Vascular compactness of unruptured brain arteriovenous malformation predicts risk of hemorrhage after stereotactic radiosurgery
Abstract The aim of the study was to investigate whether morphology (i.e. compact/diffuse) of brain arteriovenous malformations (bAVMs) correlates with the incidence of hemorrhagic events in patients receiving Stereotactic Radiosurgery (SRS) for unruptured bAVMs. This retrospective study included 26...
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2024-02-01
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| Series: | Scientific Reports |
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| Online Access: | https://doi.org/10.1038/s41598-024-54369-2 |
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| author | Po-Wei Huang Syu-Jyun Peng David Hung-Chi Pan Huai-Che Yang Jo-Ting Tsai Cheng-Ying Shiau I-Chang Su Ching-Jen Chen Hsiu-Mei Wu Chung-Jung Lin Wen-Yuh Chung Wan-Yuo Guo Wei-Lun Lo Shao-Wen Lai Cheng-Chia Lee |
| author_facet | Po-Wei Huang Syu-Jyun Peng David Hung-Chi Pan Huai-Che Yang Jo-Ting Tsai Cheng-Ying Shiau I-Chang Su Ching-Jen Chen Hsiu-Mei Wu Chung-Jung Lin Wen-Yuh Chung Wan-Yuo Guo Wei-Lun Lo Shao-Wen Lai Cheng-Chia Lee |
| author_sort | Po-Wei Huang |
| collection | DOAJ |
| description | Abstract The aim of the study was to investigate whether morphology (i.e. compact/diffuse) of brain arteriovenous malformations (bAVMs) correlates with the incidence of hemorrhagic events in patients receiving Stereotactic Radiosurgery (SRS) for unruptured bAVMs. This retrospective study included 262 adult patients with unruptured bAVMs who underwent upfront SRS. Hemorrhagic events were defined as evidence of blood on CT or MRI. The morphology of bAVMs was evaluated using automated segmentation which calculated the proportion of vessel, brain tissue, and cerebrospinal fluid in bAVMs on T2-weighted MRI. Compactness index, defined as the ratio of vessel to brain tissue, categorized bAVMs into compact and diffuse types based on the optimal cutoff. Cox proportional hazard model was used to identify the independent factors for post-SRS hemorrhage. The median clinical follow-ups was 62.1 months. Post-SRS hemorrhage occurred in 13 (5.0%) patients and one of them had two bleeds, resulting in an annual bleeding rate of 0.8%. Multivariable analysis revealed bAVM morphology (compact versus diffuse), bAVM volume, and prescribed margin dose were significant predictors. The post-SRS hemorrhage rate increased with larger bAVM volume only among the diffuse nidi (1.7 versus 14.9 versus 30.6 hemorrhage per 1000 person-years in bAVM volume < 20 cm3 versus 20–40 cm3 versus > 40 cm3; p = 0.022). The significantly higher post-SRS hemorrhage rate of Spetzler-Martin grade IV–V compared with grade I–III bAVMs (20.0 versus 3.3 hemorrhages per 1000 person-years; p = 0.001) mainly originated from the diffuse bAVMs rather than the compact subgroup (30.9 versus 4.8 hemorrhages per 1000 person-years; p = 0.035). Compact and smaller bAVMs, with higher prescribed margin dose harbor lower risks of post-SRS hemorrhage. The post-SRS hemorrhage rate exceeded 2.2% annually within the diffuse and large (> 40 cm3) bAVMs and the diffuse Spetzler-Martin IV–V bAVMs. These findings may help guide patient selection of SRS for the unruptured bAVMs. |
| first_indexed | 2024-03-07T15:09:57Z |
| format | Article |
| id | doaj.art-3822602701c44faf9b39e2a80b3c555e |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-07T15:09:57Z |
| publishDate | 2024-02-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-3822602701c44faf9b39e2a80b3c555e2024-03-05T18:42:58ZengNature PortfolioScientific Reports2045-23222024-02-0114111010.1038/s41598-024-54369-2Vascular compactness of unruptured brain arteriovenous malformation predicts risk of hemorrhage after stereotactic radiosurgeryPo-Wei Huang0Syu-Jyun Peng1David Hung-Chi Pan2Huai-Che Yang3Jo-Ting Tsai4Cheng-Ying Shiau5I-Chang Su6Ching-Jen Chen7Hsiu-Mei Wu8Chung-Jung Lin9Wen-Yuh Chung10Wan-Yuo Guo11Wei-Lun Lo12Shao-Wen Lai13Cheng-Chia Lee14Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical UniversityProgram in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical UniversityDepartment of Neurosurgery, Neurological Institute, Taipei Veterans General HospitalDepartment of Neurosurgery, Neurological Institute, Taipei Veterans General HospitalDepartment of Radiation Oncology, Shuang Ho Hospital, Taipei Medical UniversityCancer Center, Taipei Veterans General