RT Journal Article
SR Electronic
T1 Noninvasive Follow-up Imaging of Ruptured Pediatric Brain AVMs Using Arterial Spin-Labeling
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1363
OP 1368
DO 10.3174/ajnr.A7612
VO 43
IS 9
A1 Hak, J.F.
A1 Boulouis, G.
A1 Kerleroux, B.
A1 Benichi, S.
A1 Stricker, S.
A1 Gariel, F.
A1 Garzelli, L.
A1 Meyer, P.
A1 Kossorotoff, M.
A1 Boddaert, N.
A1 Girard, N.
A1 Vidal, V.
A1 Dangouloff Ros, V.
A1 Blauwblomme, T.
A1 Naggara, O.
YR 2022
UL http://www.ajnr.org/content/43/9/1363.abstract
AB BACKGROUND AND PURPOSE: Brain AVMs represent the main etiology of pediatric intracranial hemorrhage. Noninvasive imaging techniques to monitor the treatment effect of brain AVMs remain an unmet need. In a large cohort of pediatric ruptured brain AVMs, we aimed to investigate the role of arterial spin-labeling for the longitudinal follow-up during treatment and after complete obliteration by analyzing CBF variations across treatment sessions.MATERIALS AND METHODS: Consecutive patients with ruptured brain AVMs referred to a pediatric quaternary care center were prospectively included in a registry that was retrospectively queried for children treated between 2011 and 2019 with unimodal or multimodal treatment (surgery, radiosurgery, embolization). We included children who underwent an arterial spin-labeling sequence before and after treatment and a follow-up DSA. CBF variations were analyzed in univariable analyses.RESULTS: Fifty-nine children with 105 distinct treatment sessions were included. The median CBF variation after treatment was −43 mL/100 mg/min (interquartile range, −102−5.5), significantly lower after complete nidal surgical resection. Following radiosurgery, patients who were healed on the last DSA follow-up demonstrated a greater CBF decrease on intercurrent MR imaging, compared with patients with a persisting shunt at last follow-up (mean, −62 [SD, 61] mL/100 mg/min versus −17 [SD, 40.1] mL/100 mg/min; P = .02). In children with obliterated AVMs, recurrences occurred in 12% and resulted in a constant increase in CBF (mean, +89 [SD, 77] mL/100 mg/min).CONCLUSIONS: Our results contribute data on the role of noninvasive arterial spin-labeling monitoring of the response to treatment or follow-up after obliteration of pediatric AVMs. Future research may help to better delineate how arterial spin-labeling can assist in decisions regarding the optimal timing for DSA.ASLarterial spin-labelingEVTendovascular treatmentIQRinterquartile rangeSRSstereotactic radiosurgery