Analysis of the role of perfusion parameters in predicting rupture of brain arteriovenous malformations: a multi-center study

Abstract

This study aimed to investigate the potential correlation between the perfusion parameters of brain arteriovenous malformations (bAVMs) as determined by multiphase CT angiography and bAVM rupture. Based on the occurrence of bAVM-related hemorrhage, 480 diagnosed bAVM patients were divided into hemorrhage (n = 220) and non-hemorrhage (n = 260) groups in this retrospective multi-center study spanning 2010 to 2020. On initial rupture CT images, the bAVM nidus and major draining vein were segmented, and time-density curves were extracted to compute perfusion parameters including mean transit time (MTT), time to peak (TTP), blood volume (BV), and blood flow (BF). To examine the potential correlation between these parameters and bAVM rupture, logistic regression was utilized to analyze multifactorial data and compare differences between the two groups. The ruptured group demonstrated a bAVM nidus characterized by an increased BF, a shorter TTP and MTT, and a higher peak density. The veins that were draining exhibited a reduced TTP, MTT, and peak density. A nidus TTP of less than 4s was identified by the multifactorial analysis as a critical risk factor for bAVM rupture. The statistical results highlight the noteworthy correlation between nidus TTP and bAVM rupture, presenting an original framework for assessing the risk of rupture.

Keywords: Brain arteriovenous malformations; CT perfusion; Cerebrovascular circulation; Computed tomography angiography; Intracranial hemorrhages.

Fig. 1

The workflow of this study. Patients diagnosed with bAVM, who met the inclusion and exclusion criteria, were divided into two groups based on their prior history of bAVM-associated hemorrhage: hemorrhage and non-hemorrhage. Patients lacking multiphase CT in the non-hemorrhagic group and those without multiphase CT initial hemorrhage in the hemorrhage group were excluded.

Fig. 2

An example of segmentation. The green mask represents the nidus, while the blue markings indicate the major draining veins.

Fig. 3

Time-density plot and schematic diagram of each parameter. As shown in the figure, TTP is the time from the onset of blood flow density in the nidus or draining vein to the time when the density reaches its maximum value; MTT is the time from the onset of blood flow density in the nidus or draining vein to the time when the density drops back to the initial level of density; BF is the maximum slope of the ascending interval of the time-density curve; BV is the area under the curve at the time of MTT. The time to reach the vein (TTD) is also labeled in the figure.

Fig. 4

The ROC curves of features with significant intergroup differences in predicting bAVM rupture.

Fig. 5

(A) Comparison of the overall density change of nidus. The blue line in the figure shows the trend of the overall density change of teratomas in the hemorrhagic group, and the yellow line shows the trend of the overall density change in the non-hemorrhagic group. (B) Comparison of the overall density change of the draining veins. The blue line in the figure shows the trend of the overall density change of the nidus in the hemorrhage group, and the yellow line shows the trend of the overall density change in the non-hemorrhage group.