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Validation of cerebral arteriovenous malformation hemodynamics assessed by DSA using quantitative magnetic resonance angiography: preliminary study
  1. Sophia F Shakur1,
  2. Denise Brunozzi1,
  3. Ahmed E Hussein1,
  4. Andreas Linninger1,2,
  5. Chih-Yang Hsu2,
  6. Fady T Charbel1,
  7. Ali Alaraj1,2
  1. 1Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
  2. 2Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Ali Alaraj, Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, MC-799, Chicago, IL 60612, USA; alaraj{at}


Background The hemodynamic evaluation of cerebral arteriovenous malformations (AVMs) using DSA has not been validated against true flow measurements.

Objective To validate AVM hemodynamics assessed by DSA using quantitative magnetic resonance angiography (QMRA).

Materials and methods Patients seen at our institution between 2007 and 2016 with a supratentorial AVM and DSA and QMRA obtained before any treatment were retrospectively reviewed. DSA assessment of AVM flow comprised AVM arterial-to-venous time (A-Vt) and iFlow transit time. A-Vt was defined as the difference between peak contrast intensity in the cavernous internal carotid artery and peak contrast intensity in the draining vein. iFlow transit times were determined using syngo iFlow software. A-Vt and iFlow transit times were correlated with total AVM flow measured using QMRA and AVM angioarchitectural and clinical features.

Results 33 patients (mean age 33 years) were included. Nine patients presented with hemorrhage. Mean AVM volume was 9.8 mL (range 0.3–57.7 mL). Both A-Vt (r=−0.47, p=0.01) and iFlow (r=−0.44, p=0.01) correlated significantly with total AVM flow. iFlow transit time was significantly shorter in patients who presented with seizure but A-Vt and iFlow did not vary with other AVM angioarchitectural features such as venous stenosis or hemorrhagic presentation.

Conclusions A-Vt and iFlow transit times on DSA correlate with cerebral AVM flow measured using QMRA. Thus, these parameters may be used to indirectly estimate AVM flow before and after embolization during angiography in real time.

  • Arteriovenous Malformation
  • Angiography
  • Blood Flow
  • Magnetic Resonance Angiography

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  • Contributors SFS: drafted and revised manuscript. DB: data collection and statistical analysis. AEH and AL: data collection and review of the manuscript. C-YH: data collection. FTC: Reviewed rmanuscript. AA: devised and supervised the project. Critically revised manuscript.

  • Competing interests AA: research grant, NIH; consultant, Cordis-Codman. FTC: ownership interest, VasSol Inc; consultant, Transonic.

  • Ethics approval University of Illinois at Chicago.

  • Provenance and peer review Not commissioned; externally peer reviewed.