European Radiology:定量DSA在脑动静脉畸形评估中的应用

2022-08-03 shaosai MedSci原创

磁共振成像(MRI)和数字减影血管造影(DSA)是评估BAVM最常见的两种成像方式。

脑动静脉畸形(BAVMs)涉及脑动脉和静脉之间的直接沟通,可以没有症状,但通常表现为出血、癫痫发作、头痛和神经系统功能障碍。首次出现的无诱因癫痫发作有1%归因于BAVMs,而癫痫发作占BAVMs初始临床表现的20%。在最初出现癫痫发作的BAVM中,5年内无诱因癫痫复发的风险为67%。

分布上看,癫痫性BAVMs多见于皮质位置,尤其是额颞部BAVMs患者更容易出现癫痫发作。磁共振成像(MRI)和数字减影血管造影(DSA)是评估BAVM最常见的两种成像方式。血管结构分析被用来确定BAVMs出血和发作的危险因素,其中皮质、长引流静脉、静脉狭窄、静脉异位和浅层引流会增加癫痫发作的风险。

在血液动力学上,动脉盗血现象传统上被认为是癫痫发作的主要原因,但在多普勒研究中没有观察到这一点。相比之下,Shankar等人提出,静脉流出停滞可能在癫痫性BAVMs中起主要作用。定量DSA(QDSA)提供了一个客观即时的血管内流动评估指标。通过使用转运时间、栓塞到达时间(BAT)或时间-密度曲线域中的瘀滞指数,QDSA有助于确定出血风险和伽玛刀放射手术的治疗反应。

近日,发表在European Radiology杂志的一项研究利用QDSA探讨了BAVMs与癫痫发作相关的血流动力学影响,并将QDSA参数与常规风险因素进行了比较,进一步阐明了BAVMs患者的血流特征与癫痫发作之间的关系,为进一步的治疗和评估提供了参考依据。

本研究从2011年到2019年纳入了104名以前没有出血或治疗的BAVMs患者,并根据癫痫发作的初始表现进行分组。每位患者的血管图和MRI结果被分析为形态特征和定量数字减影血管图(QDSA)参数。修正的脑循环时间(mCCT)被定义为同侧颈内动脉海绵和DSA上顶静脉的栓塞到达时间之差。进行Logistic回归分析,估计BAVMs出现癫痫发作的几率(OR)。 

与非癫痫组相比,癫痫组的mCCT更短(1.98秒对2.44秒,p = 0.005),更多的BAVM表现为位于颞部位置(45%对30.8%,p = 0.013)、新血管生成(55%对33%,p = 0.03)和长引流静脉(95%对72%,p = 0.004)。在调整了年龄、性别、BAVM体积和长引流静脉后,较短的mCCT(OR:3.4,p = 0.02)、颞部位置(OR:13.4,p < 0.001)和新血管生成(OR:4.7,p = 0.013)与癫痫发作的高风险独立相关。 


 在出现癫痫发作(A)和没有癫痫发作(C)的脑动静脉畸形(BAVMs)患者上基于栓塞到达时间(BAT,秒)的彩色编码QDSA侧视图。两个BAVM都有长的引流静脉、动脉扩张和新血管生成。选择同侧颈内动脉(ICA)海绵窦段和顶静脉(PV)的相应时间密度曲线是(B)有癫痫发作的BAVM和(D)没有癫痫发作的BAVM。与没有发作的BAVM相比,有发作的BAVM在时间密度曲线中的修正脑循环时间(mCCT)明显缩短

本研究发现,在BAVMs患者中,较短的mCCT、颞部位置和新血管生成与较高的癫痫发作风险有关。临床上可使用QDSA对癫痫性BAVMs的脑血流动力学损伤进行客观地评估。本研究表明,血流动力学分析可以提高临床对BAVM发作的病理生理学的认识,为进一步的治疗提供了参考。

 

原文出处:

Jing Kai Loo,Yong-Sin Hu,Te-Ming Lin,et al.Shortened cerebral circulation time correlates with seizures in brain arteriovenous malformation: a cross-sectional quantitative digital subtraction angiography study.DOI:10.1007/s00330-022-08690-x

