Detection of Predictors of Hemorrhage in Patients with Cerebral Arteriovenous Malformation by Digital Subtraction Angiography

2019 ◽  
Vol 8 (2) ◽  
pp. 87-92
Author(s):  
Fazlul Haque ◽  
Shariful Islam ◽  
Monzurul Haque ◽  
Shafiul Alam ◽  
Raziul Haque
Keyword(s):  
Arteriovenous Malformation ◽  
Digital Subtraction Angiography ◽  
Venous Drainage ◽  
High Flow ◽  
Cerebral Arteriovenous Malformation ◽  
P Value ◽  
Digital Subtraction ◽  
College Hospital ◽  
Multiple Imaging ◽  
Arterial Feeder

Background: Cerebral arteriovenous malformation (AVM) is a complex tangled of dilated blood vessels in which arteries flow directly into veins without capillaries. The main cause of death in patients with cerebral AVM is intraparenchymal hemorrhage. There are multiple imaging tools that can detect the predictors of hemorrhage in cerebralarteriovenous malformation. But nowadays digital subtraction angiography (DSA) is playing a wonderful role to detect these predictors. Objectives: To detect the common predicting factors of hemorrhage from in brain by DSA. Methodology:This observational cross-sectional study was carried out in the department of Neurosurgery, Dhaka Medical College Hospital and study period was from October, 2014 to March, 2016. 76 patients of hemorrhagic stroke with clinical and radiological (CT scan) suspicion of ruptured cerebral AVM were selected by non-probability purposive sampling technique. After that enrolled patients were scrutinized according to selection criteria. Finally selected 50 patients who underwent DSA and were positive for AVM were included in this study. All the included patients’ demographic, clinical and DSA profile were recorded in pre-structured data collection sheet. All the data were compiled, edited and plotted in tabular and figure forms. Data analysis was done by chi-square test. P value was determined significant when it was <0.05. Results: In angiographic presentation, maximum cases were found deep seated (72%), small sized (<3 cm) (70%), having compact type of nidus (58%), having superficial arterial feeder (62%), having high flow draining vein (70%), having deep venous drainage (56%) and single draining vein (78%). Associated aneurysm and venous ectasia were 12% and 4% respectively. The statistically significant predictors were deep location (P=0.036) and superficial arterial feeder (P=0.03) between male and female subjects. Conclusion: Our results showed that small sized, deep-seated Cerebral arteriovenous malformation, having high flow draining vein, having deep venous drainage and single number of draining vein are the possible causes of hemorrhage. Lesions that have associated aneurysms have a risk of bleeding. Bang. J Neurosurgery 2019; 8(2): 87-92

scholarly journals The features of computed tomography and digital subtraction angiography images of ruptured cerebral arteriovenous malformation

2021 ◽  
Vol 8 (2) ◽  
pp. 105-115
Author(s):  
Van Tuan Nguyen ◽  
◽  
Anh Tuan Tran ◽  
Nguyen Quyen Le ◽  
Thi Huong Nguyen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Arteriovenous Malformation ◽  
Digital Subtraction Angiography ◽  
Cerebral Arteriovenous Malformation ◽  
Digital Subtraction

scholarly journals Signal intensity ratio of draining vein on silent MR angiography as an indicator of high-flow arteriovenous shunt in brain arteriovenous malformation

2021 ◽  
Author(s):  
Chun-Xue Wu ◽  
Zhen-Xiang Zang ◽  
Tao Hong ◽  
Meng-Qi Dong ◽  
Yi Shan ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Digital Subtraction Angiography ◽  
Transit Time ◽  
Signal Intensity ◽  
Intensity Ratio ◽  
Mr Angiography ◽  
High Flow ◽  
Signal Intensity Ratio ◽  
Digital Subtraction ◽  
Brain Arteriovenous Malformation

Abstract Objectives To evaluate whether the signal intensity ratio (rSI) of the draining vein on silent MR angiography is correlated with arteriovenous (A–V) transit time on digital subtraction angiography (DSA), thereby identifying high-flow A–V shunt in brain arteriovenous malformation (BAVM), and to analyze whether the rSI and the characteristic of draining veins on silent MRA are associated with hemorrhage presentation. Methods Eighty-one draining veins of 46 participants with BAVM (mean age 33.2 ± 16.9 years) who underwent silent MRA and DSA were evaluated retrospectively. The correlation between the rSI of the draining vein on silent MRA and A–V transit time on DSA was examined. The AUC-ROC was obtained to evaluate the performance of the rSI in determining the presence of high-flow A–V shunt. The characteristics of draining veins with the maximum rSI (rSImax) were further compared between the hemorrhagic and non-hemorrhagic untreated BAVM. Results The rSI of each draining vein on silent MRA was significantly correlated with A–V transit time from DSA (r = −0.81, p < .001). The AUC-ROC was 0.89 for using the rSI to determine the presence of high-flow A–V shunt. A cut-off rSI value of 1.09 yielded a sensitivity of 82.4% and a specificity of 82.8%. The draining vein with rSImax and no ectasia was significantly more observed in the hemorrhagic group (p = 0.045). Conclusions The rSI of the draining vein on silent MRA is significantly correlated with A–V transit time on DSA, and it can be used as an indicator of high-flow A–V shunt in BAVM. Key Points • The signal intensity ratio (rSI) of the draining vein on silent MRA significantly correlated with arteriovenous (A–V) transit time of brain arteriovenous malformation (BAVM) on digital subtraction angiography (DSA). • The area under the receiver operating characteristic curve (AUC) was 0.89 for using the rSI of draining veins to determine high-flow A–V shunt. • Draining veins with maximum rSI and no ectasia were significantly more observed in the hemorrhagic group of BAVM (p = 0.045).

