title: Cerebral hemodynamics and metabolism in patients with cerebral arteriovenous malformations: an evaluation using positron emission tomography scanning.
abstract: OBJECTIVE
  The purpose of this study was to evaluate cerebral hemodynamic and metabolic features in patients with arteriovenous malformations (AVMs) by using positron emission tomography (PET) scanning.
  
  
  METHODS
  Twenty-four patients with supratentorial cerebral AVMs participated in PET studies in which 15O inhalation steady-state methods were used. The authors recorded the values of regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), the regional oxygen extraction fraction (rOEF), and the regional cerebral metabolic rate of O2 (rCMRO2) at three designated regions of interest (ROIs) in each patient. These ROIs included perilesional (ROI-p), ipsilateral remote (ROI-i), and contralateral symmetrical (ROI-c) brain regions. To identify the factors that exert a direct effect on the hemodynamics of brains affected by AVM, we also separated the lesions according to their size and flow type shown on angiograms, and grouped the patients according to the presence or absence of progressive neurological deficits. We then compared the PET parameters at different ROIs in individual patients and evaluated the mean values obtained for all 24 patients according to AVM flow type and size, and the presence or absence of progressive neurological deficits.
  
  
  CONCLUSIONS
  Overall, mean rCBV and rOEF values were significantly higher in ROI-p than in ROI-c (p = 0.00046 and p = 0.015, respectively). No significant differences were seen between the ROI-i and ROI-c with respect to rCBF, rCBV, and rOEF. Mean rCMRO2 values were similar in the three ROIs; however, the mean rCBF was significantly lower in the ROI-p than in the ROI-c in patients with high-flow AVMs (p = 0.019), large AVMs (p = 0.017), and progressive neurological deficits (p = 0.021). Furthermore, the mean rOEF values were significantly higher in the ROI-p than in the ROI-c in patients with high-flow AVMs (p = 0.005), large AVMs (p = 0.019), and progressive neurological deficits (p = 0.017). The PET studies revealed hemodynamic impairment characterized by decreased rCBF and increased rOEF and rCBV values in the ROI-p of patients with large, high-flow AVMs regardless of whether they exhibited progressive neurological deficits.
authors.affiliation: Department of Neurosurgery, National Cardiovascular Center, Suita, Osaka, Japan. tiwama@cc.gifu-u.ac.jp
authors.forename: Toru
authors.initials: T
authors.lastname: Iwama
authors.forename: Kohei
authors.initials: K
authors.lastname: Hayashida
authors.forename: Jun C
authors.initials: JC
authors.lastname: Takahashi
authors.forename: Izumi
authors.initials: I
authors.lastname: Nagata
authors.forename: Nobuo
authors.initials: N
authors.lastname: Hashimoto
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000378:metabolism; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D002648:Child; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D014055:Tomography, Emission-Computed