Susceptibility weighted imaging for qualitative grading of persistent arteriovenous shunting in deep-seated arteriovenous malformations after stereotactic radiation surgery

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Hsu, Charlie Chia-Tsong
Fomin, Igor
Wray, Bradley
Brideaux, Adam
Lyons, Duncan
Kumar, Mahendrah Jaya
Watkins, Trevor
Haacke, E Mark
Krings, Timo
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2022
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Abstract

BACKGROUND AND PURPOSE: To investigate Susceptibility Weighted Imaging (SWI) signal changes in the draining vein of deep-seated arterio-venous malformations (AVMs) following stereotactic radiosurgery (SRS). METHODS AND MATERIALS: This is a retrospective study of 32 patients with deep-seated AVMs who were treated with SRS. Pre-SRS treatment and post-SRS treatment MRI were performed at 6, 12, and 24-month intervals. Deep-seated AVMs were classified based on their anatomical location and venous drainage pattern. AVM nidal volume (cm3) was estimated using the ABC/2 method. AV shunting of the AVM draining veins were graded according to its SWI signal intensity: hyperintense (grade III), mixed signal intensity (grade II), hypointense (grade I) and absent (grade 0). Conventional time-of-flight (TOF)-MRA and contrast enhanced (CE)-MRA sequences were performed to document the patency of the vein. RESULTS: Pre-SRS treatment AVM draining veins were either grade III 18/32 (56%) or grade II 14/32 (44%). Using mixed effects analysis, we demonstrate that each month following the SRS treatment nidal volumes decreased at the rate of 0.51 cm3/per month (CI -0.61 to (-0.40)) p =.00. Following the treatment, there was a clinically significant relationship between the signal and nidal volume: signal 0 corresponded with average nidal volume of 1.81 cm3 (CI 1.40-2.21), signal 1 with nidal volume of 2.06 cm3 (CI 1.69-2.44), signal 2 with nidal volume 2.73 cm3 (CI 2.35-3.11) and signal 3 with nidal volume 3.13 cm3 (CI 2.70-3.56) p = .00. CONCLUSION: Post-SRS AVM draining veins shows a stepwise regression of the SWI signal grades which can be reliably used as a surrogate to monitor the reduction of AV shunting.

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The Neuroradiology Journal

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This publication has been entered in Griffith Research Online as an advanced online version.

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Neurosciences

Biomedical imaging

Science & Technology

Life Sciences & Biomedicine

Neuroimaging

Neurosciences & Neurology

Arteriovenous malformation

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Hsu, CC-T; Fomin, I; Wray, B; Brideaux, A; Lyons, D; Kumar, MJ; Watkins, T; Haacke, EM; Krings, T, Susceptibility weighted imaging for qualitative grading of persistent arteriovenous shunting in deep-seated arteriovenous malformations after stereotactic radiation surgery, The Neuroradiology Journal, 2022

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