Université de la Méditerranée, Hôpital de la Timone, Service de Neuroradiologie diagnostique et interventionnelle, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
J Neuroradiol. 2011 Jul;38(3):167-74. doi: 10.1016/j.neurad.2010.08.005. Epub 2011 Jan 21.
The angioarchitecture of brain arteriovenous malformations (BAVM) still remains a complex subject of study despite advances in medical imaging techniques. For this reason, the present study aimed to assess whether or not 3D rotational angiography (3DXA) might improve the assessment of BAVM.
Included prospectively were 72 patients who had undergone conventional digital subtraction angiography (DSA) and 3DXA for pretherapeutic assessment of BAVM prior to radiosurgery. Dimensional criteria, arterial-feed patterns, venous drainage, points of weakness and vascular densities (VD) of the nidus and shunt zone were studied.
3DXA detected all arteriovenous shunts by revealing abnormal venous enhancement. Post-processing tools similar to CT and MRI may also be used to make complex 3D reconstructions. In addition, the technique provided significant help for volumetric estimations, extraction of arterial feeders and origins of draining veins, and analysis of the 3D conformation of the nidus. Furthermore, 3DXA detected significantly more points of weakness, such as intranidus aneurysms and venous anomalies (P<0.005). In 65% of cases, a gradient of vascular enhancement intensity was found between the arteries and draining veins surrounding or comprising the nidus. VD, or the percentages of space occupied by the enhanced vascular elements, was evaluated in both the nidus and shunt zone. VD in the shunt zone was highest in untreated patients with no history of bleeding (P<0.005).
3DXA offers a useful approach to BAVM exploration and can improve our knowledge of lesional angioarchitecture, necessary for the planning of therapeutic strategies.
尽管医学影像技术取得了进步，但脑动静脉畸形（BAVM）的血管构筑仍然是一个复杂的研究课题。因此，本研究旨在评估 3D 旋转血管造影（3DXA）是否可以改善 BAVM 的评估。
前瞻性纳入 72 例患者，这些患者在放射外科治疗前接受了常规数字减影血管造影（DSA）和 3DXA 对 BAVM 的术前评估。研究了形态学标准、动脉供血模式、静脉引流、病灶和分流区的弱点以及血管密度（VD）。
3DXA 通过显示异常静脉增强检测到所有动静脉分流。类似于 CT 和 MRI 的后处理工具也可用于进行复杂的 3D 重建。此外，该技术还为容积估计、动脉供血者和引流静脉起源的提取以及病灶的 3D 形态分析提供了重要帮助。此外，3DXA 还检测到更多的弱点，如病灶内动脉瘤和静脉异常（P<0.005）。在 65%的病例中，在围绕或包含病灶的动脉和引流静脉周围发现了血管增强强度的梯度。评估了病灶和分流区的 VD，或增强血管元素所占空间的百分比。在未接受治疗且无出血史的患者中，分流区的 VD 最高（P<0.005）。
3DXA 为 BAVM 探查提供了一种有用的方法，可以提高我们对病变血管构筑的认识，这对于治疗策略的规划是必要的。
