Multimodality Imaging for Radiosurgical Management of Arteriovenous Malformations

Abstract

<jats:p>Background: Cerebral arteriovenous malformations (AVMs) are rarely seen congenital vascular anomalies. AVMs may lead to intracranial hemorrages due to disorganized tangle of vessels. Lifetime risk of bleeding from AVMs may be significant given the diagnosis at typically earlier ages of the lifespan, and complications associated with hemorrhage may lead to substantial morbidity or mortality. Management of AVMs aims at eliminating or reducing the risk of subsequent bleeding. In this context, microvascular surgical resection, endovascular embolization and radiosurgical treatment may be used for management of AVMs.Objective: In this study, we assessed the incorporation of Magnetic Resonance Imaging (MRI) in treatment planning for AVM radiosurgery. Methods: We identified 25 patients receiving radiosurgery for AVMs at our institution. Radiosurgery target volumes generated by using CT-only based imaging and CT-MR fusion based imaging for each patient were evaluated.Results: Twenty five patients undergoing SRS for AVMs were evaluated for target volume determination in this study. Mean target volume was 4.9 cc (range: 1.3-15.9 cc) on CT-only imaging, 5.7 cc (range: 1.4-16.7 cc) on CT-MR fusion based imaging, and 5.9 cc (range: 1.4-16.9 cc) on consensus decision of all treating physicians with colleague peer review. Target definition based on CT-MR fusion based imaging was identical to the consensus decision of all treating physicians in majority of patients.Conclusions: Treatment planning for AVM radiosurgery may be improved by incorporating CT-MR fusion based imaging, which clearly should be supplemented with additional data from angiography. There is need for additional studies to establish a consensus on optimal target definition by multimodality imaging for SRS of AVMs.</jats:p>

Evaluation of Radiosurgery Target Volume Definition for Tectal Gliomas with Incorporation of Magnetic Resonance Imaging (MRI): An Original Article

“…Utility of multimodality imaging for radiosurgery treatment planning for tectal gliomas has been poorly addressed in the literature. In this context, our study adds to the existing literature and supports the incorporation of MRI for improved radiosurgery treatment planning for tectal gliomas consistent with another studies [48][49][50][51][52][53][54][55][56][57][58][59].…”

Utility of Multimodality Imaging Based Target Volume Definition for Radiosurgery of Trigeminal Neuralgia: An Original Article

“…In this study, we assessed incorporation of multimodality imaging into target volume definition of trigeminal neuralgia radiosurgery. Indeed, usefulness of neuroimaging with MRI for definition of central nervous system radiotherapy and radiosurgery target volumes has been an important focus of research in the literature [40][41][42][43][44][45][46][47][48][49]. Our results appear to be compatible to these studies supporting the incorporation of MRI in radiosurgery treatment planning.…”

Determination of Radiosurgery Treatment Volume for Intracranial Germ Cell Tumors (GCTS)

“…In this context, multimodality imaging may add to the accuracy of target definition for radiosurgery of intracranial GCTs. Indeed several other studies have demonstrated refined treatment volume determination by including MRI to the process of target determination [39][40][41][42][43][44][45][46][47][48][49][50][51].…”