Kodera Toshiaki, Arai Yoshikazu, Arishima Hidetaka, Higashino Yoshifumi, Isozaki Makoto, Tsunetoshi Kenzo, Matsuda Ken, Kitai Ryuhei, Shimizu Kazuhiro, Kosaka Nobuyuki, Yamamoto Tatsuya, Shioura Hiroki, Kimura Hirohiko, Kikuta Ken-Ichiro
a Department of Neurosurgery , Faculty of Medical Sciences, University of Fukui , Eiheiji , Fukui , Japan.
b Department of Neurosurgery , Municipal Tsuruga Hospital , Tsuruga , Fukui, Japan.
Br J Neurosurg. 2017 Dec;31(6):641-647. doi: 10.1080/02688697.2017.1365818. Epub 2017 Aug 22.
Complete obliteration of treated arteriovenous malformations (AVMs) can be diagnosed only by confirming the disappearance of arterio-venous (A-V) shunts with invasive catheter angiography. The authors evaluated whether non-invasive arterial spin labeling (ASL) magnetic resonance (MR) imaging can be used to diagnose the obliteration of AVMs facilitate the diagnosis of AVM obliteration after treatment with stereotactic radiosurgery (SRS).
Seven patients with a cerebral AVM treated by SRS were followed up with ASL images taken with a 3T-MR unit, and received digital subtraction angiography (DSA) after the AVM had disappeared on ASL images. Three patients among the seven received DSA also after the postradiosurgical AVM had disappeared on conventional MR images but A-V shunt was residual on ASL images. Four patients among the seven received contrast-enhanced (CE) MR imaging around the same period as DSA.
ASL images could visualize postradiosurgical residual A-V shunts clearly. In all seven patients, DSA after the disappearance of A-V shunts on ASL images demonstrated no evidence of A-V shunts. In all three patients, DSA after the AVM had disappeared on conventional MR images but not on ASL images demonstrated residual A-V shunt. CE MR findings of AVMs treated by SRS did not correspond with DSA findings in three out of four patients.
Findings of radiosurgically treated AVMs on ASL images corresponded with those on DSA. The results of this study suggest that ASL imaging can be utilized to follow up AVMs after SRS and to decide their obliteration facilitate to decide the precise timing of catheter angiography for the final diagnosis of AVM obliteration after SRS.
只有通过侵入性导管血管造影术确认动静脉（A-V）分流消失，才能诊断出治疗后的动静脉畸形（AVM）完全闭塞。作者评估了无创动脉自旋标记（ASL）磁共振（MR）成像是否可用于诊断AVM闭塞，以促进立体定向放射外科治疗（SRS）后AVM闭塞的诊断。
对7例接受SRS治疗的脑AVM患者进行3T-MR单元的ASL图像随访，并在ASL图像上AVM消失后接受数字减影血管造影（DSA）。7例患者中有3例在放射外科治疗后的AVM在传统MR图像上消失但ASL图像上仍有A-V分流时也接受了DSA。7例患者中有4例在与DSA大致相同的时期接受了对比增强（CE）MR成像。
ASL图像可以清晰地显示放射外科治疗后的残余A-V分流。在所有7例患者中，ASL图像上A-V分流消失后的DSA显示没有A-V分流的证据。在所有3例患者中，AVM在传统MR图像上消失但在ASL图像上未消失后的DSA显示有残余A-V分流。4例接受SRS治疗的AVM的CE MR结果与DSA结果在3例中不相符。
放射外科治疗的AVM在ASL图像上的表现与DSA上的表现相符。本研究结果表明，ASL成像可用于SRS后AVM的随访，并确定其闭塞情况，有助于确定导管血管造影的精确时机，以最终诊断SRS后AVM的闭塞情况。
