J F Hak1,2,3, G Boulouis4,2,3, B Kerleroux4,2,3, S Benichi5, S Stricker5, F Gariel4,6, L Garzelli4, P Meyer7, M Kossorotoff8,9, N Boddaert4,10,11, N Girard12, V Vidal13, V Dangouloff Ros4,10,11, T Blauwblomme5,9, O Naggara4,2,3,9. 1. From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.) jeanfrancois.hak@gmail.com. 2. Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France. 3. L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France. 4. From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.). 5. Department of Pediatric Neurosurgery (S.B., S.S., T.B.), Institut Imagine, L'Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Assistance Publique-Hôpitaux de Paris, Necker Hospital-Sick Children, Paris, France. 6. Department of Neuroradiology (F.G.), University Hospital of Bordeaux, Bordeaux, France. 7. Pediatric Neurointensive Care Unit (P.M.). 8. Department of Pediatric Neurology (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire, Necker Hospital-Sick Children, Paris, France. 9. INSERM U894, French Center for Pediatric Stroke (M.K., T.B., O.N.), L'Institut National de la Santé et de la Recherche Médicale, Paris, France. 10. Université de Paris (N.B., V.D.R.), L'Institut National de la Santé et de la Recherche Médicale, ERL, Paris, France. 11. Institut Imagine (N.B., V.D.R.),Université de Paris,Unité Mixte de Recherche 1163, Paris, France. 12. Departments of Neuroradiology (N.G.). 13. Radiology (V.V.), University Hospital La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
Abstract
BACKGROUND AND PURPOSE: Brain AVMs represent the main etiology of pediatric intracranial hemorrhage. Noninvasive imaging techniques to monitor the treatment effect of brain AVMs remain an unmet need. In a large cohort of pediatric ruptured brain AVMs, we aimed to investigate the role of arterial spin-labeling for the longitudinal follow-up during treatment and after complete obliteration by analyzing CBF variations across treatment sessions. MATERIALS AND METHODS: Consecutive patients with ruptured brain AVMs referred to a pediatric quaternary care center were prospectively included in a registry that was retrospectively queried for children treated between 2011 and 2019 with unimodal or multimodal treatment (surgery, radiosurgery, embolization). We included children who underwent an arterial spin-labeling sequence before and after treatment and a follow-up DSA. CBF variations were analyzed in univariable analyses. RESULTS: Fifty-nine children with 105 distinct treatment sessions were included. The median CBF variation after treatment was -43 mL/100 mg/min (interquartile range, -102-5.5), significantly lower after complete nidal surgical resection. Following radiosurgery, patients who were healed on the last DSA follow-up demonstrated a greater CBF decrease on intercurrent MR imaging, compared with patients with a persisting shunt at last follow-up (mean, -62 [SD, 61] mL/100 mg/min versus -17 [SD, 40.1] mL/100 mg/min; P = .02). In children with obliterated AVMs, recurrences occurred in 12% and resulted in a constant increase in CBF (mean, +89 [SD, 77] mL/100 mg/min). CONCLUSIONS: Our results contribute data on the role of noninvasive arterial spin-labeling monitoring of the response to treatment or follow-up after obliteration of pediatric AVMs. Future research may help to better delineate how arterial spin-labeling can assist in decisions regarding the optimal timing for DSA.
BACKGROUND AND PURPOSE: Brain AVMs represent the main etiology of pediatric intracranial hemorrhage. Noninvasive imaging techniques to monitor the treatment effect of brain AVMs remain an unmet need. In a large cohort of pediatric ruptured brain AVMs, we aimed to investigate the role of arterial spin-labeling for the longitudinal follow-up during treatment and after complete obliteration by analyzing CBF variations across treatment sessions. MATERIALS AND METHODS: Consecutive patients with ruptured brain AVMs referred to a pediatric quaternary care center were prospectively included in a registry that was retrospectively queried for children treated between 2011 and 2019 with unimodal or multimodal treatment (surgery, radiosurgery, embolization). We included children who underwent an arterial spin-labeling sequence before and after treatment and a follow-up DSA. CBF variations were analyzed in univariable analyses. RESULTS: Fifty-nine children with 105 distinct treatment sessions were included. The median CBF variation after treatment was -43 mL/100 mg/min (interquartile range, -102-5.5), significantly lower after complete nidal surgical resection. Following radiosurgery, patients who were healed on the last DSA follow-up demonstrated a greater CBF decrease on intercurrent MR imaging, compared with patients with a persisting shunt at last follow-up (mean, -62 [SD, 61] mL/100 mg/min versus -17 [SD, 40.1] mL/100 mg/min; P = .02). In children with obliterated AVMs, recurrences occurred in 12% and resulted in a constant increase in CBF (mean, +89 [SD, 77] mL/100 mg/min). CONCLUSIONS: Our results contribute data on the role of noninvasive arterial spin-labeling monitoring of the response to treatment or follow-up after obliteration of pediatric AVMs. Future research may help to better delineate how arterial spin-labeling can assist in decisions regarding the optimal timing for DSA.
Authors: Jeffrey M Pollock; Christopher T Whitlow; Justin Simonds; E Andrew Stevens; Robert A Kraft; Jonathan H Burdette; Joseph A Maldjian Journal: AJR Am J Roentgenol Date: 2011-01 Impact factor: 3.959
Authors: Tilman Schubert; Zachary Clark; Carolina Sandoval-Garcia; Ryan Zea; Oliver Wieben; Huimin Wu; Patrick A Turski; Kevin M Johnson Journal: Invest Radiol Date: 2018-02 Impact factor: 6.016