title: Persistent hemodynamic changes in ruptured brain arteriovenous malformations.
abstract: OBJECTIVE
  Hemodynamic properties of brain arteriovenous malformations (AVMs) with risk factors for a future hemorrhage are essentially unknown. We hypothesized that AVMs with anatomic properties, which are associated with an increased rupture risk, exhibit different hemodynamic characteristics than those without these properties.
  
  
  METHODS
  Seventy-two consecutive patients with AVMs diagnosed by conventional angiography underwent MRI examination, including time-resolved 3-dimensional MR angiography. Signal-intensity curves derived from the time-resolved 3-dimensional MR angiography datasets were used to calculate relative blood flow transit times through the AVM nidus based on the time-to-peak parameter. For identification of characteristics associated with altered transit times, a multiple normal regression model was fitted with stepwise selection of the following regressors: intracranial hemorrhage, deep nidus location, infratentorial location, deep drainage, associated aneurysm, nidus size, draining venous stenosis, and number of draining veins.
  
  
  RESULTS
  A previous intracranial hemorrhage is the only characteristic that was associated with a significant alteration of the relative transit time, leading to an increase of 2.4 seconds (95% CI, 1.2-3.6 seconds;, P<0.001) without adjustment and 2.1 seconds (95% CI, 0.6-3.6 seconds; P=0.007) with adjustment for all other regressors considered. The association was independent of the bleeding age.
  
  
  CONCLUSIONS
  Hemodynamic parameters do not seem useful for risk assessment of an AVM-related hemorrhage because only a previous AVM rupture leads to a significant and permanent alteration of the hemodynamic situation.
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. T.illies@uke.uni-hamburg.de
authors.forename: Till
authors.initials: T
authors.lastname: Illies
authors.forename: Nils Daniel
authors.initials: ND
authors.lastname: Forkert
authors.forename: Dennis
authors.initials: D
authors.lastname: Saering
authors.forename: Karolin
authors.initials: K
authors.lastname: Wenzel
authors.forename: Thorsten
authors.initials: T
authors.lastname: Ries
authors.forename: Jan
authors.initials: J
authors.lastname: Regelsberger
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000150:complications / Q000503:physiopathology*; D001921:Brain / Q000098:blood supply / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000503:physiopathology*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult