Comparing vascular morphology and hemodynamics in patients with vein of Galen malformations using intracranial 4D flow MRI.

Journal

AJNR. American journal of neuroradiology
ISSN: 1936-959X
Titre abrégé: AJNR Am J Neuroradiol
Pays: United States
ID NLM: 8003708

Informations de publication

Date de publication:
24 May 2024
Historique:
received: 04 03 2024
accepted: 17 05 2024
medline: 25 5 2024
pubmed: 25 5 2024
entrez: 24 5 2024
Statut: aheadofprint

Résumé

Vein of Galen malformation (VOGM) is the most common congenital cerebrovascular malformation, and many patients suffer high mortality rates and poor cognitive outcomes. Quantitative diagnostic tools are needed to improve clinical outcomes. A prospective study of children with VOGM was conducted by acquiring 4D flow MRI to quantify total blood inflow to the brain, flow in the pathologic falcine sinus, and flow in the superior sagittal sinus. Linear regression was used to test the relationships between these flows and age, clinical status, and the mediolateral diameter of the lesion's outflow tract through the falcine or straight sinus (MD), which is a known morphological prognostic metric. In all 11 subjects (mean age 22±17 weeks [SD]), total blood flow to the brain always exceeded normal levels (1063±403 ml/min [mean±SD]). Significant correlations were observed between falcine sinus flow and MD, the posterior/middle cerebral artery flow ratio and age at scan, and between superior sagittal sinus flow proximal to malformation inflow and age at scan. Using 4D flow MRI we established the hemodynamic underpinnings of MD, and investigated metrics representing parenchymal venous drainage that could be used to monitor the normalization of hemodynamics during embolization therapy. ACA = anterior cerebral artery; BA = basilar artery; MD = falcine or straight sinus mediolateral diameter; NAR = neonatal at risk; PCA = posterior cerebral artery; PCom = posterior communicating artery; SSS = superior sagittal sinus; VOGM = vein of Galen malformation.

Sections du résumé

BACKGROUND AND PURPOSE OBJECTIVE
Vein of Galen malformation (VOGM) is the most common congenital cerebrovascular malformation, and many patients suffer high mortality rates and poor cognitive outcomes. Quantitative diagnostic tools are needed to improve clinical outcomes.
MATERIALS AND METHODS METHODS
A prospective study of children with VOGM was conducted by acquiring 4D flow MRI to quantify total blood inflow to the brain, flow in the pathologic falcine sinus, and flow in the superior sagittal sinus. Linear regression was used to test the relationships between these flows and age, clinical status, and the mediolateral diameter of the lesion's outflow tract through the falcine or straight sinus (MD), which is a known morphological prognostic metric.
RESULTS RESULTS
In all 11 subjects (mean age 22±17 weeks [SD]), total blood flow to the brain always exceeded normal levels (1063±403 ml/min [mean±SD]). Significant correlations were observed between falcine sinus flow and MD, the posterior/middle cerebral artery flow ratio and age at scan, and between superior sagittal sinus flow proximal to malformation inflow and age at scan.
CONCLUSIONS CONCLUSIONS
Using 4D flow MRI we established the hemodynamic underpinnings of MD, and investigated metrics representing parenchymal venous drainage that could be used to monitor the normalization of hemodynamics during embolization therapy.
ABBREVIATIONS BACKGROUND
ACA = anterior cerebral artery; BA = basilar artery; MD = falcine or straight sinus mediolateral diameter; NAR = neonatal at risk; PCA = posterior cerebral artery; PCom = posterior communicating artery; SSS = superior sagittal sinus; VOGM = vein of Galen malformation.

Identifiants

DOI: 10.3174/ajnr.A8353 PMID: 38789120
pubmed: 38789120
pii: ajnr.A8353
doi: 10.3174/ajnr.A8353
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024 by American Journal of Neuroradiology.

Déclaration de conflit d'intérêts

The authors declare no conflicts of interest related to the content of this article.

Auteurs

Jeffrey N Stout (JN)

From the Cerebrovascular Surgery and Interventions Center, Boston Children's Hospital, Boston, MA, USA (J.N.S., A.P.S., J.M., D.B.O), and the Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (S.D.R.).

Alfred Pokmeng See (AP)

From the Cerebrovascular Surgery and Interventions Center, Boston Children's Hospital, Boston, MA, USA (J.N.S., A.P.S., J.M., D.B.O), and the Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (S.D.R.).

Julie Meadows (J)

From the Cerebrovascular Surgery and Interventions Center, Boston Children's Hospital, Boston, MA, USA (J.N.S., A.P.S., J.M., D.B.O), and the Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (S.D.R.).

Shivani D Rangwala (SD)

From the Cerebrovascular Surgery and Interventions Center, Boston Children's Hospital, Boston, MA, USA (J.N.S., A.P.S., J.M., D.B.O), and the Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (S.D.R.).

Darren B Orbach (DB)

From the Cerebrovascular Surgery and Interventions Center, Boston Children's Hospital, Boston, MA, USA (J.N.S., A.P.S., J.M., D.B.O), and the Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (S.D.R.).

Classifications MeSH