Schneider Guenther, Massmann Alexander, Fries Peter, Frenzel Felix, Buecker Arno, Raczeck Paul
Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 1, 66421 Homburg, Germany.
J Clin Med. 2021 Feb 22;10(4):887. doi: 10.3390/jcm10040887.
This paper aimed to prospectively evaluate the safety of embolization therapy of pulmonary arteriovenous malformations (PAVMs) for the detection of cerebral infarctions by pre- and post-interventional MRI. Method One hundred and five patients (male/female = 44/61; mean age 48.6+/-15.8; range 5-86) with pre-diagnosed PAVMs on contrast-enhanced MRA underwent embolization therapy. The number of PAVMs treated in each patient ranged from 1-8 PAVMs. Depending on the size and localization of the feeding arteries, either Nester-Coils or Amplatzer vascular plugs were used for embolization therapy. cMRI was performed immediately before, and at the 4 h and 3-month post-embolization therapy. Detection of peri-interventional cerebral emboli was performed via T2w and DWI sequences using three different b-values, with calculation of ADC maps. Results Embolization did not show any post-/peri-interventional, newly developed ischemic lesions in the brain. Only one patient who underwent re-embolization and was previously treated with tungsten coils that corroded over time showed newly developed, small, diffuse emboli in the post-interventional DWI sequence. This patient already had several episodes of brain emboli before re-treatment due to the corroded coils, and during treatment, when passing the corroded coils, experienced additional small, clinically inconspicuous brain emboli. However, this complication was anticipated but accepted, since the vessel had to be occluded distally. Conclusion Catheter-based embolization of PAVMs is a safe method for treatment and does not result in clinically inconspicuous cerebral ischemia, which was not demonstrated previously.
本文旨在通过介入前后的磁共振成像（MRI）前瞻性评估肺动静脉畸形（PAVM）栓塞治疗对脑梗死检测的安全性。方法 105例经对比增强磁共振血管造影（MRA）预诊断为PAVM的患者（男/女 = 44/61；平均年龄48.6±15.8岁；范围5 - 86岁）接受了栓塞治疗。每位患者治疗的PAVM数量为1 - 8个。根据供血动脉的大小和位置，使用Nester弹簧圈或Amplatzer血管塞进行栓塞治疗。在栓塞治疗前、治疗后4小时和3个月进行cMRI检查。通过T2加权成像（T2w）和扩散加权成像（DWI）序列，使用三种不同的b值检测介入期间的脑栓塞，并计算表观扩散系数（ADC）图。结果 栓塞治疗后未发现脑内有任何介入后/介入期间新出现的缺血性病变。只有1例接受再次栓塞治疗的患者，其先前使用的钨丝弹簧圈随时间腐蚀，在介入后的DWI序列中出现了新的、小的、弥漫性栓塞。该患者在再次治疗前因腐蚀的弹簧圈已发生多次脑栓塞事件，且在治疗过程中，通过腐蚀的弹簧圈时又出现了额外的、临床上不明显的小脑栓塞。然而，由于必须闭塞远端血管，这种并发症是预期的但可以接受。结论 基于导管的PAVM栓塞治疗是一种安全的治疗方法，不会导致临床上不明显的脑缺血，这在以前未得到证实。
