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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Intranidal flow and hemodynamic characteristics of cerebral AVMs evaluated by time and coloured-coded 3D-MRA

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  • Till Illies - Neuroradiologische Klinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg
  • Nils D. Forkert - Neuroradiologische Klinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg
  • Thorsten Ries - Neuroradiologische Klinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg
  • Jens Fiehler - Neuroradiologische Klinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg
  • Manfred Westphal - Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg
  • Jan Regelsberger - Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocDI.05.01

doi: 10.3205/14dgnc136, urn:nbn:de:0183-14dgnc1364

Published: May 13, 2014

© 2014 Illies et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: MRI-technique has been upgraded by colour- and time-coded sequences providing additional information about cerebrovascular malformations. Hemodynamic characteristics and intranidal flow patterns of cerebral AVMs, ruptured and non-ruptured, were studied by 4D-MRI and compared to conventional angiography (DSA).

Method: Thirty-one consecutive AVM patients were studied by DSA and 4D-MRA which were evaluated by blinded raters according to the Spetzler-Martin scale and morphological features scaled into 3 types (homogenous flow=1, unidirectional flow=2, heterogeneous flow=3). In addition identification of characteristics was associated with altered transit times. Multiple normal regression model was fitted with stepwise selection of the risk factors: ICH, deep nidus, infratentorial location, deep drainage, associated aneurysm, nidus size, venous stenosis and number of draining veins.

Results: The Spetzler-Martin grades were different to DSA in 5 and 3 cases (Rater 1 and 2) with an excellent interrater reliability of K=0.96 (4/31, one by size and three by drainage). Each reader missed 5 feeders in 4D-MRA in comparison to DSA. Draining veins could be distinguished in the temporal course in 7 on DSA but in 8 and 12 on 4D-MRA (Rater 1 and 2), giving an interrater reliability of K=0.79. In rating of the intranidal flow a type 1 pattern was recognizable in 9 (30%) nidus, type 2 in 18 (60%) a type 3 in 3 (10%) patients. Previous hemorrhage was shown to be the only characteristic that was associated with a significant alteration of transit time (increase of 2.4 sec; 95% CI, 1.2–3.6 seconds; P<0.001).

Conclusions: Although 4D-MRI was convincing in showing distinct flow patterns within the nidus, these features were not related to the rupture status of the AVM and small feeding arteries were missed on MRI. Despite these findings transit times were significant lower in ruptured AVMs and drainage patterns better visualized on 4D-MRI indicating that time- and color-coded MRI is anyhow able to add important informations on morphological and hemodynimc aspects of cerebral AVMs.