Stasis index from hemodynamic analysis using quantitative DSA correlates with hemorrhage of supratentorial arteriovenous malformation: a cross-sectional study

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  • 1 Department of Radiology and
  • 2 Neurological Institute, Department of Neurosurgery, Taipei Veterans General Hospital; and
  • 3 School of Medicine and
  • 4 Department of Biomedical Imaging and Radiological Science, National Yang-Ming University, Taipei, Taiwan
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OBJECTIVE

Assessments of hemorrhage risk based on angioarchitecture have yielded inconsistent results, and quantitative hemodynamic studies have been limited to small numbers of patients. The authors examined whether cerebral hemodynamic analysis using quantitative digital subtraction angiography (QDSA) can outperform conventional DSA angioarchitecture analysis in evaluating the risk of hemorrhage associated with supratentorial arteriovenous malformations (AVMs).

METHODS

A cross-sectional study was performed by retrospectively reviewing adult supratentorial AVM patients who had undergone both DSA and MRI studies between 2011 and 2017. Angioarchitecture characteristics, DSA parameters, age, sex, and nidus volume were analyzed using univariate and multivariate logistic regression, and QDSA software analysis was performed on DSA images. Based on the QDSA analysis, a stasis index, defined as the inflow gradient divided by the absolute value of the outflow gradient, was determined. The receiver operating characteristic (ROC) curve was used to compare diagnostic performances of conventional DSA angioarchitecture analysis and analysis using hemodynamic parameters based on QDSA.

RESULTS

A total of 119 supratentorial AVM patients were included. After adjustment for age at diagnosis, sex, and nidus volume, the exclusive deep venous drainage (p < 0.01), observed through conventional angioarchitecture examination using DSA, and the stasis index of the most dominant drainage vein (p = 0.02), measured with QDSA hemodynamic analysis, were independent risk factors for hemorrhage. The areas under the ROC curves for the conventional DSA method (0.75) and QDSA hemodynamics analysis (0.73) were similar. A venous stasis index greater than 2.18 discriminated the hemorrhage group with a sensitivity of 52.6% and a specificity of 81.5%.

CONCLUSIONS

In QDSA, a higher stasis index of the most dominant drainage vein is an objective warning sign associated with supratentorial AVM rupture. Risk assessments of AVMs using QDSA and conventional DSA angioarchitecture were equivalent. Because QDSA is a complementary noninvasive approach without extra radiation or contrast media, comprehensive hemorrhagic risk assessment of cerebral AVMs should include both DSA angioarchitecture and QDSA analyses.

ABBREVIATIONS AU = arbitrary units; AUC = area under the curve; AVM = arteriovenous malformation; BAT = bolus arrival time; DSA = digital subtraction angiography; FWHM = full width at half maximum; ICA = internal carotid artery; QDSA = quantitative digital subtraction angiography; ROC = receiver operating characteristic; ROI = region of interest.

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Contributor Notes

Correspondence Chung Jung Lin: Taipei Veterans General Hospital, Taipei City, Taiwan. bcjlin@gmail.com.

INCLUDE WHEN CITING Published online April 26, 2019; DOI: 10.3171/2019.1.JNS183386.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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