Monitoring volume changes following stereotactic radiosurgical treatment in the nidus of an intracranial arteriovenous malformation with the use of MR angiography based 3D volumetric study

Czech version

Authors: I. Vachaľová ¹; A. Ďurkovský ²; M. Šramka ³; P. Traubner ¹
Authors‘ workplace: 1. neurologická klinika LF UK a FNsPB, Bratislava ¹; Klinika stereotaktickej rádiochirurgie OÚSA, Bratislava ²; Klinika rádiodiagnostiky TU a OÚSA, Bratislava ³
Published in: Cesk Slov Neurol N 2007; 70/103(5): 527-532
Category: Original Paper

Poďakovanie: Naša úprimná vďaka patrí kolektívu neurochirurgov, rádioterapeutov, rádioonkológov, radiačných fyzikov a rádiodiagnostikov Onkologického Ústavu svätej Alžbety v Bratislave, ktorí sa svojou dennou obetavou prácou zaslúžili o dosiahnuté výsledky rádiochirugickej liečby pacientov s intrakraniálnymi arteriovenóznymi malformáciami.
Za finančnú podporu vďačíme grantu poskytnutému firmou Wyeth a Grantu Univerzity Komenského.
Všetky MR vyšetrenia sa uskutočnili na 1T supravodivom systéme Harmony firmy Siemens.

Overview

Intracranial arteriovenous malformation (AVM) is a vascular anomaly jeopardising the affected person due to the risk of intracranial haemorrhage. Stereotactic radiosurgery is a mini-invasive method of treatment of AVM with the possibility of unlimited access to all the locations in the brain. The effect of treatment can be expected after 1 to 3 years.

Objective:
Define the volumetric change of an irradiated AVM nidus in the period of one year post-surgery using the method of 3D volumetric study based on magnetic resonance angiography (MRA). Observe the method of volumetric change monitoring with traditional angiography (DSA) on the basis of available literary data. Determine adequate percentage of volumetric change of AVM nidus and find out whether the speed of obliteration depends on the initial size of the nidus and on the therapeutic dose of irradiation.

Set and methods:
Irradiation dose of 12 to 20 Gy (17.52 Gy on an average) was applied to a set of 31 patients aged 35 years, in the volume of 0.3–21.3 cm3 (6.21 cm3 on an average). 3D volumetric MRA based study was used for the calculation of volumetric changes. The non-parametric correlation method was used for testing the defined parameters.

Outcome:
Using the 3D volumetric study, we discovered an average 64 % reduction of AVM nidus volume as early as one year after radiosurgery. The percentage of reduction depends on the therapeutic dose of irradiation (p = 0.031).

Conclusion:
MRA based 3D volumetric study allows for a very precise assessment of the dynamism of even the smallest volumetric changes following radiosurgical irradiation. The 3D volumetric study appears as a suitable method for the follow up of effects of radiosurgical therapy of AVM. MRA is a non-invasive method allowing for detailed imaging of arteries in a 3D image with high spatial resolution. The information obtained is significant from the prognosis point of view, and for further management of the patients.

Key words:
arteriovenous malformation – 3D volumetric study – MR angiography – stereotactic radiosurgery

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