Abstract
ObjectivesTo evaluate whether the signal intensity ratio (rSI) of the draining vein on silent MR angiography is correlated with arteriovenous (A–V) transit time on digital subtraction angiography (DSA), thereby identifying high-flow A–V shunt in brain arteriovenous malformation (BAVM), and to analyze whether the rSI and the characteristic of draining veins on silent MRA are associated with hemorrhage presentation.MethodsEighty-one draining veins of 46 participants with BAVM (mean age 33.2 ± 16.9 years) who underwent silent MRA and DSA were evaluated retrospectively. The correlation between the rSI of the draining vein on silent MRA and A–V transit time on DSA was examined. The AUC-ROC was obtained to evaluate the performance of the rSI in determining the presence of high-flow A–V shunt. The characteristics of draining veins with the maximum rSI (rSImax) were further compared between the hemorrhagic and non-hemorrhagic untreated BAVM.ResultsThe rSI of each draining vein on silent MRA was significantly correlated with A–V transit time from DSA (r = −0.81, p < .001). The AUC-ROC was 0.89 for using the rSI to determine the presence of high-flow A–V shunt. A cut-off rSI value of 1.09 yielded a sensitivity of 82.4% and a specificity of 82.8%. The draining vein with rSImax and no ectasia was significantly more observed in the hemorrhagic group (p = 0.045).ConclusionsThe rSI of the draining vein on silent MRA is significantly correlated with A–V transit time on DSA, and it can be used as an indicator of high-flow A–V shunt in BAVM.Key Points• The signal intensity ratio (rSI) of the draining vein on silent MRA significantly correlated with arteriovenous (A–V) transit time of brain arteriovenous malformation (BAVM) on digital subtraction angiography (DSA).• The area under the receiver operating characteristic curve (AUC) was 0.89 for using the rSI of draining veins to determine high-flow A–V shunt.• Draining veins with maximum rSI and no ectasia were significantly more observed in the hemorrhagic group of BAVM (p = 0.045).
Highlights
Brain arteriovenous malformation (BAVM) is a cerebrovascular disease in which arteries connect directly with veins without intervening capillaries [1, 2]
The signal intensity ratio of the draining vein on silent MR angiography (MRA) significantly correlated with arteriovenous (A–V) transit time of brain arteriovenous malformation (BAVM) on digital subtraction angiography (DSA)
The assessment of arteriovenous (A–V) shunt was essential for risk stratification of untreated brain arteriovenous malformation (BAVM) and outcome evaluation in BAVM with endovascular or radiosurgical treatment
Summary
Brain arteriovenous malformation (BAVM) is a cerebrovascular disease in which arteries connect directly with veins without intervening capillaries [1, 2]. The main treatment modalities for BAVM include surgery, radiosurgery, and endovascular treatment [2, 3]. Previous studies have indicated that BAVM with high-flow arteriovenous (A–V) shunt are associated with increased perioperative hemorrhagic events and higher risk of incomplete obliteration [4,5,6,7]. Identification and targeted embolization of high-flow A–V shunt in BAVM are crucial in endovascular management before radiosurgery or surgical resection. Digital subtraction angiography (DSA) is the gold standard for evaluation of high-flow A–V shunt owing to its high spatial and temporal resolution. Non-invasive imaging methods such as timeresolved contrast-enhanced MRA and unenhanced timeresolved phase-contrast MRA can provide hemodynamic information, yet they require injection of contrast agent or have limited temporal resolution [8,9,10]
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