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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 25:1636-1644, November-December 2004
© 2004 American Society of Neuroradiology

BRAIN

Toward Normal Perfusion after Radiosurgery: Perfusion MR Imaging with Independent Component Analysis of Brain Arteriovenous Malformations

Wan-Yuo Guo^a,e, Yu-Te Wu^b,f, Hsiu-Mei Wu^a,e, Wen-Yuh Chung^c,e, Yi-Hsuan Kao^f, Tzu-Chen Yeh^a,b,e, Cheng-Ying Shiau^d,e, D. Hung-Chi Pan^c,e, Yue-Cune Chang^h and Jen-Chuen Hsieh^b,e,g

^a Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
^b Departments of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
^c Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
^d Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
^e Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
^f Institute of Radiological Science, National Yang-Ming University, Taipei, Taiwan, ROC
^g Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan, ROC
^h Department of Mathematics, Tamkang University, Taipei, Taiwan, ROC

Address reprint requests to Wan-Yuo Guo, MD, PhD, Department of Radiology, Taipei Veterans General Hospital, No. 201, Section II, Shih-Pai Road, 112 Taipei, Taiwan

BACKGROUND AND PURPOSE: Brain perfusion is disturbed by cerebral arteriovenous malformations (AVMs). Our study was conducted to determine the radiosurgical effects on this disturbed perfusion.

METHODS: MR perfusion imaging with independent component analysis was performed in five healthy subjects and 19 patients with AVM before and after radiosurgery (every 6 months up to 2 years). Perfusion map relative cerebral blood volume (rCBV), cerebral blood flow (rCBF), and mean transient time (rMTT) were assessed. Regions of interest (ROIs) on AVM target sections were defined as follows: N, AVM nidus; H, the rest of the ipsilateral hemisphere; P, immediately posterior to the nidus; A, immediately anterior to the nidus; Ar, anterior remote; Pr, posterior remote. Similar ROIs in the contralateral hemisphere (N1, H1, P1, A1, Pr1, and Ar1) served as internal references. Perfusion ratios of ROI–ROI1 were defined. Nonparameteric Mann-Whitney U tests and generalized linear models were used for statistical analysis.

RESULTS: Before radiosurgery, patients’ H/H1 rCBV and rCBF ratios were significantly higher than those of healthy subjects (P < .005), indicating AVM steal. Three types of perilesional perfusion disturbance were observed. From the first postradiosurgical follow-up at 6 months, N/N1 rCBV and rCBF ratios gradually decreased to 1.0 (both P < .001), whereas rMTT ratios gradually increased to 1.0 (P < .015); H/H1, A/A1, and P/P1 rCBV and rCBF ratios decreased after radiosurgery (P < .005), indicating reversal of steal toward normal perfusion.

CONCLUSION: Initial high transnidal flow and perinidal perfusion disturbances were demonstrated. They gradually changed toward normal perfusion after radiosurgery. This explains, in part, the pathophysiologic factors of AVM and therapeutic effects.

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