title: Cerebral arteriovenous malformation: complex 3D hemodynamics and 3D blood flow alterations during staged embolization.
abstract: Complex hemodynamics in cerebral arteriovenous malformations (AVM) are thought to play a key role in their pathophysiology. We applied 4D flow magnetic resonance imaging (MRI) for the detailed evaluation of AVM function at baseline and to investigate the impact of staged embolization on AVM hemodynamics in a patient with a Spetzler-Martin grade III AVM. The patient underwent three embolization procedures resulting in >50% nidal casting and obliteration of several arteriovenous fistulae. 4D flow MRI demonstrated highly complex 3D hemodynamics at baseline and revealed intricate arterial feeding, a large vascularized nidus with high variability in regional blood flow velocities, and clearly visible venous drainage with high flow velocities above 50 cm/s. 3D blood flow visualization and quantification during follow-up illustrated the systemic impact of focal embolization on cerebral hemodynamics resulting in compaction of the AVM, redistribution of blood flow velocities, and altered peak flow velocities and blood flow in multiple vascular territories. 4D flow MRI may offer a useful noninvasive tool to help to identify subtleties and nuances of the quantitative hemodynamic alterations in AVM vascular architecture as a supplement to established imaging modalities.
authors.affiliation: Departments of Radiology and Biomedical Engineering, Northwestern University, Chicago, Illinois, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Markl
authors.forename: Can
authors.initials: C
authors.lastname: Wu
authors.forename: Michael C
authors.initials: MC
authors.lastname: Hurley
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Ansari
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Carroll
authors.forename: Rudy J
authors.initials: RJ
authors.lastname: Rahme
authors.forename: Salah G
authors.initials: SG
authors.lastname: Aoun
authors.forename: James
authors.initials: J
authors.lastname: Carr
authors.forename: Hunt
authors.initials: H
authors.lastname: Batjer
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bendok
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D001164:Arteriovenous Fistula / Q000473:pathology*; D001783:Blood Flow Velocity; D004621:Embolization, Therapeutic; D006439:Hemodynamics; D006801:Humans; D021621:Imaging, Three-Dimensional; D002538:Intracranial Arteriovenous Malformations / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D013702:Temporal Lobe / Q000473:pathology; D013997:Time Factors
keywords: 4D flow MRI; AVM; MRI; hemodynamics; staged embolization