Whole-Brain Perfusion CT Patterns of Brain Arteriovenous Malformations: A Pilot Study in 18 Patients

Abstract

BACKGROUND AND PURPOSE:Little is known about the pathological mechanism or the anatomic and functional imaging features related to the clinical manifestations in patients with brain AVM. The purpose of this pilot study was to describe the pattern of whole-brain PCT abnormalities in brain AVMs and their potential to differentiate underlying pathomechanisms.

Angioarchitecture Determines Obliteration Rate After Radiosurgery in Brain Arteriovenous Malformations

“…Perinidal hypoxemia has been found to be present in the brain parenchyma surrounding certain AVMs. 35 Brain tissue hypoxemia leads to increased expression of the transcription factor hypoxia-inducible factor-1), which in turn will increase vascular endothelial growth factor production and thereby lead to a perinidal angiogenesis. 26 We found that the obliteration probability of an AVM with perinidal angiogenesis was 2.61 times lower than that of an AVM without angiogenesis (P = .01; this corresponds nearly exactly to the odds ratio of perinidal neovascularity [2.38] to predict incomplete obliteration determined by Zipfel et al 33 in their study).…”

The clinical dilemma of treating transient ischaemic attack-like symptoms in patients with coexisting arteriovenous malformation

“…Elements in the history that may be more suggestive of seizure activity include the presence of warning symptoms before the onset of transient neurological symptoms and impaired consciousness during the episode, both of which were not present in the index case. The situation is further complicated by the possibility of TIA-like symptoms being caused by localised AVM-related steal phenomena 7. In the index case, this is certainly relevant as a large left-sided parietal-occipital AVM may well explain the presence of transient right arm weakness and impaired coordination.…”

“…Spontaneous intracranial haemorrhage rates of 4–7% have been previously quoted although more modern studies have shown rates to be slightly lower at around 2–4% 6. In addition, AVMs have been shown to cause TIA-like symptoms due to steal phenomena that cause focal neurological deficit by altering perfusion in the tissue in the region of AVM 7. Management of AVM involves treating symptoms such as headaches and seizures.…”

Unusual MRI findings of dural arteriovenous fistula: Isolated perfusion lesions mimicking TIA

“…[5] ICH occurred after misdiagnosis in case 1, and the small area of perfusion abnormality accompanied by the enlarged cortical vein in case 2 helped to identify the dAVF through the further investigation. Unlike arterial ischemia, PWI revealed increase of MTT and rCBV denoting the venous congestion in a clinically corresponding area in both cases [6-8]. The DSA showed parietal dAVF supplied by the middle meningeal artery and draining to cortical vein in the area corresponding perfusion deficit on PWI.…”