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. 2024 Nov 11;47(1):840.
doi: 10.1007/s10143-024-03084-7.

Risk assessment for rupture of brain arteriovenous malformations using high-resolution black-blood magnetic resonance imaging: a single-center case series

José Maria de Campos Filho  1   2 , Alice Giotta Lucifero  3   4 , Juan Carlos Ahumada-Vizcaíno  1 , José Ernesto Chang Mulato  1 , Victor Hugo Rocha Marussi  2 , Christiane Monteiro de Siqueira Campos  5 , Marcos Devanir Silva da Costa  1 , Hugo Leonardo Dória-Netto  1   2 , Raphael Wuo-Silva  1 , Feres Chaddad-Neto  6   7
Affiliations

Risk assessment for rupture of brain arteriovenous malformations using high-resolution black-blood magnetic resonance imaging: a single-center case series

José Maria de Campos Filho et al. Neurosurg Rev. .

Abstract

Objective: Chronic inflammation's role in the pathogenesis, development, and rupture of vascular malformations is undebated. Advanced magnetic resonance imaging techniques with vessel wall studies, specifically Black Blood (bbMRI), may offer insights into vascular wall instability and predict rupture. This case series aims to assess bbMRI as a predictive diagnostic tool for brain arteriovenous malformations (bAVMs) rupture, suggesting early treatment.

Material and methods: A prospective study included demographic, clinical, and neuroimaging data from a consecutive series of patients with ruptured or unruptured bAVMs, regardless of age or gender, between October 2018 and March 2024. All patients underwent MRI brain resonance with Black Blood study. Those with impaired renal function were excluded. Statistical analyses tested sample homogeneity. Univariate and multivariate logistical regressions assessed bbMRI as a rupture predictor for bAVMs, with a p-value set at < 0.05.

Results: Ninety patients were retrieved: 64 with unruptured and 26 with ruptured bAVMs. The mean age was 31.9 years, and 55 were female. Admission symptoms were headache, neurological deficits, and seizure in 49, 21, and 19 cases, respectively. bbMRI showed wall enhancement in 56 cases, with 19 in the ruptured and 37 unruptured groups. Univariate and multivariate analyses revealed a significant correlation between bbMRI wall enhancement and bAVM rupture (p:0.033; p:0.047).

Conclusion: bbMRI may be a useful and feasible diagnostic implement to determine vessel inflammation and the bAVMs prone to rupture. Additional studies are needed to confirm the positive bbMRI as a predictive factor for bAVMs rupture.

Keywords: Black blood; Brain arteriovenous malformation; Inflammation; Magnetic resonance imaging; Vascular malformation.

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Conflict of interest statement

Declarations Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Federal University of São Paulo (No. 2936701). Consent to participate Informed consente was obtained from all individual participants included in the study. Consent to publish The authors affirm that human research participants provided informed consente for publication of the images in Figs. 1 and 2, 3 A, 3B, 3 C, 4 A, 4B and 4 C. Competing interests The authors declare no competing interests.

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