title: MRI evidence for preserved regulation of intracranial pressure in patients with cerebral arteriovenous malformations.
abstract: OBJECTIVE
  The purpose of this study was to investigate intracranial pressure and associated hemo- and hydrodynamic parameters in patients with cerebral arteriovenous malformations AVMs.
  
  
  METHODS
  Thirty consecutive patients with arteriovenous malformations (median age 38.7 years, 27/30 previously treated with radiosurgery) and 30 age- and gender-matched healthy controls were investigated on a 3.0T MR scanner. Nidus volume was quantified on dynamic MR angiography. Total arterial cerebral blood flow (tCBF), venous outflow as well as aqueductal and craniospinal stroke volumes were obtained using velocity-encoded cine-phase contrast MRI. Intracranial volume change during the cardiac cycle was calculated and intracranial pressure (ICP) was derived from systolic intracranial volume change (ICVC) and pulse pressure gradient.
  
  
  RESULTS
  TCBF was significantly higher in AVM patients as compared to healthy controls (median 799 vs. 692 mL/min, p=0.007). There was a trend for venous flow to be increased in both the ipsilateral internal jugular vein (IJV, 282 vs. 225 mL/min, p=0.16), and in the contralateral IJV (322 vs. 285 mL/min, p=0.09), but not in secondary veins. There was no significant difference in median ICP between AVM patients and control subjects (6.9 vs. 8.6 mmHg, p=0.30) and ICP did not correlate with nidus volume in AVM patients (ρ=-0.06, p=0.74). There was a significant positive correlation between tCBF and craniospinal CSF stroke volume (ρ=0.69, p=0.02).
  
  
  CONCLUSIONS
  The elevated cerebral blood flow in patients with AVMs is drained through an increased flow in IJVs but not secondary veins. ICP is maintained within ranges of normal and does not correlate with nidus volume.
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich, Germany.
authors.forename: Felix G
authors.initials: FG
authors.lastname: Meinel
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Fischer
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Pomschar
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich, Germany.
authors.forename: Natalie
authors.initials: N
authors.lastname: Wöhrle
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich, Germany.
authors.forename: Inga K
authors.initials: IK
authors.lastname: Koerte
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich, Germany.
authors.forename: Denise
authors.initials: D
authors.lastname: Steffinger
authors.affiliation: Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany.
authors.forename: Rüdiger P
authors.initials: RP
authors.lastname: Laubender
authors.affiliation: European Cyberknife Center Munich, 81377 Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Muacevic
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich, Germany.
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.affiliation: Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
authors.forename: Noam
authors.initials: N
authors.lastname: Alperin
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich, Germany. Electronic address: birgit.ertl-wagner@med.uni-muenchen.de.
authors.forename: Birgit
authors.initials: B
authors.lastname: Ertl-Wagner
mesh_terms: D000328:Adult; D000465:Algorithms; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D002538:Intracranial Arteriovenous Malformations / Q000503:physiopathology* / Q000601:surgery; D007427:Intracranial Pressure / Q000502:physiology*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D016634:Radiosurgery
keywords: Arteriovenous malformations; Blood flow; Cerebrospinal fluid; MRI; Phase-contrast MRI