scholarly journals Time resolved computed tomography angiography in the evaluation of brain arteriovenous malformation: a feasibility study

2017 ◽  
Vol 31 (3) ◽  
pp. 230-234 ◽  
Author(s):  
Rupinder Singh ◽  
Vivek Gupta ◽  
Chirag Ahuja ◽  
Niranjan Khandelwal
Keyword(s):  
Computed Tomography ◽  
Arteriovenous Malformation ◽  
Digital Subtraction Angiography ◽  
Computed Tomography Angiography ◽  
Venous Drainage ◽  
Complete Agreement ◽  
Digital Subtraction ◽  
Time Resolved ◽  
Non Invasive

Background and purpose Digital subtraction angiography is the current gold standard for diagnosing as well as the follow-up of cerebral arteriovenous malformations. However, as it is invasive, relatively expensive and time-consuming, a non-invasive alternative is of interest. We aimed to evaluate the feasibility of time resolved computed tomography angiography (TR-CTA) in a series of five diagnosed cranial arteriovenous malformation patients, demonstrated by conventional digital subtraction angiography with respect to acquisition, depiction of angiographic phases and radiation exposure. Materials and methods Five patients demonstrating a cranial arteriovenous malformation on digital subtraction angiography were studied with TR-CTA. The TR-CTA imaging was done by using a 128-detector computed tomography scanner. Digital subtraction angiography and TR-CTA studies were independently read by two blinded observers, by using a standardised scoring sheet. TR-CTA results were analysed with digital subtraction angiography as the criterion standard. Results TR-CTA generated comparable angiographic phases. In all five cases, there was complete agreement between digital subtraction angiography and TR-CTA regarding the size, arterial feeders, nidal morphology and venous drainage of the arteriovenous malformation. Conclusions TR-CTA imaging as a technique is feasible, providing images with good temporal and spatial resolution at an acceptable radiation dose. It appears to be a promising non-invasive adjunct to digital subtraction angiography.

scholarly journals PENDARAHAN BERULANG SETELAH 14 TAHUN PADA MALFORMASI ARTERIOVENA DI SEREBELARIS

2018 ◽  
Vol 35 (4) ◽  
Author(s):  
Ni Nyoman Ayu Trisnadewi ◽  
Kumara Tini
Keyword(s):  
Arteriovenous Malformation ◽  
Ct Scan ◽  
Digital Subtraction Angiography ◽  
High Flow ◽  
Superior Cerebellar Artery ◽  
Recurrent Bleeding ◽  
Digital Subtraction ◽  
Feeding Artery ◽  
Cerebellar Artery ◽  
Superior Petrosal Vein

  THE LATE ONSET RE-BLEEDING AFTER 14 YEARS OF RUPTURE CEREBELLAR AVMABSTRACTThe arteriovenous malformation (AVM), a form of abnormality in brain vascularization, in the cerebellum is a rare disorder. The risk of recurrent bleeding after initial episode at five years is very low about 3,67%. We reported a case of 25 years-old man with history of recurrent bleeding after 14 years with hydrocephalus as complication. The brain CT scan showed a bleeding in the cerebellar vermis  with non-communicant hydrocephalus. The Digital Subtraction Angiography (DSA) showed a moderate left cerebellar AVM with high-flow plexiform nidus, left superior cerebellar artery as primary feeding artery with supplementary supply of the vein draining from the superior cerebellar artery to superior petrosal vein leading to the superior petrosal vein toward the contralateral transverse sinus and left sigmoid sinus. Embolization for infratentorial posterior fossa AVM bleeding needs to be considered even though previous bleeding occurs over 5 years to prevent re-bleeding.Keywords: Arteriovenous malformation, embolization, feeding artery, nidusABSTRAKKelainan pembuluh darah malformasi arteriovena (MAV) pada serebelum merupakan kelainan vaskular yang jarang terjadi. Risiko pendarahan berulang setelah tahun kelima adalah rendah sekitar 3,67%. Dilaporkan suatu kasus laki-laki, 25 tahun, dengan riwayat pendarahan serebri berulang setelah 14 tahun dengan komplikasi hidrosefalus. CT scan kepala menunjukkan adanya pendarahan pada bagian vermis dengan hidrosefalus non-komunikan. Pemeriksaan DSA (digital subtraction angiography) menunjukkan adanya MAV fosa posterior di serebelum kiri ukuran sedang dengan nidus pleksiformis high flow dan feeder utama arteri serebelaris superior kiri ke vena petrosal superior menuju ke sinus transversus kontralateral dan sinus sigmoid kiri. Tata laksana embolisasi pada MAV infratentorial fosa posterior yang mengalami pendarahan perlu dipertimbangkan walaupun pendarahan sebelumnya terjadi lebih dari 5 tahun untuk mencegah pendarahan kembali.Kata kunci: Embolisasi, feeding arteri, malformasi arteriovena, nidus 

