Li Ruinan, Chen Yu, Chen Pingting, Ma Li, Han Heze, Li Zhipeng, Zhou Wanting, Zhou Yu, Wang Minhan, Sun Shibin, Zhao Yuanli, Chen Xiaolin
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Neurosurg Rev. 2024 Dec 6;47(1):889. doi: 10.1007/s10143-024-03135-z.
Hemodynamics significantly influences the clinical outcomes of brain arteriovenous malformations (AVM). This study aimed to determine if the lesion filling index (LFI), obtained via quantitative digital subtraction angiography (QDSA), can predict complete complete obliteration after Gamma knife radiosurgery (GKRS). We retrospectively reviewed AVM patients who underwent GKRS and DSA exams from 2011 to 2021. Clinical, angioarchitectural, and QDSA hemodynamic features were analyzed. The LFI, derived from QDSA, was evaluated as a predictor of complete complete obliteration post-SRS using Cox proportional hazards and Kaplan-Meier analyses. Among 118 AVMs with a mean follow-up of 5.76 ± 2.76 years, post-SRS complete obliteration was linked to reduced nidus volume (7.27 ± 12.3 vs. 19.2 ± 35.7 mm³, p = 0.049), smaller nidus diameter (26.0 ± 14.9 vs. 34.1 ± 19.8 mm, p = 0.015), and absence of feeding artery dilation (21.1% vs. 46.3%, p = 0.008). Higher Arterial Diagnostic Window (ADW) (972.27 ± 1615.53 vs. 515.29 ± 730.26, p = 0.036), higher LFI (905.31 ± 2288.37 vs. 249.65 ± 1092.46, p = 0.037), and lower Transnidal Relative Velocity (TRV), a parameter defined as the maximum diameter of AVM divided by the full width at half maximum (74.31 ± 95.67 vs. 137.80 ± 152.01, p = 0.021), were also associated with complete obliteration. After adjusting for confounders, only two variables-absence of feeding artery dilation (HR 0.35, 95%CI 0.16-0.78, p = 0.010) and higher LFI (HR 1.00, 95%CI 1.00-1.00, p = 0.006) remained significant predictors. The ROC curve identified 188.4 as the LFI cutoff, and Kaplan-Meier analysis confirmed LFI's predictive value (log-rank test, χ² = 12.776, p < 0.001). Elevated LFI and absence of feeding artery dilation predict AVM complete obliteration after GKRS, indicating that overfilling and low blood flow in the nidus may promote complete obliteration.
血流动力学对脑动静脉畸形（AVM）的临床结局有显著影响。本研究旨在确定通过定量数字减影血管造影（QDSA）获得的病变充盈指数（LFI）是否能够预测伽玛刀放射外科治疗（GKRS）后的完全闭塞情况。我们回顾性分析了2011年至2021年间接受GKRS和DSA检查的AVM患者。对临床、血管构筑和QDSA血流动力学特征进行了分析。使用Cox比例风险模型和Kaplan-Meier分析，将源自QDSA的LFI评估为立体定向放射治疗（SRS）后完全闭塞的预测指标。在118例平均随访5.76±2.76年的AVM中，SRS后完全闭塞与病灶体积减小（7.27±12.3 vs. 19.2±35.7 mm³，p = 0.049）、病灶直径较小（26.0±14.9 vs. 34.1±19.8 mm，p = 0.015）以及无供血动脉扩张（21.1% vs. 46.3%，p = 0.008）相关。较高的动脉诊断窗（ADW）（972.27±1615.53 vs. 515.29±730.26，p = 0.036）、较高的LFI（905.31±2288.37 vs. 249.65±1092.46，p = 0.037）以及较低的经病灶相对速度（TRV，定义为AVM最大直径除以半高全宽的参数）（74.31±95.67 vs. 137.80±152.01，p = 0.021）也与完全闭塞相关。在对混杂因素进行校正后，只有两个变量——无供血动脉扩张（HR 0.35，95%CI 0.16 - 0.78，p = 0.010）和较高的LFI（HR 1.00，95%CI 1.00 - 1.00，p = 0.006）仍然是显著的预测指标。ROC曲线确定LFI的截断值为188.4，Kaplan-Meier分析证实了LFI的预测价值（对数秩检验，χ² = 12.776，p < 0.001）。升高的LFI和无供血动脉扩张可预测GKRS后AVM的完全闭塞，表明病灶内的过度充盈和低血流可能促进完全闭塞。
