Investigation of ASL MRI Brain Perfusion Changes in Patients With Intracranial Dural Arteriovenous Fistula Following Embolization and Their Correlation With Cognitive Status Improvement.

Background: Dural arteriovenous fistulas (dAVFs) are anomalous connections between the meningeal arteries supplying the dura and the brain venous system. dAVFs are known to cause thalamic dementia, with studies showing its reversible nature post treatment.

Purpose: To assess changes in brain perfusion following embolization in dAVF patients using quantitative arterial spin labeling (ASL) MRI and to investigate their correlation with changes in post-embolization cognitive status.

Study type: Prospective study.

Population: Twenty patients with angiographically diagnosed intracranial dAVF (mean age = 45.2 years, 70% males) who underwent cognitive assessment and ASL perfusion MRI pre and post embolization.

Field strength/sequence: 3D phase contrast pseudo-continuous arterial spin labeling (pcASL), 3D T2 fluid attenuated inversion recovery, and 3D T1 fast spoiled gradient recalled brain volume (BRAVO) sequences at 3 T.

Assessment: Baseline and 1 month post embolization, cerebral blood flow was assessed in the left and right thalamus, precuneus, posterior cingulate, and parahippocampal regions, with averaged bilateral values to account for laterality. Baseline and post-embolization Addenbrooke's cognitive examination (ACE) scores were obtained in five domains (attention, memory, fluency, language, and visual orientation) and in total.

Statistical tests: Paired t tests and Wilcoxon signed rank tests were performed to assess changes in brain perfusion and cognitive scores, respectively. Spearman correlation analysis was performed to assess the correlation between changes in brain perfusion and cognitive scores. Statistical significance was set at p < 0.05.

Results: Post-embolization, significant increases were observed in left (35.16-42.92 mL/100 g/min) and averaged thalamic perfusion (35.25 to 40.74 mL/100 g/min). Median total ACE score (75-80), visuospatial (10-11.5), and language (20-21.5) domains also improved significantly. Positive correlations were found between increased averaged and right thalamic perfusion and improvements in memory and language scores (r = 0.55-0.58).

Data conclusion: Improved thalamic perfusion post-embolization was positively correlated with cognitive gains, especially in language and memory. ASL MRI brain perfusion has the potential to be a marker for neurocognitive status and may help in the treatment planning of intracranial dAVF.

Level of evidence: 2:

Technical efficacy: Stage 3.