Kim Myung Ji, Chang Kyung Won, Park So Hee, Chang Won Seok, Chang Jong Hee, Chang Jin Woo, Jung Hyun Ho
Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, Gyeonggi-do 15355, Korea.
Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodamungu, Seoul 03722, Korea.
J Clin Med. 2021 May 19;10(10):2186. doi: 10.3390/jcm10102186.
We evaluated for possible predictors of radiation-induced changes (RICs) after gamma knife radiosurgery (GKRS) for arteriovenous malformations (AVMs). We identified the nidal component within AVMs to analyze the correlation between the volume of brain parenchyma within the 50% isodose line (IDL) and RICs. We retrospectively reviewed patients with AVMs who underwent a single-session of GKRS at our institution between 2007 and 2017 with at least a 2-year minimum follow-up. Follow-up magnetic resonance images were evaluated for newly developed T2 signal changes and the proportions of nidus and intervening parenchyma were quantified. A total of 180 AVM patients (98 males and 82 females) with a median age of 34 years were included in the present study. The overall obliteration rate was 67.8%. The median target volume was 3.65 cc. The median nidus and parenchyma volumes within the 50% IDL were 1.54 cc and 2.41 cc, respectively. RICs were identified in 79 of the 180 patients (43.9%). AVMs associated with previous hemorrhages showed a significant inverse correlation with RICs. In a multivariate analysis, RICs were associated with a higher proportion of brain parenchyma within the 50% IDL (hazard ratio (HR) 169.033; < 0.001) and inversely correlated with the proportion of nidus volume within the 50% IDL (HR 0.006; < 0.001). Our study identified that a greater proportion of brain tissue between the nidus within the 50% IDL was significantly correlated with RICs. Nidus angioarchitectural complexity and the absence of a prior hemorrhage were also associated with RICs. The identification of possible predictors of RICs could facilitate radiosurgical planning and treatment decisions as well as the planning of appropriate follow-up after GKRS; this could minimize the risk of RICs, which would be particularly beneficial for the treatment of incidentally found asymptomatic AVMs.
我们评估了伽玛刀放射外科治疗（GKRS）动静脉畸形（AVM）后辐射诱导变化（RICs）的可能预测因素。我们确定了AVM内的巢状成分，以分析50%等剂量线（IDL）内脑实质体积与RICs之间的相关性。我们回顾性分析了2007年至2017年间在我院接受单次GKRS治疗且至少随访2年的AVM患者。对随访磁共振图像进行评估，以观察新出现的T2信号变化，并对巢和其间脑实质的比例进行量化。本研究共纳入180例AVM患者（男性98例，女性82例），中位年龄为34岁。总体闭塞率为67.8%。中位靶体积为3.65立方厘米。50% IDL内巢和脑实质的中位体积分别为1.54立方厘米和2.41立方厘米。180例患者中有79例（43.9%）出现RICs。既往有出血史的AVM与RICs呈显著负相关。在多变量分析中，RICs与50% IDL内较高比例的脑实质相关（风险比（HR）169.033；P<0.001），与50% IDL内巢体积比例呈负相关（HR 0.006；P<0.001）。我们的研究发现，50% IDL内巢之间较大比例的脑组织与RICs显著相关。巢血管构筑复杂性及无既往出血史也与RICs有关。确定RICs的可能预测因素有助于放射外科手术规划和治疗决策，以及GKRS后适当随访的规划；这可以将RICs的风险降至最低，这对偶然发现的无症状AVM的治疗尤为有益。
