Evaluation of 4D Vascular Flow and Tissue Perfusion in Cerebral Arteriovenous Malformations: Influence of Spetzler-Martin Grade, Clinical Presentation, and AVM Risk Factors

Phase-contrast MRA (PC-MRA), time-integrated 3D pathlines, and perfusion (CBF) for 4 patients with AVMs (SMG = 1–4). AVM arterial feeding (solid white arrows) and venous draining patterns (open white arrows) can be clearly appreciated in the PC-MRA and 4D flow pathlines. The draining veins of AVM-17 and AVM-14 are obscured by pathlines and are not shown. 4D flow pathlines also illustrate the distribution of blood flow velocities in the entire brain. Note the flow voids (thin white arrows) within the nidus for AVM-11, AVM-17, and AVM-14 due to high transnidal shunt flow. LPICA indicates left posterior inferior cerebellar artery; LACA, left anterior cerebral artery; DV, draining vein; RTS, right transverse sinus; StrS, straight sinus; SSS, superior sagittal sinus.

Distribution of peak velocities and blood flow in the AVM feeding (Feeders) and corresponding normal contralateral arteries (Contra) (A and E), as well as in the major feeding arteries (B and F), draining veins (C and G), and the straight sinus (D and H) for the low (SMG-A) and high (SMG-B) grade AVM groups. The feeding arteries had significantly higher peak velocity and blood flow compared with the normal contralateral arteries. The high-grade AVM group (SMG-B) had significantly higher peak velocity and blood flow in the major feeding arteries and the straight sinus and significantly higher blood flow in the draining veins compared with the low-grade group (SMG-A). The asterisk indicates significant difference with P < .05; NS, not significant.