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<meta name="DC.Title" content="Evaluation of 4D Vascular Flow and Tissue Perfusion in Cerebral Arteriovenous Malformations: Influence of Spetzler-Martin Grade, Clinical Presentation, and AVM Risk Factors" />
<meta name="DC.Identifier" content="10.3174/ajnr.A4259" />
<meta name="DC.Date" content="2015-06-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2015 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: The role of intracranial hemodynamics in the pathophysiology and risk stratification of brain AVMs remains poorly understood. The purpose of this study was to assess the influence of Spetzler-Martin grade, clinical history, and risk factors on vascular flow and tissue perfusion in cerebral AVMs.

MATERIALS AND METHODS: 4D flow and perfusion MR imaging was performed in 17 patients with AVMs. Peak velocity and blood flow were quantified in AVM feeding and contralateral arteries, draining veins, and the straight sinus. Regional perfusion ratios (CBF, CBV, and MTT) were calculated between affected and nonaffected hemispheres.

RESULTS: Regarding flow parameters, high-grade AVMs (Spetzler-Martin grade of &gt;2) demonstrated significantly increased peak velocity and blood flow in the major feeding arteries ( P &lt; .001 and P = .004) and straight sinus ( P = .003 and P = .012) and increased venous draining flow ( P = .001). The Spetzler-Martin grade significantly correlated with cumulative feeding artery flow ( r = 0.85, P &lt; .001) and draining vein flow ( r = 0.80, P &lt; .001). Regarding perfusion parameters, perinidal CBF and CBV ratios were significantly lower ( P &lt; .001) compared with the remote ratios and correlated negatively with cumulative feeding artery flow ( r = −0.60, P = .014 and r = −0.55, P = .026) and draining vein flow ( r = −0.60, P = .013 and r = −0.56, P = .025). Multiple regression analysis revealed no significant association of AVM flow or perfusion parameters with clinical presentation (rupture and seizure history) and AVM risk factors.

CONCLUSIONS: Macrovascular flow was significantly associated with increasing Spetzler-Martin grade and correlated with perinidal microvascular perfusion in cerebral AVMs. Future longitudinal studies are needed to evaluate the potential of comprehensive cerebral flow and perfusion MR imaging for AVM risk stratification.

