title: Angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in a Chinese paediatric population.
abstract: OBJECTIVE
  To identify specific angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in Chinese paediatric patients.
  
  
  METHODS
  Retrospective cross-sectional observational study.
  
  
  METHODS
  Four locoregional tertiary neurosurgical centres in Hong Kong: Queen Elizabeth Hospital, Tuen Mun Hospital, Kwong Wah Hospital, and Pamela Youde Nethersole Eastern Hospital.
  
  
  METHODS
  Patients aged 18 years or younger who underwent pretreatment digital subtraction angiography for brain arteriovenous malformation between 1 January 2005 and 31 July 2013 were included. Patients were divided into haemorrhagic and non-haemorrhagic groups based on the initial presentation. Pretreatment digital subtraction angiographies were independently reviewed by two experienced neuroradiologists.
  
  
  METHODS
  The following parameters were evaluated for their association with haemorrhagic presentation by univariate and multivariate analyses: nidus location, nidus size, nidus morphology (diffuse or compact); origin and number of arterial feeders; venous drainage; number of draining veins; presence of aneurysms, venous varices, and venous stenosis.
  
  
  RESULTS
  A total of 67 children and adolescents (28 male, 39 female) with a mean age of 12 years were included. Of them, 52 (78%) presented with haemorrhage. Arteriovenous malformation size (P=0.004) and morphology (P=0.05) were found to be associated with haemorrhagic presentation by univariate analysis. Small arteriovenous malformation nidus size and diffuse nidal morphology were identified as independent risk factors for haemorrhage by multivariate analysis.
  
  
  CONCLUSIONS
  Smaller arteriovenous malformation size and diffuse nidal morphology are angiographic factors independently associated with haemorrhagic presentation. Bleeding risk is important in determining the therapeutic approach (aggressive vs conservative) and timeframe, particularly in paediatric patients.
authors.affiliation: Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong.
authors.forename: Elaine W S
authors.initials: EW
authors.lastname: Fok
authors.affiliation: Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong.
authors.forename: W L
authors.initials: WL
authors.lastname: Poon
authors.affiliation: Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong.
authors.forename: K S
authors.initials: KS
authors.lastname: Tse
authors.affiliation: Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong.
authors.forename: H Y
authors.initials: HY
authors.lastname: Lau
authors.affiliation: Department of Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong.
authors.forename: C H
authors.initials: CH
authors.lastname: Chan
authors.affiliation: Department of Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong (currently at Department of Radiology, Princess Margaret Hospital, Laichikok, Hong Kong).
authors.forename: N Y
authors.initials: NY
authors.lastname: Pan
authors.affiliation: Department of Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong.
authors.forename: H Y
authors.initials: HY
authors.lastname: Cho
authors.affiliation: Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong.
authors.forename: T W
authors.initials: TW
authors.lastname: Yeung
authors.affiliation: Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong.
authors.forename: Y C
authors.initials: YC
authors.lastname: Wong
authors.affiliation: Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
authors.forename: K W
authors.initials: KW
authors.lastname: Leung
authors.affiliation: Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
authors.forename: Jennifer L S
authors.initials: JL
authors.lastname: Khoo
authors.affiliation: Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong.
authors.forename: K W
authors.initials: KW
authors.lastname: Tang
mesh_terms: D000293:Adolescent; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006723:Hong Kong; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Cerebral angiography; Hemorrhage; Intracranial arteriovenous malformations