INTRACRANIAL ARTERIOVENOUS MALFORMATION - RELATIONSHIPS BETWEEN CLINICAL AND RADIOGRAPHIC FACTORS AND IPSILATERAL STEAL SEVERITY
INTRACRANIAL ARTERIOVENOUS MALFORMATION - RELATIONSHIPS BETWEEN CLINICAL AND RADIOGRAPHIC FACTORS AND IPSILATERAL STEAL SEVERITY
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DOI：
10.1227/00006123-198809000-00006
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发表时间：
1988-09-01
期刊：
影响因子：
4.8
通讯作者：
BONTE, FJ
中科院分区：
文献类型：
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作者：
BATJER, HH;DEVOUS, MD;BONTE, FJ
颅内动静脉畸形（AVM）是一种高流量分流，可能危及邻近组织的灌注。分析了62例患者的临床和影像学数据，以确定其与单光子发射计算机断层扫描（SPECT）测量的盗血严重程度的关系。通过将同侧半球中手绘灌注不足区域内的局部脑血流量（rCBF）值除以总脑流量（计算为每个半球的平均rCBF），确定同侧盗血指数[Steal（i）]。在这些患者中，40%的患者年龄小于30岁，45%的患者年龄在30至50岁之间，15%的患者年龄超过50岁。48%的患者出现出血，34%的患者出现进行性功能障碍。37%的患者发生血管造影盗血，21%的患者发生术后充血并发症。所有患者均出现同侧低灌注区。23例（37%）的I Steal（i）< 0.7，20例（32%）为0.7至0.8，19例（31%）为> 0.8。在50岁以上的患者中，ISeal（i）的严重程度明显较低;这些患者中有78%的ISeal（i）> 0.8（P < 0.01）。有出血史的患者与盗血严重程度的相关性低于无流血的史的患者（P = 0.088）。有进行性功能缺损史的患者盗血严重程度高于无进行性功能缺损史的患者（P < 0.05）。在预后不良的患者中，注意到盗血严重程度降低的趋势。动静脉畸形的大小、是否存在血管造影盗血、主要供血血管的数量和穿支血管的募集似乎与盗血的严重程度无关。术前SPECT测量可以准确定量血流不对称和灌注不足，并可能评估治疗对脑血流动力学的影响。
Intracranial arteriovenous malformations (AVMs) are high flow shunts that may jeopardize the perfusion of adjacent tissue. Clinical and radiographic data from 62 patients were analyzed to determine their relationship to the severity of steal measured by single photon emission computed tomography (SPECT). The ipsilateral steal index [Steal(i)] was determined by dividing regional cerebral blood flow (rCBF) values within hand-drawn regions of hypoperfusion in the ipsilateral hemisphere by total brain flow, which was calculated as the average rCBF of each hemisphere. Of the patients, 40% were less than 30 years of age, 45% were 30 to 50 years old, and 15% were over 50. Forty-eight per cent presented with hemorrhage and 34% presented with progressive deficits. There was angiographic steal in 37%, and postoperative hyperemic complications developed in 21%. All patients had ipsilateral regions of hypoperfusion. The ISteal(i) was < 0.7 in 23 (37%), 0.7 to 0.8 in 20 (32%), and > 0.8 in 19 (31%). The ISteal(i) was significantly less severe in the patients over 50; 78% of these patients had an ISteal(i) of > 0.8 (P < 0.01). A history of hemorrhage was associated with less severe steal than that in patients who had not bled (P = 0.088). Patients presenting with a history of progressive deficits had increased severity of steal compared with those without progressive deficits (P < 0.05). A trend toward decreased severity of steal was noted in patients with unfavorable outcomes. The size of the AVM, the presence of angiographic steal, the number of major feeding vessels, and the recruitment of perforating vessels seemed to have no relationship to steal severity. Preoperative SPECT measurements can accurately quantitate flow asymmetry and hypoperfusion and potentially assess the impact of treatment on cerebral hemodynamics.