Abstract
BackgroundThere are controversies concerning the natural history of arteriovenous malformations (AVMs) in literature and it is not clear which AVMs should be treated and which should be just observed. Objective criteria beyond growth in serial MRIs or angiographies are needed. The use of black blood MRI is currently under investigation for evaluating the rupture risk of cerebral aneurysms, however its use for assessment of AVMs has yet to be evaluated. We therefore conducted a feasibility study on the application of black blood MRI (bbMRI) in AVMs to assess rupture risk.MethodsRetrospective study of 10 patients with intracranial AVMs and 4 patients with arteriovenous fistulas who received a black blood MRI before treatment.ResultsAVM niduses (9/10) show contrast enhancement irrespective of rupture or size. All arteriovenous fistulas (4 / 4) were contrast enhancing irrespective of rupture.ConclusionHigh flow malformations are in a permanent stage of inflammation which does not seem to allow conclusions on their rupture risk at the current stage. BbMRI is a feasible method of identifying inflammation in AVMs and arteriovenous fistulas. However, future prospective studies are needed to evaluate whether bbMRI contrast enhancement correlates with rupture risk.
Highlights
There are controversies concerning the natural history of arteriovenous malformations (AVMs) in literature and it is not clear which Arteriovenous Malformations (AVM) should be treated and which should be just observed
* Correspondence: athanasios.petridis@med.uni-duesseldorf.de 1Department of Neurosurgery, Heinrich Heine University, Duesseldorf, Germany Full list of author information is available at the end of the article enhancement in the aneurysm wall reflects inflammatory processes and inflammation in the AVM vessel wall has been shown histologically [5], we studied the possibility of black blood MRI (bbMRI) on high flow AVMs in order to evaluate differences in inflammatory processes which could signify instability
After demonstrating that bbMRI contrast enhancement is present in AVMs as well as in arteriovenous fistulas we looked for differences between ruptured and non-ruptured AVMs as well as size and inflammation
Summary
There are controversies concerning the natural history of arteriovenous malformations (AVMs) in literature and it is not clear which AVMs should be treated and which should be just observed. The use of black blood MRI is currently under investigation for evaluating the rupture risk of cerebral aneurysms, its use for assessment of AVMs has yet to be evaluated. We conducted a feasibility study on the application of black blood MRI (bbMRI) in AVMs to assess rupture risk. The natural history of arteriovenous malformations (AVMs) represents a controversial topic. Little is known about the pathophysiological processes in an AVM and even less about any factors which could predict a risk of bleeding. The black blood MRI (bbMRI) appeared on the diagnostic horizon and offers a promising outlook in predicting rupture risk in intracranial aneurysms [3, 4].
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