A simple relationship between radiological arteriovenous malformation hemodynamics and clinical presentation: a prospective, blinded analysis of 31 cases

Js, Norris; Valiante, Taufik A.; Wallace, Megan Jane; Ra, Willinsky; Wj, Montanera; Kg, Terbrugge; Tymianski, Michael

doi:10.3171/jns.1999.90.4.0673

Cited by 66 publications

(39 citation statements)

References 19 publications

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“…Some studies identified an elevated flow in feeding arteries, 35 whereas other studies found a reduced flow. 22,36 Our finding of a prolonged transit time is in accordance with disequilibrium of faster inflow, whereas outflow remains unchanged or is reduced. It has to be pointed out that transit times as measured in our study are not necessarily equivalent with the time, which is required for the blood to flow through the AVM nidus.…”

Section: Discussionsupporting

confidence: 73%

Persistent Hemodynamic Changes in Ruptured Brain Arteriovenous Malformations

Illies

Forkert

Saering

et al. 2012

Stroke

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Background and Purpose-Hemodynamic properties of brain arteriovenous malformations (AVMs) with risk factors for a future hemorrhage are essentially unknown. We hypothesized that AVMs with anatomic properties, which are associated with an increased rupture risk, exhibit different hemodynamic characteristics than those without these properties. Methods-Seventy-two consecutive patients with AVMs diagnosed by conventional angiography underwent MRI examination, including time-resolved 3-dimensional MR angiography. Signal-intensity curves derived from the timeresolved 3-dimensional MR angiography datasets were used to calculate relative blood flow transit times through the AVM nidus based on the time-to-peak parameter. For identification of characteristics associated with altered transit times, a multiple normal regression model was fitted with stepwise selection of the following regressors: intracranial hemorrhage, deep nidus location, infratentorial location, deep drainage, associated aneurysm, nidus size, draining venous stenosis, and number of draining veins. Results-A previous intracranial hemorrhage is the only characteristic that was associated with a significant alteration of the relative transit time, leading to an increase of 2.4 seconds (95% CI, 1.2-3.6 seconds;, P<0.001) without adjustment and 2.1 seconds (95% CI, 0.6-3.6 seconds; P=0.007) with adjustment for all other regressors considered. The association was independent of the bleeding age. Conclusion-Hemodynamic

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Section: Discussionsupporting

confidence: 73%

Persistent Hemodynamic Changes in Ruptured Brain Arteriovenous Malformations

Illies

Forkert

Saering

et al. 2012

Stroke

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“…Further studies are needed to provide direct experimental confirmation of this relationship. Norris et al 29 suggested that AVMs in which contrast medium took longer to reach maximum concentration in the feeders were more likely to rupture. On the other hand, Matsumoto et al 23 reported that the MTT of feeders tended to be shorter in hemorrhagic than in nonhemorrhagic AVMs.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Mean Transit Time of Contrast Medium in Ruptured and Unruptured Arteriovenous Malformations

Todaka

Hamada

Kai

et al. 2003

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Background and Purpose-To clarify hemodynamic risk factors for hemorrhage in arteriovenous malformations (AVMs), the mean transit time (MTT) of feeding arteries and draining veins in AVMs with and without hemorrhage was measured and analyzed. Methods-Morphological features such as the number and diameter of draining and feeding vessels and the AVM nidus volume were evaluated in 30 patients with supratentorial AVMs. The MTT of feeding arteries and draining veins was measured with the use of time-density curves obtained by digital subtraction angiography. The correlation between hemorrhage and morphology and hemorrhage and MTT was analyzed statistically. Results-The nidus volume was not significantly different between hemorrhagic and nonhemorrhagic AVMs. However, between ruptured and unruptured AVMs there was a significant difference in the mean number of draining veins (1.5Ϯ0.69 versus 2.3Ϯ0.50; Pϭ0.006), the MTT of the feeding artery (1.10Ϯ0.24 versus 1.62Ϯ0.55; Pϭ0.03), and the ratio of the MTT of the draining to the feeding vessels (1.71Ϯ0.43 versus 1.05Ϯ0.07; PϽ0.001). Conclusions-A high ratio of the MTT of draining veins to feeding arteries suggests disequilibrium between nidal inflow and outflow. The consequent increased pressure in the draining vein may contribute to the development of AVM hemorrhage.

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“…Factors related to high flow such as dilation of the feeding artery and a fistulous component in the nidus can give rise to relative arterial functional steal in the region of the nidus. This has been described in the literature in the past [8][9][10] and has been demonstrated in perfusion studies. 25,26 This arterial steal with subsequent local hypoxemia may lead to an increased perinidal angiogenesis with blood being rerouted from the normal brain tissue due to the sump effect of the BAVM.…”

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confidence: 99%

“…This pathomechanism was referred to as "arterial steal." [8][9][10] However, the actual existence of steal has been questioned because it has been difficult to demonstrate quantitatively. 7,11,12 Others have raised the possibility that seizures are more often related to a disrupted venous outflow pattern than to an inadequacy of arterial blood supply.…”

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confidence: 99%

Angioarchitecture of Brain AVM Determines the Presentation with Seizures: Proposed Scoring System

Shankar

Menezes

Pohlmann‐Eden³

et al. 2012

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Seizures are a common presentation in patients with brain arteriovenous malformations, but the pathogenesis of seizures remains poorly understood. The purpose of our study was to analyze various morphologic and hemodynamic characteristics of unruptured BAVMs presenting primarily with seizures and, on the basis of these, to propose a scoring system to predict seizures in patients with BAVMs.

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A simple relationship between radiological arteriovenous malformation hemodynamics and clinical presentation: a prospective, blinded analysis of 31 cases

Abstract: These simple hemodynamic parameters, which can be obtained without added risk to the patient, may help identify a subset of individuals in whom AVMs pose a higher risk of future hemorrhage and who may therefore warrant more expeditious treatment.

Cited by 66 publications

References 19 publications

Persistent Hemodynamic Changes in Ruptured Brain Arteriovenous Malformations

Persistent Hemodynamic Changes in Ruptured Brain Arteriovenous Malformations

Analysis of Mean Transit Time of Contrast Medium in Ruptured and Unruptured Arteriovenous Malformations

Angioarchitecture of Brain AVM Determines the Presentation with Seizures: Proposed Scoring System

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