Huang Po-Wei, Peng Syu-Jyun, Pan David Hung-Chi, Yang Huai-Che, Tsai Jo-Ting, Shiau Cheng-Ying, Su I-Chang, Chen Ching-Jen, Wu Hsiu-Mei, Lin Chung-Jung, Chung Wen-Yuh, Guo Wan-Yuo, Lo Wei-Lun, Lai Shao-Wen, Lee Cheng-Chia
1Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City.
2Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei.
J Neurosurg. 2022 May 20;138(1):241-250. doi: 10.3171/2022.4.JNS212369. Print 2023 Jan 1.
OBJECTIVE: The goal of the study was to define and quantify brain arteriovenous malformation (bAVM) compactness and to assess its effect on outcomes after Gamma Knife radiosurgery (GKRS) for unruptured bAVMs. METHODS: Unsupervised machine learning with fuzzy c-means clustering was used to differentiate the tissue constituents of bAVMs on T2-weighted MR images. The percentages of vessel, brain, and CSF were quantified. The proposed compactness index, defined as the ratio of vasculature tissue to brain tissue, categorized bAVM morphology into compact, intermediate, and diffuse types according to the tertiles of this index. The outcomes of interest were complete obliteration and radiation-induced changes (RICs). RESULTS: A total of 209 unruptured bAVMs treated with GKRS were retrospectively included. The median imaging and clinical follow-up periods were 49.2 and 72.3 months, respectively. One hundred seventy-three bAVMs (82.8%) achieved complete obliteration after a median latency period of 43.3 months. The rates of RIC and permanent RIC were 76.1% and 3.8%, respectively. Post-GKRS hemorrhage occurred in 14 patients (6.7%), resulting in an annual bleeding risk of 1.0%. Compact bAVM, smaller bAVM volume, and exclusively superficial venous drainage were independent predictors of complete obliteration. Diffuse bAVM morphology, larger bAVM volume, and higher margin dose were independently associated with RICs. CONCLUSIONS: The compactness index quantitatively describes the compactness of unruptured bAVMs. Moreover, compact bAVMs may have a higher obliteration rate and a smaller risk of RICs than diffuse bAVMs. This finding could help guide decision-making regarding GKRS treatment for patients with unruptured bAVMs.
目的：本研究的目的是定义并量化脑动静脉畸形（bAVM）的致密性，并评估其对未破裂bAVM伽玛刀放射外科治疗（GKRS）后结局的影响。 方法：采用模糊c均值聚类的无监督机器学习方法，在T2加权磁共振图像上区分bAVM的组织成分。对血管、脑和脑脊液的百分比进行量化。提出的致密性指数定义为血管组织与脑组织的比值，根据该指数的三分位数将bAVM形态分为致密型、中间型和弥散型。感兴趣的结局是完全闭塞和放射诱导改变（RICs）。 结果：回顾性纳入了209例接受GKRS治疗的未破裂bAVM。影像学和临床随访的中位时间分别为49.2个月和72.3个月。173例bAVM（82.8%）在中位潜伏期43.3个月后实现完全闭塞。RIC和永久性RIC的发生率分别为76.1%和3.8%。14例患者（6.7%）在GKRS后发生出血，年出血风险为1.0%。致密型bAVM、较小的bAVM体积和仅为浅表静脉引流是完全闭塞的独立预测因素。弥散型bAVM形态、较大的bAVM体积和较高的边缘剂量与RICs独立相关。 结论：致密性指数定量描述了未破裂bAVM的致密性。此外，与弥散型bAVM相比，致密型bAVM可能具有更高的闭塞率和更低的RIC风险。这一发现有助于指导未破裂bAVM患者GKRS治疗的决策。
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