c
:   contralateral hemisphere
H
:   hemisphere excluding the nidus
i
:   ipsilateral hemisphere
P
:   perinidal
PCA
:   posterior cerebral artery
R
:   remote area
SMG
:   Spetzler-Martin grade" />
<meta name="DC.Contributor" content="C. Wu" />
<meta name="DC.Contributor" content="S.A. Ansari" />
<meta name="DC.Contributor" content="A.R. Honarmand" />
<meta name="DC.Contributor" content="P. Vakil" />
<meta name="DC.Contributor" content="M.C. Hurley" />
<meta name="DC.Contributor" content="B.R. Bendok" />
<meta name="DC.Contributor" content="J. Carr" />
<meta name="DC.Contributor" content="T.J. Carroll" />
<meta name="DC.Contributor" content="M. Markl" />
<meta name="article:published_time" content="2015-06-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Evaluation of 4D Vascular Flow and Tissue Perfusion in Cerebral Arteriovenous Malformations: Influence of Spetzler-Martin Grade, Clinical Presentation, and AVM Risk Factors" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;The role of intracranial hemodynamics in the pathophysiology and risk stratification of brain AVMs remains poorly understood. The purpose of this study was to assess the influence of Spetzler-Martin grade, clinical history, and risk factors on vascular flow and tissue perfusion in cerebral AVMs.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;4D flow and perfusion MR imaging was performed in 17 patients with AVMs. Peak velocity and blood flow were quantified in AVM feeding and contralateral arteries, draining veins, and the straight sinus. Regional perfusion ratios (CBF, CBV, and MTT) were calculated between affected and nonaffected hemispheres.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Regarding flow parameters, high-grade AVMs (Spetzler-Martin grade of &amp;gt;2) demonstrated significantly increased peak velocity and blood flow in the major feeding arteries (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001 and &lt;i&gt;P&lt;/i&gt; = .004) and straight sinus (&lt;i&gt;P&lt;/i&gt; = .003 and &lt;i&gt;P&lt;/i&gt; = .012) and increased venous draining flow (&lt;i&gt;P&lt;/i&gt; = .001). The Spetzler-Martin grade significantly correlated with cumulative feeding artery flow (&lt;i&gt;r&lt;/i&gt; = 0.85, &lt;i&gt;P&lt;/i&gt; &amp;lt; .001) and draining vein flow (&lt;i&gt;r&lt;/i&gt; = 0.80, &lt;i&gt;P&lt;/i&gt; &amp;lt; .001). Regarding perfusion parameters, perinidal CBF and CBV ratios were significantly lower (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001) compared with the remote ratios and correlated negatively with cumulative feeding artery flow (&lt;i&gt;r&lt;/i&gt; = −0.60, &lt;i&gt;P&lt;/i&gt; = .014 and &lt;i&gt;r&lt;/i&gt; = −0.55, &lt;i&gt;P&lt;/i&gt; = .026) and draining vein flow (&lt;i&gt;r&lt;/i&gt; = −0.60, &lt;i&gt;P&lt;/i&gt; = .013 and &lt;i&gt;r&lt;/i&gt; = −0.56, &lt;i&gt;P&lt;/i&gt; = .025). Multiple regression analysis revealed no significant association of AVM flow or perfusion parameters with clinical presentation (rupture and seizure history) and AVM risk factors.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Macrovascular flow was significantly associated with increasing Spetzler-Martin grade and correlated with perinidal microvascular perfusion in cerebral AVMs. Future longitudinal studies are needed to evaluate the potential of comprehensive cerebral flow and perfusion MR imaging for AVM risk stratification.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2015/06/01" />
<meta name="citation_mjid" content="ajnr;36/6/1142" />
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<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
<meta name="citation_doi" content="10.3174/ajnr.A4259" />
<meta name="citation_pmid" content="25721076" />
<meta name="citation_volume" content="36" />
<meta name="citation_issue" content="6" />
<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="Interventional" />
<meta name="citation_firstpage" content="1142" />
<meta name="citation_lastpage" content="1149" />
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<meta name="citation_author" content="C. Wu" />
<meta name="citation_author_institution" content="aFrom the Department of Biomedical Engineering (C.W., T.J.C., M.M.), McCormick School of Engineering, Northwestern University, Evanston, Illinois" />
<meta name="citation_author_institution" content="bDepartments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.)" />
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<meta name="twitter:title" content="Evaluation of 4D Vascular Flow and Tissue Perfusion in Cerebral Arteriovenous Malformations: Influence of Spetzler-Martin Grade, Clinical Presentation, and AVM Risk Factors" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: The role of intracranial hemodynamics in the pathophysiology and risk stratification of brain AVMs remains poorly understood. The purpose of this study was to assess the influence of Spetzler-Martin grade, clinical history, and risk factors on vascular flow and tissue perfusion in cerebral AVMs.

MATERIALS AND METHODS: 4D flow and perfusion MR imaging was performed in 17 patients with AVMs. Peak velocity and blood flow were quantified in AVM feeding and contralateral arteries, draining veins, and the straight sinus. Regional perfusion ratios (CBF, CBV, and MTT) were calculated between affected and nonaffected hemispheres.

RESULTS: Regarding flow parameters, high-grade AVMs (Spetzler-Martin grade of &gt;2) demonstrated significantly increased peak velocity and blood flow in the major feeding arteries ( P &lt; .001 and P = .004) and straight sinus ( P = .003 and P = .012) and increased venous draining flow ( P = .001). The Spetzler-Martin grade significantly correlated with cumulative feeding artery flow ( r = 0.85, P &lt; .001) and draining vein flow ( r = 0.80, P &lt; .001). Regarding perfusion parameters, perinidal CBF and CBV ratios were significantly lower ( P &lt; .001) compared with the remote ratios and correlated negatively with cumulative feeding artery flow ( r = −0.60, P = .014 and r = −0.55, P = .026) and draining vein flow ( r = −0.60, P = .013 and r = −0.56, P = .025). Multiple regression analysis revealed no significant association of AVM flow or perfusion parameters with clinical presentation (rupture and seizure history) and AVM risk factors.

CONCLUSIONS: Macrovascular flow was significantly associated with increasing Spetzler-Martin grade and correlated with perinidal microvascular perfusion in cerebral AVMs. Future longitudinal studies are needed to evaluate the potential of comprehensive cerebral flow and perfusion MR imaging for AVM risk stratification.

c
:   contralateral hemisphere
H
:   hemisphere excluding the nidus
i
:   ipsilateral hemisphere
P
:   perinidal
PCA
:   posterior cerebral artery
R
:   remote area
SMG
:   Spetzler-Martin grade" />
<meta name="og-title" property="og:title" content="Evaluation of 4D Vascular Flow and Tissue Perfusion in Cerebral Arteriovenous Malformations: Influence of Spetzler-Martin Grade, Clinical Presentation, and AVM Risk Factors" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/36/6/1142" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: The role of intracranial hemodynamics in the pathophysiology and risk stratification of brain AVMs remains poorly understood. The purpose of this study was to assess the influence of Spetzler-Martin grade, clinical history, and risk factors on vascular flow and tissue perfusion in cerebral AVMs.

