title: Cerebral hemodynamic disturbance in dural arteriovenous fistula with retrograde leptomeningeal venous drainage: a prospective study using (123)I-iodoamphetamine single photon emission computed tomography.
abstract: OBJECTIVE
  The severity of cerebral hemodynamic disturbance caused by retrograde leptomeningeal venous drainage (RLVD) of a dural arteriovenous fistula (dAVF) is related to neurological morbidity and unfavorable outcome. However, the cerebral hemodynamics of this disorder have not been elucidated well. The aim of this study was to assess the relationship between the cerebral venous congestive encephalopathy represented as a high-intensity area (HIA) on T2-weighted MR images and the cerebral hemodynamics examined by (123)I-iodoamphetamine (IMP) single photon emission computed tomography (SPECT), as well as the predictive value of (123)I-IMP SPECT for the development and reversibility of venous congestion encephalopathy.
  
  
  METHODS
  Based on the pre- and posttreatment T2 HIAs associated with venous congestion encephalopathy, patients were divided into 3 groups: a normal group, an edema group, and an infarction group. The regional cerebral blood flow (rCBF) at the region with RLVD was analyzed by (123)I-IMP SPECT, and the results were compared among the groups.
  
  
  RESULTS
  There were 11, 6, and 3 patients in the normal, edema, and infarction groups, respectively. No patients in the normal group showed any symptoms related to venous congestion. In contrast, all patients in the edema and infarction groups developed neurological symptoms. The rCBF in the edema group was significantly lower than that in the normal group, and significantly higher than that in the infarction group. The cerebral vascular reactivity (CVR) of the infarction group was significantly lower than that of the normal and edema groups. After treatment, the neurological signs disappeared in the edema group, but only partial improvement was seen in the infarction group. The rCBF also significantly increased in the normal and edema groups, but not in the infarction group.
  
  
  CONCLUSIONS
  Quantitative rCBF measurement is useful for evaluating hemodynamic disturbance in dAVF with RLVD. The reduction of rCBF was strongly correlated with the severity of venous congestive encephalopathy, and loss of CVR is a reliable indicator of irreversible venous infarction caused by RLVD.
authors: Departments of 1 Neurosurgery and.
authors: Kazuya
authors: K
authors: Kanemaru
authors: Departments of 1 Neurosurgery and.
authors: Hiroyuki
authors: H
authors: Kinouchi
authors: Departments of 1 Neurosurgery and.
authors: Hideyuki
authors: H
authors: Yoshioka
authors: Departments of 1 Neurosurgery and.
authors: Takashi
authors: T
authors: Yagi
authors: Departments of 1 Neurosurgery and.
authors: Takuma
authors: T
authors: Wakai
authors: Departments of 1 Neurosurgery and.
authors: Koji
authors: K
authors: Hashimoto
authors: Departments of 1 Neurosurgery and.
authors: Yuichiro
authors: Y
authors: Fukumoto
authors: Radiology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan.
authors: Takako
authors: T
authors: Umeda
authors: Radiology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan.
authors: Hiroshi
authors: H
authors: Onishi
authors: Departments of 1 Neurosurgery and.
authors: Yoshihisa
authors: Y
authors: Nishiyama
authors: Departments of 1 Neurosurgery and.
authors: Toru
authors: T
authors: Horikoshi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000661:Amphetamine; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D004322:Drainage / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007457:Iodine Radioisotopes; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D007457:Iodine Radioisotopes; D000661:Amphetamine
keywords: ACR = affected-to-contralateral side asymmetry ratio; CBF = cerebral blood flow; CVR = cerebral vascular reactivity; DSA = digital subtraction angiography; DTARG = dual-table autoradiographic; HIA = high-intensity area; IMP = iodoamphetamine; QSPECT = quantitative SPECT; RLVD = retrograde leptomeningeal venous drainage; ROI = region of interest; SPECT = single photon emission computed tomography; TAE = transarterial embolization; TVE = transvenous embolization; dAVF = dural arteriovenous fistula; dural arteriovenous fistula; endovascular treatment; rCBF = regional CBF; retrograde leptomeningeal venous drainage; single photon emission computed tomography; vascular disorders; venous congestion