title: Evaluation of 4D vascular flow and tissue perfusion in cerebral arteriovenous malformations: influence of Spetzler-Martin grade, clinical presentation, and AVM risk factors.
abstract: OBJECTIVE
  The role of intracranial hemodynamics in the pathophysiology and risk stratification of brain AVMs remains poorly understood. The purpose of this study was to assess the influence of Spetzler-Martin grade, clinical history, and risk factors on vascular flow and tissue perfusion in cerebral AVMs.
  
  
  METHODS
  4D flow and perfusion MR imaging was performed in 17 patients with AVMs. Peak velocity and blood flow were quantified in AVM feeding and contralateral arteries, draining veins, and the straight sinus. Regional perfusion ratios (CBF, CBV, and MTT) were calculated between affected and nonaffected hemispheres.
  
  
  RESULTS
  Regarding flow parameters, high-grade AVMs (Spetzler-Martin grade of >2) demonstrated significantly increased peak velocity and blood flow in the major feeding arteries (P < .001 and P = .004) and straight sinus (P = .003 and P = .012) and increased venous draining flow (P = .001). The Spetzler-Martin grade significantly correlated with cumulative feeding artery flow (r = 0.85, P < .001) and draining vein flow (r = 0.80, P < .001). Regarding perfusion parameters, perinidal CBF and CBV ratios were significantly lower (P < .001) compared with the remote ratios and correlated negatively with cumulative feeding artery flow (r = -0.60, P = .014 and r = -0.55, P = .026) and draining vein flow (r = -0.60, P = .013 and r = -0.56, P = .025). Multiple regression analysis revealed no significant association of AVM flow or perfusion parameters with clinical presentation (rupture and seizure history) and AVM risk factors.
  
  
  CONCLUSIONS
  Macrovascular flow was significantly associated with increasing Spetzler-Martin grade and correlated with perinidal microvascular perfusion in cerebral AVMs. Future longitudinal studies are needed to evaluate the potential of comprehensive cerebral flow and perfusion MR imaging for AVM risk stratification.
authors.affiliation: From the Department of Biomedical Engineering (C.W., T.J.C., M.M.), McCormick School of Engineering, Northwestern University, Evanston, Illinois Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.) canwu2016@u.northwestern.edu.
authors.forename: C
authors.initials: C
authors.lastname: Wu
authors.affiliation: Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.) Neurological Surgery (S.A.A., M.C.H., B.R.B.) Neurology (S.A.A.).
authors.forename: S A
authors.initials: SA
authors.lastname: Ansari
authors.affiliation: Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.).
authors.forename: A R
authors.initials: AR
authors.lastname: Honarmand
authors.affiliation: Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.).
authors.forename: P
authors.initials: P
authors.lastname: Vakil
authors.affiliation: Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.) Neurological Surgery (S.A.A., M.C.H., B.R.B.).
authors.forename: M C
authors.initials: MC
authors.lastname: Hurley
authors.affiliation: Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.) Neurological Surgery (S.A.A., M.C.H., B.R.B.) Otolaryngology (B.R.B.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: B R
authors.initials: BR
authors.lastname: Bendok
authors.affiliation: Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.).
authors.forename: J
authors.initials: J
authors.lastname: Carr
authors.affiliation: From the Department of Biomedical Engineering (C.W., T.J.C., M.M.), McCormick School of Engineering, Northwestern University, Evanston, Illinois Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.).
authors.forename: T J
authors.initials: TJ
authors.lastname: Carroll
authors.affiliation: From the Department of Biomedical Engineering (C.W., T.J.C., M.M.), McCormick School of Engineering, Northwestern University, Evanston, Illinois Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.).
authors.forename: M
authors.initials: M
authors.lastname: Markl
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction / Q000379:methods*; D001783:Blood Flow Velocity / Q000502:physiology*; D002533:Cerebral Angiography / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D004292:Dominance, Cerebral / Q000502:physiology; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D002538:Intracranial Arteriovenous Malformations / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D012307:Risk Factors