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      <h1 class="highwire-cite-title" id="page-title">Is an Early Angiogram Needed?</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Wan-Yuo Guo</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">March 2000,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">21 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">608-609; </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-11532--6393315727" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Wan-Yuo Guo </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Veterans General Hospital Taipei, Taiwan</div>MD, PhD</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=Wan-Yuo%2BGuo%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=Guo%20W&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%3AWan-Yuo%2BGuo%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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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 fulltext-view "><span class="highwire-journal-article-marker-start"></span><div class="section" id="sec-1"><p id="p-1">The value of arteriovenous malformation (AVM) radiosurgery is its noninvasive nature, and efforts should be made to minimize the invasiveness that is relevant to associated diagnostic imaging procedures. MR imaging, for diagnosis, treatment guidance, and follow-up is the most helpful tool to meet this purpose. For many AVMs that have a classic MR appearance, we may reconsider the use of diagnostic X-ray angiography to determine the feasibility of radiosurgery. For radiosurgical guidance, stereotaxic X-ray angiography remains the standard of reference imaging technique <a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">(1)</a>, and for those AVMs with repeated episodes of hemorrhage or previous partial surgical extirpation, X-ray angiography is mandatory. Stereotaxic MR imaging, however, is of great value in providing three-dimensional delineation of the AVM nidus, which is the only target in AVM radiosurgery <a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">(2)</a>. In AVM radiosurgery, stereotaxic X-ray angiography and stereotaxic MR imaging are performed on the same stereotaxic system, and the location and coordinates of the target lesion in the stereotaxic space is transferable. We are, therefore, able to integrate the information derived from MR imaging and X-ray angiography for a better delineation of the AVM nidus. This imaging strategy improves the delivery of effective dose levels and provides a better irradiation volume in AVM radiosurgery. It, consequently, safely expands the indication of radiosurgery for larger AVMs and explores new indications, such as dural arteriovenous fistulas of the cavernous sinus with radiosurgery <a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">(3–5)</a>.</p><p id="p-2">After radiosurgery, the involuting AVM seems to be equally “visible” on both MR images and X-ray angiograms. MR imaging can show a decreasing size as early as 3 months after radiosurgery <a id="xref-ref-6-1" class="xref-bibr" href="#ref-6">(6)</a>. Concerning the bleeding rate of AVMs treated radiosurgically in the time lag prior to complete obliteration, the data available in the literature is controversial. Our data, based on follow-up of our protocol of AVM patients, have shown that the clinical bleeding rate in this time period is lower than the natural history of bleeding. Subclinical hemorrhage, however, (eg, petechia in AVM regions), as depicted on MR images, is much more frequent than expected <a id="xref-ref-7-1" class="xref-bibr" href="#ref-7">(7)</a>. In documenting complete obliteration in AVM radiosurgery, MR imaging plays a vital role <a id="xref-ref-8-1" class="xref-bibr" href="#ref-8">(8)</a>. The challenge to neuroradiologists should be to use MR imaging exclusively to verify complete AVM obliteration.</p></div><div class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-other" id="cit-21.3.608.1"><div class="cit-metadata"><cite>Guo WY, Lindqvist M, Linquist C,  et al.  <strong>Stereotaxic angiography in gamma knife radiosurgery of intracranial arteriovenous malformations.