Article Figures & Data
Figures
- Fig 1.
AVM hemodynamics visualized by time-integrated 3D pathlines in 6 of 20 patients. Color-coding shows the local velocity of blood traveling along the traces during 1 cardiac cycle. Different AVM sizes as well as feeding artery (solid white arrows) and draining vein patterns (white open arrows) can clearly be appreciated. AVM 4, 5, and 10: Deep AVM location and deep venous drainage resulting in with high SMG. AVM 17, 19, and 20: Superficial AVM location with superficial and deep venous drainage.
- Fig 2.
Three-dimensional blood flow visualization and quantification in a patient with a large unruptured temporo-occipital AVM (AVM 13, SMG = 4). Complex arterial feeding and convoluted hemodynamics as well as differences in pre-embolization and postembolization vascularization and hemodynamics are clearly visible. Flow quantification in 3 feeding arteries (FA 1–3) revealed substantial changes and redistribution of peak velocities during the course of staged embolization. Note that FA 3 was embolized during the third procedure. Note that embolization resulted in reduced flow in the right posterior communicating artery (yellow arrows). As evident from the changes in peak velocity in feeding arteries FA1 and FA2, the final embolization stage resulted in a substantial decrease in peak velocity in the FA2 systems. As a result, shunting to the FA2 system through the right posterior communicating artery was reduced, which resulted in its diminished appearance.
- Fig 3.
A, Three-dimensional blood flow in a large frontal AVM (AVM 1, SMG = 3). Staged embolization resulted in compaction of the AVM with reduced blood flow velocities (yellow arrows). B, Quantification of postinterventional changes in AVM hemodynamics on the basis of 4D flow MR imaging after multiple embolization procedures in all 4 patients who underwent MR imaging follow-up.
- Fig 4.
Flow connectivity mapping of AVM feeding and draining patterns in 2 large AVMs with complex vascularization (both SMG = 4). The gray shaded iso-surfaces show 3D-PC-MRA that was calculated from the 4D flow MR data. FA = feeding artery; DV = draining vein.
Tables
AVM No. Age, y Sex History Venous Drainage Location AVM Size, cm SMG Deep/Superficial Eloquent Superficial/Deep 1a 43 M d+s 0 s 5.6 × 4.1 × 5.1 3 2 22 M Ruptured d+s 0 s 2.5 × 2.3 × 2.4 2 3 68 F d+s 1 d 4.0 × 3.0 × 2.5 4 4 44 M d+s 1 d 1.0 × 1.0 × 1.0 3 5a 29 M d+s 0 d 4.0 × 3.5 × 3.4 3 6 48 F s 0 s 3.5 × 3.5 × 3.0 2 7 34 M Ruptured s 0 s 3.3 × 2.3 × 2.5 1 8 22 F s 1 s 1.3 × 1.6 × 1.3 2 9 40 F d+s 0 s 3.0 × 2.0 × 4.0 2 10a 43 M Ruptured d+s 1 d 2.7 × 3.1 × 3.1 3 11 35 F d+s 0 s 3.1 × 1.6 × 1.0 2 12 25 F d+s 0 s 2.3 × 2.3 × 1.7 2 13a 21 F d+s 1 s 4.0 × 3.4 × 3.8 4 14 52 F s 0 s 2.4 × 2.1 × 2.6 1 15 16 F s 1 d 2.3 × 2.8 × 2.8 2 16 66 M s 0 s 0.8 × 1.0 × 0.8 1 17 49 M s 0 s 1.9 × 2.4 × 2.0 1 18 22 F s 0 s 1.0 × 2.5 × 0.6 1 19 41 F d+s 1 s 6.6 × 3.7 × 5.2 4 20 55 M s 0 s 2.1 × 3.6 × 2.6 2 ↵a Patients for whom follow-up 4D flow MRI was obtained during staged embolization.
Note:—d indicates deep; s, superficial.
- Table 2:
Summary of the results of visual flow pattern grading in patients with AVM (n = 18)
SMG 1 (n = 4) SMG 2 (n = 7) SMG ≥3 (n = 7) Arterial feeders No. of arteries Single Single and multiple (1–3) Single and multiple (1–4) Flow across arteries Homogeneous Heterogeneous n = 4 Heterogeneous n = 3 Velocity grading 1.7 ± 0.6 1.4 ± 0.5 1.5 ± 0.6 Range = 1–2 Range = 1–2 Range = 0–2 Median = 2 Median = 1 Median = 1 Venous drainage No. of veins Superficial only (1–2) Superficial/deep (1–3) Superficial/deep (1–3) Flow across veins Heterogeneous n = 2 Heterogeneous n = 3 Heterogeneous n = 4 Velocity grading 0.5 ± 0.6 0.8 ± 0.8 1.1 ± 0.6 Range = 0–1 Range = 0–2 Range = 0–2 Median = 0.5 Median = 1 Median = 1
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