Department of Radiology, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan; School of Medicine, National Yang Ming University, Taipei, Taiwan.
School of Medicine, National Yang Ming University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Eur J Radiol. 2021 Jan;134:109455. doi: 10.1016/j.ejrad.2020.109455. Epub 2020 Dec 1.
To investigate the reproducibility of quantitative digital subtraction angiography (QDSA) measurements and their associations with brain arteriovenous malformation (BAVM) hemorrhage.
From 2011-2019, 37 patients with BAVMs who had undergone both diagnostic and stereotactic DSA were divided into hemorrhagic and nonhemorrhagic groups. QDSA analysis was performed on the 2 DSA exams. The inter-exam reliabilities of QDSA measurements across the diagnostic and stereotactic DSA were tested using intraclass correlation coefficients (ICCs). Demographics, BAVM characteristics, and QDSA results for the hemorrhagic and nonhemorrhagic groups were compared.
Fifteen of 37 (40.5 %) patients presented with hemorrhage were associated with smaller BAVM volume and the presence of intranidal aneurysm and exclusive deep venous drainage. The median interval between the diagnostic and stereotactic DSA was 49 days and did not differ between the groups. In both groups, the inter-exam QDSA measurements were more reliable for drainage veins and transnidal time (ICCs ranged from 0.38-0.93) than for feeding arteries (ICCs ranged from 0.01-0.74). Among the venous parameters, the hemorrhagic group had lower peak density, area under the curve, inflow gradient, and outflow gradient on both DSA exams and larger full width at half maximum and stasis index on the stereotactic DSA exam than the nonhemorrhagic group.
In BAVMs, the QDSA measurements for veins are more reliable than those for arteries. QDSA analysis reflecting stagnant venous drainage is associated with BAVM hemorrhage, but may be confounded by the acute hemodynamic change after hemorrhage.
研究定量数字减影血管造影（QDSA）测量的可重复性及其与脑动静脉畸形（BAVM）出血的关系。
2011 年至 2019 年，将 37 例接受诊断性和立体定向 DSA 的 BAVM 患者分为出血组和非出血组。对 2 次 DSA 检查进行 QDSA 分析。采用组内相关系数（ICC）检验诊断性和立体定向 DSA 检查之间 QDSA 测量的组内可靠性。比较出血组和非出血组的人口统计学、BAVM 特征和 QDSA 结果。
15 例（40.5%）患者发生出血，与 BAVM 体积较小、瘤内动脉瘤和单纯深部静脉引流有关。诊断性和立体定向 DSA 之间的中位数间隔为 49 天，两组之间无差异。在两组中，静脉 QDSA 测量的组内可靠性均高于供血动脉（ICC 范围为 0.38-0.93）（ICC 范围为 0.01-0.74）。在静脉参数中，出血组在两次 DSA 检查中峰值密度、曲线下面积、流入梯度和流出梯度均较低，立体定向 DSA 检查中半最大值全宽和停滞指数较大。
在 BAVM 中，静脉的 QDSA 测量比动脉更可靠。反映静脉淤滞引流的 QDSA 分析与 BAVM 出血有关，但可能与出血后的急性血流动力学变化有关。
