Wang Yuting, Wei Haining, Wang Yishuang, Zhu Chengcheng, Li Rui, Cheng Meixiong
Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Center for Biomedical Imaging Research, School of Biomedical Engineering, Tsinghua University, Beijing, China.
Quant Imaging Med Surg. 2024 Dec 5;14(12):8798-8810. doi: 10.21037/qims-24-1150. Epub 2024 Nov 27.
The hemodynamics of cerebral arteriovenous malformation (cAVM) is difficult to evaluate with conventional imaging or clinical grading. The aim of this study is to: (I) investigate the association between the angioarchitecture and hemodynamic parameters in cAVM based on 4-dimentional flow magnetic resonance (4D flow MR); (II) quantify flow changes during follow-up after embolization and explore the potential of flow-guided staged embolization.
Twenty-one patients with digital subtraction angiography (DSA)-diagnosed cAVM were prospectively enrolled in a tertiary hospital consecutively from April 2022 to January 2024 for a cohort study. Lesion angioarchitecture at baseline was assessed by DSA. 4D flow MR was performed to assess hemodynamics. Flow-derived parameters included velocity, flow, time averaged wall shear stress (WSS) of the main feeding artery, and inflow-to-outflow ratio. Hemodynamic metrics were compared between groups with different angioarchitecture and rupture status. Seven patients had a post embolization follow-up 4D flow MR scan with a median interval of 8.9 months.
Among multiple angioarchitectural features, supply by a single feeding artery (6/7 in the ruptured group and 0/14 in the unruptured group, P<0.001) and intra nidal aneurysm (7/7 in the ruptured group and 5/14 in the unruptured group, P=0.007) were significantly associated with lesion rupture. The ruptured cAVM showed lower total flow of feeding arteries (2.09±3.15 . 6.05±3.76 mL/s, P=0.029), lower WSS (0.99±0.73 . 2.10±0.45 Pa, P=0.023) and higher inflow-to-outflow ratio (2.46±0.79 . 1.46±0.55, P=0.041). During follow-up, the total flow of the lesions decreased by 10-100% after the embolization. The nidus volume decreased significantly (reduction rate: 59.6-100%, P=0.009). The flow of the minor feeding artery increased in 2 cases out of 5, indicating flow remodeling. Three patients had a second embolization guided by the follow-up imaging.
cAVM lesions tend to have heterogeneous hemodynamics even with similar angioarchitecture. This could be captured and quantified on an individual basis using 4D flow MR. Flow analysis by MR offers the potential to guide a second embolization.
脑动静脉畸形（cAVM）的血流动力学难以通过传统成像或临床分级进行评估。本研究的目的是：（I）基于四维血流磁共振成像（4D流MR）研究cAVM的血管结构与血流动力学参数之间的关联；（II）量化栓塞后随访期间的血流变化，并探索血流引导的分期栓塞的潜力。
2022年4月至2024年1月，一家三级医院连续前瞻性纳入21例经数字减影血管造影（DSA）诊断为cAVM的患者进行队列研究。通过DSA评估基线时的病变血管结构。进行4D流MR以评估血流动力学。血流衍生参数包括速度、流量、主要供血动脉的时间平均壁面切应力（WSS）以及流入流出比。比较不同血管结构和破裂状态组之间的血流动力学指标。7例患者在栓塞后进行了4D流MR随访扫描，中位间隔时间为8.9个月。
在多种血管结构特征中，单支供血动脉供血（破裂组6/7，未破裂组0/14，P<0.001）和瘤内动脉瘤（破裂组7/7，未破裂组5/14，P=0.007）与病变破裂显著相关。破裂的cAVM显示供血动脉总流量较低（2.09±3.15对6.05±3.76 mL/s，P=0.029），WSS较低（0.99±0.73对2.10±0.45 Pa，P=0.023），流入流出比更高（2.46±0.79对1.46±0.55，P=0.041）。随访期间，栓塞后病变的总流量下降了10%至100%。瘤体体积显著减小（缩小率：59.6%至100%，P=0.009）。5例中有2例次要供血动脉的血流增加，表明血流重塑。3例患者在随访成像引导下进行了第二次栓塞。
即使血管结构相似，cAVM病变的血流动力学也往往具有异质性。这可以通过4D流MR在个体基础上进行捕捉和量化。MR血流分析为指导第二次栓塞提供了潜力。