HospitalDepartment of Neurosurgery, Shuang Ho Hospital, Taipei Medical UniversityDepartment of Neurosurgery, University of Texas Health Science CenterDepartment of Radiology, Taipei Veterans General HospitalDepartment of Radiology, Taipei Veterans General HospitalDepartment of Neurosurgery, Neurological Institute, Taipei Veterans General HospitalDepartment of Radiology, Taipei Veterans General HospitalDepartment of Neurosurgery, Shuang Ho Hospital, Taipei Medical UniversityProduct and Engineering, ZippinDepartment of Neurosurgery, Neurological Institute, Taipei Veterans General HospitalAbstract The aim of the study was to investigate whether morphology (i.e. compact/diffuse) of brain arteriovenous malformations (bAVMs) correlates with the incidence of hemorrhagic events in patients receiving Stereotactic Radiosurgery (SRS) for unruptured bAVMs. This retrospective study included 262 adult patients with unruptured bAVMs who underwent upfront SRS. Hemorrhagic events were defined as evidence of blood on CT or MRI. The morphology of bAVMs was evaluated using automated segmentation which calculated the proportion of vessel, brain tissue, and cerebrospinal fluid in bAVMs on T2-weighted MRI. Compactness index, defined as the ratio of vessel to brain tissue, categorized bAVMs into compact and diffuse types based on the optimal cutoff. Cox proportional hazard model was used to identify the independent factors for post-SRS hemorrhage. The median clinical follow-ups was 62.1 months. Post-SRS hemorrhage occurred in 13 (5.0%) patients and one of them had two bleeds, resulting in an annual bleeding rate of 0.8%. Multivariable analysis revealed bAVM morphology (compact versus diffuse), bAVM volume, and prescribed margin dose were significant predictors. The post-SRS hemorrhage rate increased with larger bAVM volume only among the diffuse nidi (1.7 versus 14.9 versus 30.6 hemorrhage per 1000 person-years in bAVM volume < 20 cm3 versus 20–40 cm3 versus > 40 cm3; p = 0.022). The significantly higher post-SRS hemorrhage rate of Spetzler-Martin grade IV–V compared with grade I–III bAVMs (20.0 versus 3.3 hemorrhages per 1000 person-years; p = 0.001) mainly originated from the diffuse bAVMs rather than the compact subgroup (30.9 versus 4.8 hemorrhages per 1000 person-years; p = 0.035). Compact and smaller bAVMs, with higher prescribed margin dose harbor lower risks of post-SRS hemorrhage. The post-SRS hemorrhage rate exceeded 2.2% annually within the diffuse and large (> 40 cm3) bAVMs and the diffuse Spetzler-Martin IV–V bAVMs. These findings may help guide patient selection of SRS for the unruptured bAVMs.https://doi.org/10.1038/s41598-024-54369-2Stereotactic radiosurgeryPost-SRS hemorrhageCompactness indexAutomated segmentationArteriovenous malformation morphologyVascular disorders |
| spellingShingle | Po-Wei Huang Syu-Jyun Peng David Hung-Chi Pan Huai-Che Yang Jo-Ting Tsai Cheng-Ying Shiau I-Chang Su Ching-Jen Chen Hsiu-Mei Wu Chung-Jung Lin Wen-Yuh Chung Wan-Yuo Guo Wei-Lun Lo Shao-Wen Lai Cheng-Chia Lee Vascular compactness of unruptured brain arteriovenous malformation predicts risk of hemorrhage after stereotactic radiosurgery Scientific Reports Stereotactic radiosurgery Post-SRS hemorrhage Compactness index Automated segmentation Arteriovenous malformation morphology Vascular disorders |
| title | Vascular compactness of unruptured brain arteriovenous malformation predicts risk of hemorrhage after stereotactic radiosurgery |
| title_full | Vascular compactness of unruptured brain arteriovenous malformation predicts risk of hemorrhage after stereotactic radiosurgery |
| title_fullStr | Vascular compactness of unruptured brain arteriovenous malformation predicts risk of hemorrhage after stereotactic radiosurgery |
| title_full_unstemmed | Vascular compactness of unruptured brain arteriovenous malformation predicts risk of hemorrhage after stereotactic radiosurgery |
| title_short | Vascular compactness of unruptured brain arteriovenous malformation predicts risk of hemorrhage after stereotactic radiosurgery |
| title_sort | vascular compactness of unruptured brain arteriovenous malformation predicts risk of hemorrhage after stereotactic radiosurgery |
| topic | Stereotactic radiosurgery Post-SRS hemorrhage Compactness index Automated segmentation Arteriovenous malformation morphology Vascular disorders |
| url | https://doi.org/10.1038/s41598-024-54369-2 |
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