MATERIALS AND METHODS: 4D flow and perfusion MR imaging was performed in 17 patients with AVMs. Peak velocity and blood flow were quantified in AVM feeding and contralateral arteries, draining veins, and the straight sinus. Regional perfusion ratios (CBF, CBV, and MTT) were calculated between affected and nonaffected hemispheres.

RESULTS: Regarding flow parameters, high-grade AVMs (Spetzler-Martin grade of &gt;2) demonstrated significantly increased peak velocity and blood flow in the major feeding arteries ( P &lt; .001 and P = .004) and straight sinus ( P = .003 and P = .012) and increased venous draining flow ( P = .001). The Spetzler-Martin grade significantly correlated with cumulative feeding artery flow ( r = 0.85, P &lt; .001) and draining vein flow ( r = 0.80, P &lt; .001). Regarding perfusion parameters, perinidal CBF and CBV ratios were significantly lower ( P &lt; .001) compared with the remote ratios and correlated negatively with cumulative feeding artery flow ( r = −0.60, P = .014 and r = −0.55, P = .026) and draining vein flow ( r = −0.60, P = .013 and r = −0.56, P = .025). Multiple regression analysis revealed no significant association of AVM flow or perfusion parameters with clinical presentation (rupture and seizure history) and AVM risk factors.

CONCLUSIONS: Macrovascular flow was significantly associated with increasing Spetzler-Martin grade and correlated with perinidal microvascular perfusion in cerebral AVMs. Future longitudinal studies are needed to evaluate the potential of comprehensive cerebral flow and perfusion MR imaging for AVM risk stratification.