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1698408, encodeId=b0981698408ae, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Jan 26 08:53:00 CST 2023, time=2023-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1729697, encodeId=975b1e296975f, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Tue Jun 13 02:53:00 CST 2023, time=2023-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1642156, encodeId=4c611642156a8, content=<a href='/topic/show?id=5070333625b' target=_blank style='color:#2F92EE;'>#动静脉畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33362, encryptionId=5070333625b, topicName=动静脉畸形)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=46c022864035, createdName=12498cf9m42(暂无昵称), createdTime=Thu Sep 22 22:53:00 CST 2022, time=2022-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1361474, encodeId=86d513614e494, content=<a href='/topic/show?id=068a62e790' target=_blank style='color:#2F92EE;'>#DSA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6277, encryptionId=068a62e790, topicName=DSA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Thu Aug 04 13:53:00 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362384, encodeId=5656136238461, content=<a href='/topic/show?id=9857e03444b' target=_blank style='color:#2F92EE;'>#畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70344, encryptionId=9857e03444b, topicName=畸形)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Thu Aug 04 13:53:00 CST 2022, time=2022-08-04, status=1, ipAttribution=)]
    2023-01-26 fusion
  2. [GetPortalCommentsPageByObjectIdResponse(id=1698408, encodeId=b0981698408ae, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Jan 26 08:53:00 CST 2023, time=2023-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1729697, encodeId=975b1e296975f, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Tue Jun 13 02:53:00 CST 2023, time=2023-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1642156, encodeId=4c611642156a8, content=<a href='/topic/show?id=5070333625b' target=_blank style='color:#2F92EE;'>#动静脉畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33362, encryptionId=5070333625b, topicName=动静脉畸形)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=46c022864035, createdName=12498cf9m42(暂无昵称), createdTime=Thu Sep 22 22:53:00 CST 2022, time=2022-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1361474, encodeId=86d513614e494, content=<a href='/topic/show?id=068a62e790' target=_blank style='color:#2F92EE;'>#DSA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6277, encryptionId=068a62e790, topicName=DSA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Thu Aug 04 13:53:00 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362384, encodeId=5656136238461, content=<a href='/topic/show?id=9857e03444b' target=_blank style='color:#2F92EE;'>#畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70344, encryptionId=9857e03444b, topicName=畸形)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Thu Aug 04 13:53:00 CST 2022, time=2022-08-04, status=1, ipAttribution=)]
    2023-06-13 feather89
  3. [GetPortalCommentsPageByObjectIdResponse(id=1698408, encodeId=b0981698408ae, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Jan 26 08:53:00 CST 2023, time=2023-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1729697, encodeId=975b1e296975f, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Tue Jun 13 02:53:00 CST 2023, time=2023-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1642156, encodeId=4c611642156a8, content=<a href='/topic/show?id=5070333625b' target=_blank style='color:#2F92EE;'>#动静脉畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33362, encryptionId=5070333625b, topicName=动静脉畸形)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=46c022864035, createdName=12498cf9m42(暂无昵称), createdTime=Thu Sep 22 22:53:00 CST 2022, time=2022-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1361474, encodeId=86d513614e494, content=<a href='/topic/show?id=068a62e790' target=_blank style='color:#2F92EE;'>#DSA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6277, encryptionId=068a62e790, topicName=DSA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Thu Aug 04 13:53:00 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362384, encodeId=5656136238461, content=<a href='/topic/show?id=9857e03444b' target=_blank style='color:#2F92EE;'>#畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70344, encryptionId=9857e03444b, topicName=畸形)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Thu Aug 04 13:53:00 CST 2022, time=2022-08-04, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1698408, encodeId=b0981698408ae, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Jan 26 08:53:00 CST 2023, time=2023-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1729697, encodeId=975b1e296975f, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Tue Jun 13 02:53:00 CST 2023, time=2023-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1642156, encodeId=4c611642156a8, content=<a href='/topic/show?id=5070333625b' target=_blank style='color:#2F92EE;'>#动静脉畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33362, encryptionId=5070333625b, topicName=动静脉畸形)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=46c022864035, createdName=12498cf9m42(暂无昵称), createdTime=Thu Sep 22 22:53:00 CST 2022, time=2022-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1361474, encodeId=86d513614e494, content=<a href='/topic/show?id=068a62e790' target=_blank style='color:#2F92EE;'>#DSA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6277, encryptionId=068a62e790, topicName=DSA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Thu Aug 04 13:53:00 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362384, encodeId=5656136238461, content=<a href='/topic/show?id=9857e03444b' target=_blank style='color:#2F92EE;'>#畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70344, encryptionId=9857e03444b, topicName=畸形)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Thu Aug 04 13:53:00 CST 2022, time=2022-08-04, status=1, ipAttribution=)]
    2022-08-04 zhmscau
  5. [GetPortalCommentsPageByObjectIdResponse(id=1698408, encodeId=b0981698408ae, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Jan 26 08:53:00 CST 2023, time=2023-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1729697, encodeId=975b1e296975f, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Tue Jun 13 02:53:00 CST 2023, time=2023-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1642156, encodeId=4c611642156a8, content=<a href='/topic/show?id=5070333625b' target=_blank style='color:#2F92EE;'>#动静脉畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33362, encryptionId=5070333625b, topicName=动静脉畸形)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=46c022864035, createdName=12498cf9m42(暂无昵称), createdTime=Thu Sep 22 22:53:00 CST 2022, time=2022-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1361474, encodeId=86d513614e494, content=<a href='/topic/show?id=068a62e790' target=_blank style='color:#2F92EE;'>#DSA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6277, encryptionId=068a62e790, topicName=DSA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Thu Aug 04 13:53:00 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362384, encodeId=5656136238461, content=<a href='/topic/show?id=9857e03444b' target=_blank style='color:#2F92EE;'>#畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70344, encryptionId=9857e03444b, topicName=畸形)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Thu Aug 04 13:53:00 CST 2022, time=2022-08-04, status=1, ipAttribution=)]
    2022-08-04 wushaoling

