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Abstract
Introduction: While some brain arteriovenous malformations (bAVM) demonstrate long-term stability, others demonstrate dynamic changes (new aneurysms or venous outflow stenosis) that confer higher rupture risk even after apparent cure. The objective of this study is to evaluate the feasibility and efficacy of 4D Flow MRI to quantitatively assess the hemodynamic changes in pediatric bAVMs following treatment and its use for early detection of high-risk changes. Methods: We have prospectively enrolled 20 children (mean age 11.8 ± 3.8 years) with bAVM into a single center cohort study. 4D Flow MRI was acquired in a transverse slab covering the circle of Willis using prospective gating, compressed sensing, and a resolution of 0.7 x 0.7 x 1.0 mm 3 on a 3T GE Discovery MR750 scanner. MRI at baseline and post-intervention (6-month and 1-year follow up) has been acquired for 5 patients thus far. 4D Flow data was post-processed by segmenting the main cerebral arteries and calculating cardiac-averaged flow rates in cross-sections orthogonal to the centerline of each vessel segment. Results: The flow rate accuracy was evaluated by calculating the flow conservation at the right/left internal carotid and basilar junctions, yielding average errors of 10.7% ± 12.7, 14.0% ± 9.5, and 19.3% ± 13.8 respectively. The hemisphere containing the bAVM received an average of 57.2% ± 2.8 of total brain flow at baseline, which decreased to an average of 51.2% ± 2.9 1-year follow-up. In 2 of 5 patients, the flow laterality between hemispheres flipped post-intervention with increased flow to the contralateral hemisphere. In all the post-intervention studies, we observed a decrease in flow and maximum velocities, as well as an increase in pulsatility index, in the primary feeding arteries to the bAVM (Figure). Conclusion: These preliminary results indicate that 4D Flow MRI may be a robust and useful tool for monitoring changes in intracranial flow patterns after bAVM treatment in children.
Published Version
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