Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
World Neurosurg. 2019 Jun;126:405-412. doi: 10.1016/j.wneu.2019.02.131. Epub 2019 Mar 5.
Vein of Galen malformations (VoGMs) induce cerebrovascular dysfunction through arterial steal and venous hypertension resulting, if untreated, in severe neurologic morbidity and mortality. Noninvasive techniques for quantitative, serial evaluation of cerebrovascular hemodynamics in VoGMs are lacking. This proof of concept study using quantitative blood flow measurements from 4-dimensional flow magnetic resonance imaging may be useful as a noninvasive biomarker to guide timing of intervention and assess disease progression and treatment outcomes.
Between July 2016 and July 2018, 4 patients harboring VoGMs underwent Phase Contrast Vastly undersampled Isotropic PRojection (PCVIPR) imaging at the University of Wisconsin Hospitals and Clinics. We applied PCVIPR imaging to assess its potential for obtaining anatomic and physiologic flow data before and after surgical embolization of VoGMs. Hemodynamic pressure parameters obtained from PCVIPR imaging were compared with stump pressures recorded in vivo. We found a decrease in mean arterial pressure from 97 mm Hg pretreatment to 65 mm Hg post treatment. These findings corroborate the decrement in venous pressure gradients documented on PCVIPR imaging. For all patients, pressure gradient changes on PCVIPR imaging correlated with in vivo arterial pressures and aided in clinical decision related to cerebrovascular evaluation, treatment planning, and clinical course.
Four-dimensional flow magnetic resonance imaging/PCVIPR imaging has a potential role in determining endovascular embolization and therapeutic outcomes on the basis of objective and reproducible hemodynamic characteristics of the vascular lesion. It represents a novel, noninvasive approach that may guide the extent and timing of therapeutic intervention and treatment of cerebrovascular diseases in pediatric patients.
Galen 静脉畸形（VoGM）通过动脉盗血和静脉高压引起脑血管功能障碍，如果不治疗，会导致严重的神经功能障碍和死亡率。目前缺乏用于定量评估 VoGM 患者脑血管血液动力学的非侵入性技术。本研究使用 4 维血流磁共振成像的定量血流测量作为概念验证，可能有助于作为一种非侵入性生物标志物来指导干预时机，并评估疾病进展和治疗效果。
2016 年 7 月至 2018 年 7 月，在威斯康星大学医院和诊所，4 名患有 VoGM 的患者接受了相位对比超采样各向同性投影（PCVIPR）成像。我们应用 PCVIPR 成像来评估其在 VoGM 手术栓塞前后获取解剖和生理流量数据的潜力。从 PCVIPR 成像中获得的血流动力学压力参数与体内记录的残端压力进行比较。我们发现平均动脉压从术前的 97mmHg 降至术后的 65mmHg。这些发现与 PCVIPR 成像上记录的静脉压力梯度下降相符。对于所有患者，PCVIPR 成像上的压力梯度变化与体内动脉压力相关，并有助于与脑血管评估、治疗计划和临床病程相关的临床决策。
4 维血流磁共振成像/PCVIPR 成像有可能根据血管病变的客观和可重复的血流动力学特征来确定血管内栓塞和治疗结果。它代表了一种新颖的非侵入性方法，可能有助于指导治疗干预的程度和时机，以及儿科患者脑血管疾病的治疗。
