Signal intensity ratio of draining vein on silent MR angiography as an indicator of high-flow arteriovenous shunt in brain arteriovenous malformation

Abstract

Objectives To 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. Methods Eighty-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. Results The 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). Conclusions The 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).

Commentary on “Signal intensity ratio of draining vein on silent MR angiography as an indicator of high-flow arteriovenous shunt in brain arteriovenous malformation”

“…Our angiogram data suggested a fast inflow along with restricted venous outflow structure was predictive of future hemorrhage risk. The present study also confirmed a higher ratio of undilated draining vein with high signal intensity or fast flow though AVM lesion in ruptured AVM [2]. The fast flow through AVM nidus was found to be correlated with reduced mural cell coverage of AVM vessels and may contribute to vascular instability in AVM with hemorrhage [5].…”

“…The fast flow through AVM nidus was found to be correlated with reduced mural cell coverage of AVM vessels and may contribute to vascular instability in AVM with hemorrhage [5]. This silent MRA study of AVM presented the relationship between venous signal intensity and the transit time through nidus [2], which supplement the spatial resolution of hemodynamic analysis on angiogram. However, it should be noted that the signal intensity and transit time were not derived from the same vascular segment, and the accurate meaning of signal intensity on silent MRA was not fully understood.…”

“…The hemodynamic and angioarchitectural features were also potential target and tailored individually in surgical and endovascular treatment. This preliminary study introduced a non-invasive approach to evaluate the high-flow A-V shunt and revealed a negative correlation between venous signal intensity on silent MRA and transit time of blood flow through AVM nidus on DSA [2]. A draining vein of high signal intensity on silent MRA suggests fast blood flow through AVM nidus.…”

The dural angioleiomyoma harbors frequent GJA4 mutation and a distinct DNA methylation profile

“…Intracranial vascular lesions encompass a broad spectrum of entities which differ in hemodynamic physiology, structure and prognosis [ 1 – 3 ]. They have been increasingly seen in clinical practice primarily because of new developments in imaging technology [ 4 ]. In recent years, an effort has been made to categorize these vascular anomalies, classified over the years in a variety of ways by many authors, often on the basis of blood flow patterns, amplified magnetic resonance imaging (MRI), angiography, histopathological features or demographics [ 5 ].…”

Non-contrast enhanced silent MR angiography to evaluate hemodynamics and morphology of unruptured intracranial aneurysms: a comparative computational fluid dynamics study

“…In addition to sound reduction, silent MRA outperformed time-of-flight MRA (TOF-MRA) in visualizing flow in a small diameter, slow-flow, multidirectional flow, whirlpools, turbulent flow blood vessels, and flowing blood in stents or residual space in aneurysms after coiling 7. Consequently, silent MRA has been proven to better visualize unruptured aneurysms, Moyamoya vessels, brain arteriovenous malformations, intracranial dural arteriovenous fistulas, and follow-up after endovascular treatment of cerebral aneurysms than TOF-MRA 8–11. However, to date, the ability of silent MRA to reliably assess the three-dimensional (3D) morphology and hemodynamics of IAs remains unclear.…”