相关资讯

脑胶质瘤卒中误诊为脑动静脉畸形并出血1例

男性,20岁,因突发右侧肢体活动障碍伴失语1d入院。入院时体格检查:生命体征平稳,神志清楚,自动睁眼,运动性失语,右上肢肌力1级,右下肢肌力3级,左侧肢体肌力正常,四肢肌张力正常,右侧巴氏征阳性,左侧巴氏征阴性。

Neurology:脑动静脉畸形患者的长期健康相关生活质量

通过仔细选择患者,SPC B类患者可获得与SPC A类患者相同的HRQOL,提前是手术成功。应采取有效治疗以防止完全AVM闭塞,预防多次出血事件。AVM患者的术后治疗应侧重于预防抑郁症状、焦虑和癫痫发作。研究人员鼓励其他研究小组使用HRQOL工具充分了解神经病学和神经外科疾病对患者HRQOL的影响。

European Radiology:静音MRA为脑动静脉畸形的评估提供了新的指标

脑动静脉畸形(BAVM)是一种常见脑血管发育畸形,表现为动脉与静脉之间无毛细血管网而直接相连。BAVM的主要治疗方式包括手术、外科和血管内治疗。

2019 专家共识:脑动静脉畸形的治疗

脑动静脉畸形(bAVMs)是一种复杂的异质性罕见颅内病变,可通过栓塞、放射外科或纤维外科切除治疗。本文主要针对脑动静脉畸形的治疗提出指导建议。

Neurology:北京天坛医院神经外科团队新成果——脑动静脉畸形患者De Novo和罕见基因变异的外显子全序列分析

脑动静脉畸形(bAVM)是一种高流量的血管病变。近日,有研究人员试图描述bAVM的de novo突变和罕见的种系变异的情况,通过外显子组的罕见变异关联分析,确定SLC19A3为bAVM的疾病相关基因。

Stroke:脑动静脉畸形患者语言相关白质损伤与可塑性

当AVM病灶涉及常规语言区域时,会发生语言相关白质的重构,其重组模式因AVM病灶的位置而异。束状损伤主要由髓鞘缺陷所致,其可塑性可能受轴突重塑过程所支配。