title: Arterial spin labeling magnetic resonance imaging: toward noninvasive diagnosis and follow-up of pediatric brain arteriovenous malformations.
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.
authors: Assistance Publique Hôpitaux de Paris, Departments of 1 Pediatric Neurosurgery.
authors: Thomas
authors: T
authors: Blauwblomme
authors: Olivier
authors: O
authors: Naggara
authors: Francis
authors: F
authors: Brunelle
authors: David
authors: D
authors: Grévent
authors: Stéphanie
authors: S
authors: Puget
authors: Federico
authors: F
authors: Di Rocco
authors: Kevin
authors: K
authors: Beccaria
authors: Giovanna
authors: G
authors: Paternoster
authors: Marie
authors: M
authors: Bourgeois
authors: Manoelle
authors: M
authors: Kossorotoff
authors: Michel
authors: M
authors: Zerah
authors: Christian
authors: C
authors: Sainte-Rose
authors: Nathalie
authors: N
authors: Boddaert
mesh_terms: D000293:Adolescent; D015901:Angiography, Digital Subtraction; D002536:Cerebral Arteries; D002648:Child; D003287:Contrast Media; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000473:pathology* / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods; D012189:Retrospective Studies; D013113:Spin Labels
chemical_list: D003287:Contrast Media; D013113:Spin Labels
keywords: ASL = arterial spin labeling; AVM = arteriovenous malformation; CBF = cerebral blood flow; DSA = digital subtraction angiography; ROI = region of interest; arterial spin labeling; arteriovenous malformations; technique