scholarly journals A Comparative Study of Magnetic Resonance Angiography & Digital Subtraction Angiography in Diagnosis of Cerebral Arteriovenous Malformation

2014 ◽  
Vol 24 (2) ◽  
pp. 51-58
Author(s):  
AH Chowdhury ◽  
M Islam ◽  
A Rahman ◽  
SJH Chowdhury ◽  
MN Islam ◽  
...  
Keyword(s):  
Observational Study ◽  
Digital Subtraction Angiography ◽  
Brain Area ◽  
Venous Drainage ◽  
Haemorrhagic Stroke ◽  
Retrospective Observational Study ◽  
Digital Subtraction ◽  
College Hospital ◽  
Female Ratio ◽  
Medical College

Background and purpose: Although phase-contrast MR angiography (MRA) provides some information regarding hemodynamics of cerebral arteriovenous malformations (AVMs), but mos t Conventional MR angiographic techniques have not been helpful in this respect. We attempted to determine the value of MR digital subtraction angiography (DSA) in assessing AVM hemodynamics. Soin this retrospective observational study was carried out to compare MRA and DSA in diagnosis of cerebral AVM. Methods and materials: It was a retrospective observational study conducted in the Department of Neurology Dhaka Medical College Hospital (DMCH), Dhaka during the period of January 2010 to December 2010. Thirty patients with haemorrhagic stroke age ranging from 13 to 65 years were selected on the basis of inclusion and exclusion criteria as the study sample. MRA and DSA were done in all the selected patients. Results: The mean age of the patients of haemorrhagic stroke was 30.3±14.3years and male female ratio was 2.7:1.The venous drainage of AVM 13 and 12 were superficial and deep respectively evaluated 100% by MRA. In the diagnosis of cerebral AVM  nidussize S1<3, S2:6 cm sensitivity 100% but accuracy 100% and 73.3% respectively. Sensitivity 33.3% found in diagnosis of cerebral AVM nidus size S3:>6cm, 100% sensitive in the diagnosis of superficial and deep venous drainage AVM. Regarding the eloquence of brain area 15 was no eloquence by both MRA and DSA and identification of eloquence of brain area sensitivity 73.3% and accuracy 86.7%.The feeding vessels main vessels was found 22(73.3%) in both DSA and MRA findings. Distal vessels was seen 8(26.7%) in DSA but not seen in MRA findings. Intranidal aneurysm and Angiopathic AVM were seen 3(10.0%) and 4(13.3%) respectively in DSA, Conclusion: This study was carried out to diagnose the patients presented with cerebral AVM by MRA and DSA. MRA could not be evaluated flow status of AVM, distal feeding arteries, intranidal aneurysm and angiopathic AVM which could be detected by DSA. So, DSA is superior to MRA in diagnosis of cerebral AVM. DOI: http://dx.doi.org/10.3329/bjmed.v24i2.18699 Bangladesh J Medicine 2013; 24 : 51-58

scholarly journals Value of Three-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping

2021 ◽  
Author(s):  
Serge Marbacher ◽  
Matthias Halter ◽  
Deborah R Vogt ◽  
Jenny C Kienzler ◽  
Christian T J Magyar ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Digital Subtraction Angiography ◽  
Diagnostic Yield ◽  
Three Dimensional ◽  
P Value ◽  
Digital Subtraction ◽  
Patient Demographics ◽  
Included Patient ◽  
2D And 3D

Abstract BACKGROUND The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison. OBJECTIVE To compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics. METHODS We evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments. RESULTS Although 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value = &lt;.001), and more often missed grade 1 (&lt; 2 mm) clipped remnants (odds ratio [95% CI]: 4.3 [1.6, 12.7], P-value .005). CONCLUSION Compared with 2D-DSA, 3D-DSA achieves a better diagnostic yield in the evaluation of clipped IA. Our proposed method to grade 3D-DSA remnants proved to be simple and practical. Especially small IA remnants have a high risk to be missed in 2D-DSA. We advocate routine use of either intraoperative or postoperative 3D-DSA as a baseline for lifelong follow-up of clipped IA.

Sign in / Sign up

Export Citation Format

Share Document