Hemodynamic changes in patients with arteriovenous malformations assessed using high-resolution 3D radial phase-contrast MR angiography.
Hemodynamic changes in patients with arteriovenous malformations assessed using high-resolution 3D radial phase-contrast MR angiography.
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DOI：
10.3174/ajnr.a3010
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发表时间：
2012-09
期刊：
影响因子：
--
通讯作者：
Turski P
中科院分区：
文献类型：
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作者：
Chang W;Loecher MW;Wu Y;Niemann DB;Ciske B;Aagaard-Kienitz B;Kecskemeti S;Johnson KM;Wieben O;Mistretta C;Turski P
动静脉畸形的出血风险很高，但治疗存在显著的发病率和死亡率风险，包括永久性神经系统后遗症。有症状AVM患者的WSS和其他血流动力学参数发生改变，血流动力学分析可能有助于将患者分为不同的风险组。在这项研究中，我们检查了症状稳定患者和急性症状患者的血流动力学数据，以确定可能有助于风险分层的趋势。使用径向读出的相衬MRA（PC-VIPR）是一种快速、高分辨率的技术，可以在大约5分钟的扫描时间内获得全脑速度编码血管造影片。使用PC-VIPR扫描10例AVM患者;使用相位对比采集的速度数据计算AVM供血血管和正常对侧血管的速度、面积、流量和WSS。无症状表现或轻度症状的患者（n = 4）与正常对侧血管相比，供血血管的WSS无显著差异，而表现为出血、严重头痛/癫痫发作或局灶性神经功能缺损的患者（n = 6）与对侧血管相比，供血血管的WSS显著较高。在本研究中，我们证明可以在临床有用的成像时间内无创地获得AVM患者的WSS和其他血流动力学参数的估计值。供血血管和正常血管之间WSS的变化似乎与患者的临床表现有关。结合现有风险因素，进一步分析血流动力学变化可能会改善AVM患者的特征和分期。
Arteriovenous malformations have a high lifetime risk of hemorrhage; however, treatment carries a significant risk of morbidity and mortality, including permanent neurologic sequelae. WSS and other hemodynamic parameters are altered in patients with symptomatic AVMs, and analysis of hemodynamics may have value in stratifying patients into different risk groups. In this study, we examined hemodynamic data from patients with stable symptoms and those who presented with acute symptoms to identify trends which may help in risk stratification. Phase-contrast MRA using a radial readout (PC-VIPR) is a fast, high-resolution technique that can acquire whole-brain velocity-encoded angiograms with scan times of approximately 5 minutes. Ten patients with AVMs were scanned using PC-VIPR; velocity, area, flow, and WSS in vessels feeding the AVMs and normal contralateral vessels were calculated using velocity data from the phase-contrast acquisition. Patients with an asymptomatic presentation or mild symptoms (n = 4) had no significant difference in WSS in feeding vessels compared with normal contralateral vessels, whereas patients presenting with hemorrhage, severe headaches/seizures, or focal neurologic deficits (n = 6) had significantly higher WSS in feeding vessels compared with contralateral vessels. In this study, we demonstrate that estimates of WSS and other hemodynamic parameters can be obtained noninvasively in patients with AVMs in clinically useful imaging times. Variation in WSS between feeders and normal vessels appears to relate to the clinical presentation of the patient. Further analysis of hemodynamic changes may improve characterization and staging of AVM patients, when combined with existing risk factors.