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Arterial spin labeling magnetic resonance imaging: toward noninvasive diagnosis and follow-up of pediatric brain arteriovenous malformations

Authors :
Stéphanie Puget
Marie Bourgeois
David Grevent
Francis Brunelle
Manoelle Kossorotoff
Federico Di Rocco
Thomas Blauwblomme
Nathalie Boddaert
Kevin Beccaria
M. Zerah
Giovanna Paternoster
Christian Sainte-Rose
Olivier Naggara
Source :
Journal of Neurosurgery: Pediatrics. 15:451-458
Publication Year :
2015
Publisher :
Journal of Neurosurgery Publishing Group (JNSPG), 2015.

Abstract

OBJECT Arterial spin labeling (ASL)-MRI is becoming a routinely used sequence for ischemic strokes, as it quantifies cerebral blood flow (CBF) without the need for contrast injection. As brain arteriovenous malformations (AVMs) are highflow vascular abnormalities, increased CBF can be identified inside the nidus or draining veins. The authors aimed to analyze the relevance of ASL-MRI in the diagnosis and follow-up of children with brain AVM. METHODS The authors performed a retrospective analysis of 21 patients who had undergone digital subtraction angiography (DSA) and pseudo-continuous ASL-MRI for the diagnosis or follow-up of brain AVM after radiosurgery or embolization. They compared the AVM nidus location between ASL-MRI and 3D contrast-enhanced T1 MRI, as well as the CBF values obtained in the nidus (CBFnidus) and the normal cortex (CBFcortex) before and after treatment. RESULTS The ASL-MRI correctly demonstrated the nidus location in all cases. Nidal perfusion (mean CBFnidus 137.7 ml/100 mg/min) was significantly higher than perfusion in the contralateral normal cortex (mean CBFcortex 58.6 ml/100 mg/min; p < 0.0001, Mann-Whitney test). Among 3 patients followed up after embolization, a reduction in both AVM size and CBF values was noted. Among 5 patients followed up after radiosurgery, a reduction in the nidus size was observed, whereas CBFnidus remained higher than CBFcortex. CONCLUSIONS In this study, ASL-MRI revealed nidus location and patency after treatment thanks to its ability to demonstrate focal increased CBF values. Absolute quantification of CBF values could be relevant in the follow-up of pediatric brain AVM after partial treatment, although this must be confirmed in larger prospective trials.

Details

ISSN :
19330715 and 19330707
Volume :
15
Database :
OpenAIRE
Journal :
Journal of Neurosurgery: Pediatrics
Accession number :
edsair.doi.dedup.....1eb49b198a0590c811adcac9120a2605
Full Text :
https://doi.org/10.3171/2014.9.peds14194