Evaluation of cerebral AVM's using transcranial Doppler ultrasound

Abstract

Blood flow velocities in basal cerebral arteries were recorded noninvasively in 28 patients with cerebral arteriovenous malformations (AVM's) and were correlated with the angiographic findings. In normal arteries remote from the AVM, flow velocities ranged from 44 to 94 cm/sec (median 65 cm/sec) with pulsatility indexes from 0.65 to 1.10 (median 0.87). This is consistent with findings in normal individuals. Arteries feeding the AVM's were identified by the high flow velocities (ranging from 75 to 237 cm/sec, median 124 cm/sec). The pulsatility index ranged from 0.22 to 0.74 (median 0.48). The difference of these results from findings in normal remote arteries was highly significant (p less than 0.001). Hyperventilation tests illustrated the hemodynamic difference between an AVM and normal cerebrovascular beds. Flow velocity measurements permitted noninvasive diagnosis of AVM's in 26 of the 28 patients. Furthermore, the identification of individual feeding arteries permitted good definition of the anatomical localization of individual AVM's. Flow velocity measurements combined with computerized tomography scans are useful in the diagnosis of AVM's. With the feeding artery's configuration identified on angiography, flow velocity measurements permit a new insight into the "hemodynamic dimension" of an AVM and its possible effects on adjacent normal brain-tissue perfusion in the individual patient.

Quantitative Assessment of Changes in Cerebral Arteriovenous Malformation Hemodynamics After Embolization

“…In their seminal work, Lindegaard et al used transcranial Doppler ultrasound to demonstrate high flow velocities within AVM feeder arteries and concomitant low perfusion pressure in areas of brain adjacent to the AVM responsible for steal phenomena. 13 More recently, Kaspera et al used transcranial color-coded Doppler to examine AVM flow after staged embolization.…”

“…The mean number of pedicles embolized per session was 3 (range 1-8) and the mean total number of pedicles embolized was 8 (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] (Table 2). However, the total number of pedicles embolized (R 2 =0.64, P<0.001) and embolization of an intranidal fistula (R 2 =0.40, P=0.002) are each significantly associated with total decreased AVM flow after completion of all sessions of embolization.…”

Utilidad del doppler transcraneal en la hemorragia subaracnoidea: Revisión

“…En 1986, Lindegaard publica su experiencia en la evaluación de pacientes con malformaciones arteriovenosas y sugiere utilizar la proporción entre la velocidad de fl ujo de la arteria cerebral media y la carótida ipsilateral para diferenciar entre el incremento de la velocidad de fl ujo como consecuencia de una estenosis intracraneal o de vasoespasmo arterial, del provocado por una malformación arteriovenosa 18 . El resultado permite diferenciar entre el aumento de la vfm causado por vasoespasmo e hiperfl ujo (provocado por una malformación arteriovenosa o por el tratamiento con hemodilución).…”

The application of ultrasound in the management of cerebral arteriovenous malformation

“…Side-to-side differences were significantly higher in patients with AVMs than in those without a malformation. In 1986, Lindegaard et al [20] had recorded blood flow velocities in basal cerebral arteries noninvasively in 28 patients with AVMs. In normal arteries remote from the AVM, flow velocities ranged from 44 to 94 cm/s (median 65 cm/s) with PIs from 0.65 to 1.10 (median 0.87).…”