c
:   contralateral hemisphere
H
:   hemisphere excluding the nidus
i
:   ipsilateral hemisphere
P
:   perinidal
PCA
:   posterior cerebral artery
R
:   remote area
SMG
:   Spetzler-Martin grade" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node13925--5" data-node-nid="13925" id="top-node-13925--6606271873" data-pisa="ajnr;36/6/1142" data-pisa-master="ajnr;ajnr.A4259" data-apath="/ajnr/36/6/1142.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Interventional</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Evaluation of 4D Vascular Flow and Tissue Perfusion in Cerebral Arteriovenous Malformations: Influence of Spetzler-Martin Grade, Clinical Presentation, and AVM Risk Factors</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">C. Wu</span>, <span class="highwire-citation-author" data-delta="1">S.A. Ansari</span>, <span class="highwire-citation-author" data-delta="2">A.R. Honarmand</span>, <span class="highwire-citation-author" data-delta="3">P. Vakil</span>, <span class="highwire-citation-author" data-delta="4">M.C. Hurley</span>, <span class="highwire-citation-author" data-delta="5">B.R. Bendok</span>, <span class="highwire-citation-author" data-delta="6">J. Carr</span>, <span class="highwire-citation-author" data-delta="7">T.J. Carroll</span> and <span class="highwire-citation-author" data-delta="8">M. Markl</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">June 2015,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">36 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1142-1149; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4259 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-13925--6606271873" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">C. Wu </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Biomedical Engineering (C.W., T.J.C., M.M.), McCormick School of Engineering, Northwestern University, Evanston, Illinois</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BWu%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wu%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AC.%2BWu%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">S.A. Ansari </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurological Surgery (S.A.A., M.C.H., B.R.B.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Neurology (S.A.A.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.A.%2BAnsari%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ansari%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.A.%2BAnsari%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">A.R. Honarmand </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.R.%2BHonarmand%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Honarmand%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AA.R.%2BHonarmand%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">P. Vakil </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BVakil%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Vakil%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AP.%2BVakil%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">M.C. Hurley </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurological Surgery (S.A.A., M.C.H., B.R.B.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.C.%2BHurley%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hurley%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AM.C.%2BHurley%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">B.R. Bendok </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Departments of Radiology (C.W., S.A.A., A.R.H., P.V., M.C.H., B.R.B., J.C., T.J.C., M.M.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurological Surgery (S.A.A., M.C.H., B.R.B.)</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Otolaryngology (B.R.B.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.R.%2BBendok%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Bendok%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AB.R.%2BBendok%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">J. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> The role of intracranial hemodynamics in the pathophysiology and risk stratification of brain AVMs remains poorly understood. The purpose of this study was to assess the influence of Spetzler-Martin grade, clinical history, and risk factors on vascular flow and tissue perfusion in cerebral AVMs.</p></div><div id="sec-2" class="subsection"><p id="p-3"><strong>MATERIALS AND METHODS:</strong> 4D flow and perfusion MR imaging was performed in 17 patients with AVMs. Peak velocity and blood flow were quantified in AVM feeding and contralateral arteries, draining veins, and the straight sinus. Regional perfusion ratios (CBF, CBV, and MTT) were calculated between affected and nonaffected hemispheres.</p></div><div id="sec-3" class="subsection"><p id="p-4"><strong>RESULTS:</strong> Regarding flow parameters, high-grade AVMs (Spetzler-Martin grade of &gt;2) demonstrated significantly increased peak velocity and blood flow in the major feeding arteries (<em>P</em> &lt; .001 and <em>P</em> = .004) and straight sinus (<em>P</em> = .003 and <em>P</em> = .012) and increased venous draining flow (<em>P</em> = .001). The Spetzler-Martin grade significantly correlated with cumulative feeding artery flow (<em>r</em> = 0.85, <em>P</em> &lt; .001) and draining vein flow (<em>r</em> = 0.80, <em>P</em> &lt; .001). Regarding perfusion parameters, perinidal CBF and CBV ratios were significantly lower (<em>P</em> &lt; .001) compared with the remote ratios and correlated negatively with cumulative feeding artery flow (<em>r</em> = −0.60, <em>P</em> = .014 and <em>r</em> = −0.55, <em>P</em> = .026) and draining vein flow (<em>r</em> = −0.60, <em>P</em> = .013 and <em>r</em> = −0.56, <em>P</em> = .025). Multiple regression analysis revealed no significant association of AVM flow or perfusion parameters with clinical presentation (rupture and seizure history) and AVM risk factors.</p></div><div id="sec-4" class="subsection"><p id="p-5"><strong>CONCLUSIONS:</strong> Macrovascular flow was significantly associated with increasing Spetzler-Martin grade and correlated with perinidal microvascular perfusion in cerebral AVMs. Future longitudinal studies are needed to evaluate the potential of comprehensive cerebral flow and perfusion MR imaging for AVM risk stratification.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">c<span class="def-item-dt-sep"></span></dt><dd>contralateral hemisphere<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">H<span class="def-item-dt-sep"></span></dt><dd>hemisphere excluding the nidus<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">i<span class="def-item-dt-sep"></span></dt><dd>ipsilateral hemisphere<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">P<span class="def-item-dt-sep"></span></dt><dd>perinidal<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">PCA<span class="def-item-dt-sep"></span></dt><dd>posterior cerebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">R<span class="def-item-dt-sep"></span></dt><dd>remote area<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">SMG<span class="def-item-dt-sep"></span></dt><dd>Spetzler-Martin grade</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2015 by American Journal of Neuroradiology</li></ul><div class="license" id="license-1"><p id="p-1">Indicates open access to non-subscribers at <a href="http://www.ajnr.org" rel="license">www.ajnr.org</a></p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/36/6/1142.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 36</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 6 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jun 2015 </div></div>
      
      
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Wu</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">S.A.</span> <span class="nlm-surname">Ansari</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">A.R.</span> <span class="nlm-surname">Honarmand</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Vakil</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">M.C.</span> <span class="nlm-surname">Hurley</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">B.R.</span> <span class="nlm-surname">Bendok</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Carr</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">T.J.</span> <span class="nlm-surname">Carroll</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Markl</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jun 2015, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">36 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1142-1149; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4259 </span></div>
  
  
  
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      <div class="highwire-cite-title">Evaluation of 4D Vascular Flow and Tissue Perfusion in Cerebral Arteriovenous Malformations: Influence of Spetzler-Martin Grade, Clinical Presentation, and AVM Risk Factors</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Wu</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">S.A.</span> <span class="nlm-surname">Ansari</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">A.R.</span> <span class="nlm-surname">Honarmand</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Vakil</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">M.C.</span> <span class="nlm-surname">Hurley</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">B.R.</span> <span class="nlm-surname">Bendok</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Carr</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">T.J.</span> <span class="nlm-surname">Carroll</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Markl</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jun 2015, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">36 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1142-1149; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4259 </span></div>
  
  
  
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