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Research ArticleBRAIN

Territorial and Microvascular Perfusion Impairment in Brain Arteriovenous Malformations

J. Fiehler, T. Illies, M. Piening, D. Säring, N. Forkert, J. Regelsberger, U. Grzyska, H. Handels and J.V. Byrne
American Journal of Neuroradiology February 2009, 30 (2) 356-361; DOI: https://doi.org/10.3174/ajnr.A1351
J. Fiehler
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T. Illies
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M. Piening
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D. Säring
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N. Forkert
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J. Regelsberger
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U. Grzyska
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H. Handels
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J.V. Byrne
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  • Fig 1.
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    Fig 1.

    Temporal assignment of inflow time points. A, Section of an MIP of a vessel tree (based on 4D-MRA) with 2 manually selected locations (i and j). B, In maximum slope (in AUs) versus time (in seconds) curves, the time points for the maximum slope can be determined separately for i and j, and a delay can be calculated. C, The time points of those maxima are color-coded and projected onto the complete vessel tree of the AVM in the TOF-MRA.

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    Fig 2.

    A and B, Determination of the PND after manual delineation of the AVM nidus in the TOF-MRA source images (A) and after the complex shape is transferred to the coregistered PASL map (B). C, Signal intensities for each piece of cake are determined in AUs in each segment beginning from the AVM nidus to the periphery. The segments outside the skull are excluded from further analysis. s indicates seconds.

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    Fig 3.

    PASL maps (CBF-weighted) are coregistered to TOF-MRA source images. The patients either fulfill the 20% dip criterion (A, patient 18; 3647) or do not (B, patient 13; 3136). Nevertheless, dark-blue low CBF regions (arrows) are observed in both patients, suggesting local CBF decreases, possibly as a result of a local steal. Red indicates high CBF; dark blue, low CBF.

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    Fig 4.

    There is a negative correlation of the perfusion ratio with the inflow ratio in a combined analysis of all affected vascular territories (R = −0.402, P = .015). The gray line represents the regression line with 95% confidence intervals (dotted lines).

Tables

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    Table 1:

    Demographics

    No.AgeSexNidal Volume (mL)Feeding ArterySpetzler Grade20CorticalLocationSideSymptoms
    ACAMCAPCA
    155M40–++4YesTemporalRSAH >6 months ago
    233M300+++4YesParieto-occipitalLSeizures + headache
    342M330–++5YesTemporo-occipitalRSAH >6 months ago
    451M130++–3YesFrontalLTinnitus left side pronounced
    545M130––+4YesOccipitalLSeizures + headache
    628M50+++5YesTemporalLSeizures + stuttering
    733F270+++4YesFrontoparietalRSeizures
    822F20–++3YesOccipitotemporalRSeizures + visual field defects
    922M70–+–3NoTemporalRSeizures
    1017F100+––3NoFrontoparietalLIncidental
    1135F340++–2YesParietalLSeizures + dysaesthesia
    1247M80–++3YesTemporalLSeizures
    1341F20++–2YesParietalLPulsatile headache
    1451F40–+–3NoBasal gangliaLAphasia
    1545M40+–+3YesFrontoparietalL+RIntraventricular hemorrhage >6 months ago
    1652M10––+2YesParapontineRSAH >6 months ago
    1731F30–+–3YesFrontalRSeizures
    1840M10–++4YesTemporalLSeizures
    1922M120–++1YesTemporoparietalLSeizures
    2019M60+–+5NoCorpus callosumLIncidental
    • Note:—SAH indicates subarachnoid hemorrhage; R, right, L, left; –, not involved; +, involved; ACA, anterior cerebral artery; MCA, middle cerebral artery; PCA, posterior cerebral artery.

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    Table 2:

    Perfusion ratios of affected-versus-nonaffected hemispheres for each vascular territory

    Patient No.ACAMCAPCAPND (%)Visible
    11.010.951.02–Yes
    21.020.980.99–Yes
    31.020.940.88–Yes
    4–1.001.09–Yes
    50.930.960.90–Yes
    60.980.931.00–Yes
    70.960.950.90–No
    81.031.000.89–Yes
    90.990.940.94–Yes
    100.960.950.9049Yes
    111.001.010.89–Yes
    121.190.980.9439No
    130.960.970.93–Yes
    140.950.980.9752Yes
    150.990.990.99–No
    161.091.021.02–Yes
    171.011.000.99–Yes
    180.990.981.0262Yes
    190.970.931.01–Yes
    200.980.920.8278Yes
    • Note:—PND indicates perinidal dip.

    • View popup
    Table 3:

    Inflow times at predefined measuring points

    Affected Hemisphere (in seconds)Contralateral Hemisphere (in seconds)Ratio Affected/ Contralateral
    ICA10.8 ± 3.911.9 ± 4.20.96 ± 0.19
    MCA9.2 ± 2.59.5 ± 2.81.00 ± 0.33
    ACA10.2 ± 2.510.3 ± 2.70.94 ± 0.23
    PCA12.0 ± 5.012.4 ± 4.90.90 ± 0.16
    TS11.8 ± 3.011.6 ± 3.61.09 ± 0.94
    • Note:—ICA indicates internal carotid artery; TS, transverse sinus.

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American Journal of Neuroradiology: 30 (2)
American Journal of Neuroradiology
Vol. 30, Issue 2
February 2009
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Territorial and Microvascular Perfusion Impairment in Brain Arteriovenous Malformations
J. Fiehler, T. Illies, M. Piening, D. Säring, N. Forkert, J. Regelsberger, U. Grzyska, H. Handels, J.V. Byrne
American Journal of Neuroradiology Feb 2009, 30 (2) 356-361; DOI: 10.3174/ajnr.A1351

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Territorial and Microvascular Perfusion Impairment in Brain Arteriovenous Malformations
J. Fiehler, T. Illies, M. Piening, D. Säring, N. Forkert, J. Regelsberger, U. Grzyska, H. Handels, J.V. Byrne
American Journal of Neuroradiology Feb 2009, 30 (2) 356-361; DOI: 10.3174/ajnr.A1351
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Cited By...

  • Feasibility of Flat Panel Detector CT in Perfusion Assessment of Brain Arteriovenous Malformations: Initial Clinical Experience
  • Evaluation of 4D Vascular Flow and Tissue Perfusion in Cerebral Arteriovenous Malformations: Influence of Spetzler-Martin Grade, Clinical Presentation, and AVM Risk Factors
  • Analysis of the Influence of 4D MR Angiography Temporal Resolution on Time-to-Peak Estimation Error for Different Cerebral Vessel Structures
  • Persistent Hemodynamic Changes in Ruptured Brain Arteriovenous Malformations
  • Whole-Brain Perfusion CT Patterns of Brain Arteriovenous Malformations: A Pilot Study in 18 Patients
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