脑动静脉畸形放射外科治疗后病灶闭塞的评估——一项使用动脉自旋标记的前瞻性研究

Evaluation of Nidus Occlusion After Radiosurgery in Brain Arteriovenous Malformations-A Prospective Study Using Arterial Spin Labeling.

作者信息

Hirschmann Dorian, Marik Wolfgang, Cho Anna, Dodier Philippe, Wang Wei-Te, Hosmann Arthur, Gatterbauer Brigitte, Dorfer Christian, Serles Wolfgang, Haider Lukas, Kasprian Gregor, Frischer Josa Maria

机构信息

Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.

Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.

出版信息

Neurosurgery. 2025 Jun 27. doi: 10.1227/neu.0000000000003590.

DOI:10.1227/neu.0000000000003590

PMID:40576348

Abstract

BACKGROUND AND OBJECTIVES

The gold standard for the evaluation of brain arteriovenous malformation (AVM) nidus occlusion after stereotactic radiosurgery is digital subtraction angiography (DSA), which is an invasive technique. We evaluated the role of MRI, especially arterial spin labeling (ASL) in the assessment of nidus occlusion after radiosurgery. DSA was used as the gold standard for comparison.

METHODS

Fifty radiosurgically treated brain AVMs were included in this prospective single-center study. All patients underwent a standardized MRI protocol including following sequences: 2-dimensional T2w (TSE) in 3 planes, T1-weighted Magnetization Prepared Rapid Gradient Echo (MPRAGE), axial resolve diffusion-weighted imaging, ASL, time of flight, and time-resolved angiography with interleaved stochastic trajectories. Nidus obliteration according to the standardized MRI protocol was evaluated by an experienced neuroradiologist within 3 days after image acquisition and before DSA was subsequently performed as the reference standard. A second observer retrospectively rated MRI images of all 50 cases blinded to clinical and DSA data after the prospective study was concluded.

RESULTS

All cases rated as obliterated by the MRI protocol were confirmed by DSA. However, 26 and 28 AVMs were rated as patent by the observers, which was verified in 22 (85/79%) cases by DSA. ASL had the highest sensitivity among all MRI sequences. In 3 patients, ASL was the only sequence that correctly revealed a residual nidus according to 1 observer. Overall, the sensitivity and specificity of the standardized MRI protocol for detection of a residual nidus were 100/100% and 86/79%, respectively. The interobserver agreement was excellent (κ = 0.92, 0.81-1.00). At last follow-up of this prospective study, 70% of AVMs were completely obliterated.

CONCLUSION

MRI evaluation of nidus occlusion including ASL is highly sensitive for residual nidus detection and has a high potential to replace invasive DSA examinations for patients who underwent radiosurgery of brain AVMs.

摘要

背景与目的

立体定向放射治疗后评估脑动静脉畸形（AVM）病灶闭塞情况的金标准是数字减影血管造影（DSA），这是一种侵入性技术。我们评估了MRI，尤其是动脉自旋标记（ASL）在放射治疗后病灶闭塞评估中的作用。以DSA作为比较的金标准。

方法

本前瞻性单中心研究纳入了50例接受放射治疗的脑AVM患者。所有患者均接受了标准化的MRI检查方案，包括以下序列：三个平面的二维T2加权（TSE）、T1加权磁化准备快速梯度回波（MPRAGE）、轴向分辨扩散加权成像、ASL、时间飞跃法以及时间分辨随机轨迹血管造影。由一位经验丰富的神经放射科医生在图像采集后3天内且在随后进行DSA作为参考标准之前，根据标准化MRI检查方案评估病灶闭塞情况。在前瞻性研究结束后，第二位观察者对所有50例病例的MRI图像进行回顾性评分，该观察者对临床和DSA数据不知情。

结果

MRI检查方案判定为闭塞的所有病例均经DSA证实。然而，观察者将26例和28例AVM评定为通畅，其中22例（85/79%）经DSA证实。在所有MRI序列中，ASL的敏感性最高。根据一位观察者的判断，在3例患者中，ASL是唯一正确显示残留病灶的序列。总体而言，标准化MRI检查方案检测残留病灶的敏感性和特异性分别为100/100%和86/79%。观察者间一致性良好（κ = 0.92，0.81 - 1.00）。在这项前瞻性研究的最后随访中，70%的AVM完全闭塞。