denominations. Based on radiological and histomolecular findings, we suggest the new terminology of “dural angioleiomyomas” (DALM) to designate these lesions characterized by a distinct DNA methylation pattern and frequent GJA4 mutations.

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Intracranial arteriovenous malformations

Cited by 2 publications

References 98 publications

Frameless Co-Registration of Biplane 2D Digital Subtraction Angiography Whole Frames and 3D Rotational Angiography-Based Cone-Beam Computed Tomography Angiogram on Dedicated Software for Stereotactic Radiosurgery of Cranial Vascular Malformations

Frameless Co-Registration of Biplane 2D Digital Subtraction Angiography Whole Frames and 3D Rotational Angiography-Based Cone-Beam Computed Tomography Angiogram on Dedicated Software for Stereotactic Radiosurgery of Cranial Vascular Malformations

The dural angioleiomyoma harbors frequent GJA4 mutation and a distinct DNA methylation profile

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