Departments of *Neurosurgery and ‡Radiation Oncology §Division of Public Health Sciences, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
Neurosurgery. 2012 Oct;71(4):893-9. doi: 10.1227/NEU.0b013e3182672a83.
It has been well established that Gamma Knife radiosurgery (GKS) is an effective treatment for brain arteriovenous malformations (AVMs).
To evaluate complete obliteration rates for magnetic resonance imaging (MRI)-based GKS treatment planning performed with and without angiography and to conduct a preliminary assessment of the utility of using pulsed arterial spin labeling (PASL) magnetic resonance (MR) perfusion imaging to confirm complete obliteration.
Forty-six patients were identified who had undergone GKS without embolization with a minimum follow-up of 2 years. One group was planned with integrated stereotactic angiography and MR (spoiled gradient recalled) images obtained on the day of GKS. A second technique avoided the risk of arteriography by using only axial MR images. Beginning in 2007, PASL MR perfusion imaging was routinely performed as a portion of the follow-up MRI to assess the restoration of normal blood flow of the nidus and surrounding area.
The overall obliteration rate for the angiography/MRI group was 88.0% (29 of 33). Patients in the MRI-only group had an obliteration rate of 61.5% (8 of 13), with P=.092 with the Fisher exact test, which is not statistically significant. A Kaplan-Meier analysis was also not statistically significant (log rank test, P=.474). Four of 9 patients with incomplete obliteration on angiography also had shown residual abnormal blood flow on PASL imaging.
This retrospective analysis shows that treatment planning technique used in GKS does not play a role in the eventual obliteration of treated AVMs. PASL may have potential in the evaluation of AVM obliteration.
伽玛刀放射外科（GKS）是治疗脑动静脉畸形（AVM）的有效方法，这一点已得到充分证实。
评估基于磁共振成像（MRI）的 GKS 治疗计划中有无血管造影的完全闭塞率，并初步评估使用脉冲动脉自旋标记（PASL）磁共振（MR）灌注成像来确认完全闭塞的效用。
共确定了 46 例接受 GKS 治疗而未栓塞的患者，其随访时间至少为 2 年。一组计划采用集成立体定向血管造影和 GKS 当天获得的 MR（扰相梯度回波）图像。第二种技术通过仅使用轴向 MR 图像避免了血管造影的风险。从 2007 年开始，PASL MR 灌注成像作为随访 MRI 的一部分常规进行，以评估病灶和周围区域的正常血流恢复情况。
血管造影/MRI 组的总体闭塞率为 88.0%（33 例中的 29 例）。MRI 组的闭塞率为 61.5%（13 例中的 8 例），Fisher 确切检验 P=0.092，无统计学意义。Kaplan-Meier 分析也无统计学意义（对数秩检验，P=0.474）。在血管造影显示不完全闭塞的 9 例患者中，有 4 例在 PASL 成像上也显示残留异常血流。
本回顾性分析表明，GKS 中使用的治疗计划技术与治疗后 AVM 的最终闭塞无关。PASL 在评估 AVM 闭塞方面可能具有潜力。
