{"title":"Lesion filling index predicts brain arteriovenous malformation obliteration after Gamma knife radiosurgery: a hemodynamic analysis.","authors":"Ruinan Li, Yu Chen, Pingting Chen, Li Ma, Heze Han, Zhipeng Li, Wanting Zhou, Yu Zhou, Minhan Wang, Shibin Sun, Yuanli Zhao, Xiaolin Chen","doi":"10.1007/s10143-024-03135-z","DOIUrl":null,"url":null,"abstract":"<p><p>Hemodynamics significantly influences the clinical outcomes of brain arteriovenous malformations (AVM). This study aimed to determine if the lesion filling index (LFI), obtained via quantitative digital subtraction angiography (QDSA), can predict complete complete obliteration after Gamma knife radiosurgery (GKRS). We retrospectively reviewed AVM patients who underwent GKRS and DSA exams from 2011 to 2021. Clinical, angioarchitectural, and QDSA hemodynamic features were analyzed. The LFI, derived from QDSA, was evaluated as a predictor of complete complete obliteration post-SRS using Cox proportional hazards and Kaplan-Meier analyses. Among 118 AVMs with a mean follow-up of 5.76 ± 2.76 years, post-SRS complete obliteration was linked to reduced nidus volume (7.27 ± 12.3 vs. 19.2 ± 35.7 mm³, p = 0.049), smaller nidus diameter (26.0 ± 14.9 vs. 34.1 ± 19.8 mm, p = 0.015), and absence of feeding artery dilation (21.1% vs. 46.3%, p = 0.008). Higher Arterial Diagnostic Window (ADW) (972.27 ± 1615.53 vs. 515.29 ± 730.26, p = 0.036), higher LFI (905.31 ± 2288.37 vs. 249.65 ± 1092.46, p = 0.037), and lower Transnidal Relative Velocity (TRV), a parameter defined as the maximum diameter of AVM divided by the full width at half maximum (74.31 ± 95.67 vs. 137.80 ± 152.01, p = 0.021), were also associated with complete obliteration. After adjusting for confounders, only two variables-absence of feeding artery dilation (HR 0.35, 95%CI 0.16-0.78, p = 0.010) and higher LFI (HR 1.00, 95%CI 1.00-1.00, p = 0.006) remained significant predictors. The ROC curve identified 188.4 as the LFI cutoff, and Kaplan-Meier analysis confirmed LFI's predictive value (log-rank test, χ² = 12.776, p < 0.001). Elevated LFI and absence of feeding artery dilation predict AVM complete obliteration after GKRS, indicating that overfilling and low blood flow in the nidus may promote complete obliteration.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"889"},"PeriodicalIF":2.5000,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurosurgical Review","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10143-024-03135-z","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Hemodynamics significantly influences the clinical outcomes of brain arteriovenous malformations (AVM). This study aimed to determine if the lesion filling index (LFI), obtained via quantitative digital subtraction angiography (QDSA), can predict complete complete obliteration after Gamma knife radiosurgery (GKRS). We retrospectively reviewed AVM patients who underwent GKRS and DSA exams from 2011 to 2021. Clinical, angioarchitectural, and QDSA hemodynamic features were analyzed. The LFI, derived from QDSA, was evaluated as a predictor of complete complete obliteration post-SRS using Cox proportional hazards and Kaplan-Meier analyses. Among 118 AVMs with a mean follow-up of 5.76 ± 2.76 years, post-SRS complete obliteration was linked to reduced nidus volume (7.27 ± 12.3 vs. 19.2 ± 35.7 mm³, p = 0.049), smaller nidus diameter (26.0 ± 14.9 vs. 34.1 ± 19.8 mm, p = 0.015), and absence of feeding artery dilation (21.1% vs. 46.3%, p = 0.008). Higher Arterial Diagnostic Window (ADW) (972.27 ± 1615.53 vs. 515.29 ± 730.26, p = 0.036), higher LFI (905.31 ± 2288.37 vs. 249.65 ± 1092.46, p = 0.037), and lower Transnidal Relative Velocity (TRV), a parameter defined as the maximum diameter of AVM divided by the full width at half maximum (74.31 ± 95.67 vs. 137.80 ± 152.01, p = 0.021), were also associated with complete obliteration. After adjusting for confounders, only two variables-absence of feeding artery dilation (HR 0.35, 95%CI 0.16-0.78, p = 0.010) and higher LFI (HR 1.00, 95%CI 1.00-1.00, p = 0.006) remained significant predictors. The ROC curve identified 188.4 as the LFI cutoff, and Kaplan-Meier analysis confirmed LFI's predictive value (log-rank test, χ² = 12.776, p < 0.001). Elevated LFI and absence of feeding artery dilation predict AVM complete obliteration after GKRS, indicating that overfilling and low blood flow in the nidus may promote complete obliteration.
血流动力学对脑动静脉畸形(AVM)的临床预后有显著影响。本研究旨在确定通过定量数字减影血管造影(QDSA)获得的病变充盈指数(LFI)是否可以预测伽玛刀放射手术(GKRS)后完全完全闭塞。我们回顾性回顾了2011年至2021年接受GKRS和DSA检查的AVM患者。分析临床、血管建筑学和QDSA血流动力学特征。使用Cox比例风险和Kaplan-Meier分析,评估由QDSA得出的LFI作为srs后完全完全湮没的预测因子。118例AVMs平均随访5.76±2.76年,srs后完全闭塞与病灶体积减小(7.27±12.3 vs. 19.2±35.7 mm³,p = 0.049)、病灶直径减小(26.0±14.9 vs. 34.1±19.8 mm, p = 0.015)、无供血动脉扩张(21.1% vs. 46.3%, p = 0.008)有关。较高的动脉诊断窗口(ADW)(972.27±1615.53 vs. 515.29±730.26,p = 0.036)、较高的LFI(905.31±2288.37 vs. 249.65±1092.46,p = 0.037)和较低的经心相对速度(TRV)(定义为AVM最大直径除以全宽的一半)(74.31±95.67 vs. 137.80±152.01,p = 0.021)也与完全闭塞相关。在调整混杂因素后,只有两个变量——没有供血动脉扩张(HR 0.35, 95%CI 0.16-0.78, p = 0.010)和较高的LFI (HR 1.00, 95%CI 1.00-1.00, p = 0.006)仍然是显著的预测因子。ROC曲线确定188.4为LFI截止点,Kaplan-Meier分析证实了LFI的预测值(log-rank检验,χ²= 12.776,p
期刊介绍:
The goal of Neurosurgical Review is to provide a forum for comprehensive reviews on current issues in neurosurgery. Each issue contains up to three reviews, reflecting all important aspects of one topic (a disease or a surgical approach). Comments by a panel of experts within the same issue complete the topic. By providing comprehensive coverage of one topic per issue, Neurosurgical Review combines the topicality of professional journals with the indepth treatment of a monograph. Original papers of high quality are also welcome.