</strong> <span class="cit-source">AJNR Am J Neuroradiol</span> <span class="cit-pub-date">1992</span>;<span class="cit-vol">13</span>:<span class="cit-fpage">1107</span>-1113</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIxMy80LzExMDciO3M6NDoiYXRvbSI7czoyMToiL2FqbnIvMjEvMy82MDguMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2 in text" id="ref-2">↵</a><div class="cit ref-cit ref-other" id="cit-21.3.608.2"><div class="cit-metadata"><cite>Guo WY, Nordell B, Karlsson B,  et al.  <strong>Target delineation in radiosurgery for cerebral arteriovenous malformations. Assessment of the value of stereotaxic MR imaging and MR angiography.</strong> <span class="cit-source">Acta Radiol</span> <span class="cit-pub-date">1993</span>;<span class="cit-vol">34</span>:<span class="cit-fpage">457</span>-463</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=8369181&amp;link_type=MED&amp;atom=%2Fajnr%2F21%2F3%2F608.1.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3 in text" id="ref-3">↵</a><div class="cit ref-cit ref-other" id="cit-21.3.608.3"><div class="cit-metadata"><cite>Guo WY, Pan HC, Shiau CY,  et al.  <strong>AVM radiosurgery,where is the volume limit?</strong> <span class="cit-source">Rivista di Neuroradiol</span> <span class="cit-pub-date">1999</span>;<span class="cit-vol">12 (Suppl 2)</span>:<span class="cit-fpage">35</span>-40</cite></div><div class="cit-extra"></div></div></li><li><div class="cit ref-cit ref-other no-rev-xref" id="cit-21.3.608.4"><div class="cit-metadata"><cite>Guo WY, Pan HC, Wu HM,  et al.  <strong>Radiosurgery as a treatment alternative for dural arteriovenous fistulas of cavernous sinus.</strong> <span class="cit-source">AJNR Am J Neuroradiol</span> <span class="cit-pub-date">1998</span>;<span class="cit-vol">19</span>:<span class="cit-fpage">1081</span>-1087</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIxOS82LzEwODEiO3M6NDoiYXRvbSI7czoyMToiL2FqbnIvMjEvMy82MDguMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span></span></a></div></div></li><li><div class="cit ref-cit ref-other no-rev-xref" id="cit-21.3.608.5"><div class="cit-metadata"><cite>Guo WY.  <strong>Application of MR in radiosurgery.</strong> <span class="cit-source">JMRI</span> <span class="cit-pub-date">1998</span>;<span class="cit-vol">8</span>:<span class="cit-fpage">415</span>-420</cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-6-1" title="View reference 6 in text" id="ref-6">↵</a><div class="cit ref-cit ref-other" id="cit-21.3.608.6"><div class="cit-metadata"><cite>Guo WY, Pan HC, Liu RS,  et al.  <strong>Early irradiation effects observed on MRI and MRA, and PET for arteriovenous malformations treated by gamma knife radiosurgery.</strong> <span class="cit-source">Stereot and Funct Neurosurg</span> <span class="cit-pub-date">1995</span>;<span class="cit-vol">64 (suppl 1)</span>:<span class="cit-fpage">258</span>-269</cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-7-1" title="View reference 7 in text" id="ref-7">↵</a><div class="cit ref-cit ref-other" id="cit-21.3.608.7"><div class="cit-metadata"><cite>Guo WY, Chung WY, Shiau CY, Wu HM, Wang LW, Pan HC.  <strong>Is subclinical hemorrhage common? Neuroimaging and clinical evaluation after AVM radiosurgery.</strong>  In: Kondziolka D, ed. <em>Radiosurgery</em> Vol 2. Basel, Krager,  <span class="cit-pub-date">1997</span>;<span class="cit-fpage">157</span>-172</cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-8-1" title="View reference 8 in text" id="ref-8">↵</a><div class="cit ref-cit ref-other" id="cit-21.3.608.8"><div class="cit-metadata"><cite>Guo WY, Pan HC, Chung WY, Wang LW, Teng MMH.  <strong>Do you need conventional angiography? The role of MR in verifying totally obliterated AVMs.</strong> <span class="cit-source">Stereot and Funct Neurosurg</span> <span class="cit-pub-date">1996</span>;<span class="cit-vol">66 (suppl 1)</span>:<span class="cit-fpage">71</span>-84</cite></div><div class="cit-extra"></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 21</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 3 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Mar 2000 </div></div>
      
      
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