Abstract：
We studied the correlation between new-onset perinidal hyperintensity (PH) on T2-weighted magnetic resonance imaging and obliteration of intracranial arteriovenous malformation (AVM) after stereotactic radiosurgery (SRS).
A retrospective study of 148 patients with an intracranial AVM who underwent SRS between September 2005 and June 2018 and had ≥1 radiological follow-up (early magnetic resonance imaging) 12-18 months after SRS was performed to analyze the correlation between PH (graded from 0 to 2) and AVM obliteration.
Of the 148 patients, 95 were male. The mean patient age was 27.7 ± 12.4 years. Of the 148 AVMs, 105 (70.9%) were obliterated at a median follow-up of 27 months (interquartile range, 14-48 months). The cumulative 3-, 5-, 10-year obliteration rate was 51.8%, 70.8%, and 91.8%, respectively. New-onset PH was observed in 58 AVMs (39.2%; 50 obliterated and 8 not obliterated). No association was found between the pretreatment variables or dose delivered and the development of PH. Grade 2 PH was associated with the risk of symptoms developing compared with grade 1 PH (37.5% vs. 4%; P = 0.002). Symptomatic PH was more likely to develop in patients with a larger AVM (P = 0.05). On multivariate analysis, the presence of a single draining vein (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.3-6.8), a lower median AVM volume (OR, 0.97; 95% CI, 0.6-0.89), a mean marginal radiation dose (OR, 1.29; 95% CI, 1.02-1.64), and the presence of PH (OR, 3.16; 95% CI, 1.29-7.71) were independent predictors of AVM obliteration.
The incidence of PH after SRS for AVM was 39.2%. PH was an independent predictor of AVM obliteration after SRS. Grade 2 PH and a larger AVM volume were associated with symptomatic PH.
A retrospective study of 148 patients with an intracranial AVM who underwent SRS between September 2005 and June 2018 and had ≥1 radiological follow-up (early magnetic resonance imaging) 12-18 months after SRS was performed to analyze the correlation between PH (graded from 0 to 2) and AVM obliteration.
Of the 148 patients, 95 were male. The mean patient age was 27.7 ± 12.4 years. Of the 148 AVMs, 105 (70.9%) were obliterated at a median follow-up of 27 months (interquartile range, 14-48 months). The cumulative 3-, 5-, 10-year obliteration rate was 51.8%, 70.8%, and 91.8%, respectively. New-onset PH was observed in 58 AVMs (39.2%; 50 obliterated and 8 not obliterated). No association was found between the pretreatment variables or dose delivered and the development of PH. Grade 2 PH was associated with the risk of symptoms developing compared with grade 1 PH (37.5% vs. 4%; P = 0.002). Symptomatic PH was more likely to develop in patients with a larger AVM (P = 0.05). On multivariate analysis, the presence of a single draining vein (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.3-6.8), a lower median AVM volume (OR, 0.97; 95% CI, 0.6-0.89), a mean marginal radiation dose (OR, 1.29; 95% CI, 1.02-1.64), and the presence of PH (OR, 3.16; 95% CI, 1.29-7.71) were independent predictors of AVM obliteration.
The incidence of PH after SRS for AVM was 39.2%. PH was an independent predictor of AVM obliteration after SRS. Grade 2 PH and a larger AVM volume were associated with symptomatic PH.
摘要：
目的：研究立体定向放射外科（SRS）后T2WMRI上新发作的围生体高强度（PH）与颅内动静脉畸形（AVM）闭塞的相关性。
方法：回顾性研究了148例颅内AVM患者，这些患者在2005年9月至2018年6月期间接受了SRS，并在SRS后12-18个月进行了至少一次放射学随访（早期MRI），分析PH(0~2级)与AVM闭塞的相关性。
结果：共有148例患者（男性95例）；平均年龄为27.7±12.4岁。148例AVM中有105例(70.9%)在中位随访27例(IQR，14-48）个月。累积的3-，5-,10年消失率为51.8%，分别为70.8%和91.8%。在58（39.2％）AVM中观察到新发作的PH（50个消失，8个未消失）。治疗前变量或递送剂量与PH的发展之间没有关联。与1级PH相比，2级PH与发展症状的风险相关（37.5％vs4％，p=0.002)。有症状的PH在AVM较大的患者中更容易发展（p=0.05）。在多变量分析中，存在单个引流静脉（OR2.9,95%CI1.3-6.8），AVM中位数较低（OR0.97,95%CI0.6-0.89），平均边缘辐射剂量(OR1.29,95%CI1.02-1.64)和PH的存在(OR3.16,95%CI1.29-7.71)是AVM消失的独立预测因子.
结论：AVMSRS后PH的发生率为39.2%。PH是SRS后AVM消失的独立预测因子。2级PH和更大的AVM体积与症状性PH相关。
方法：回顾性研究了148例颅内AVM患者，这些患者在2005年9月至2018年6月期间接受了SRS，并在SRS后12-18个月进行了至少一次放射学随访（早期MRI），分析PH(0~2级)与AVM闭塞的相关性。
结果：共有148例患者（男性95例）；平均年龄为27.7±12.4岁。148例AVM中有105例(70.9%)在中位随访27例(IQR，14-48）个月。累积的3-，5-,10年消失率为51.8%，分别为70.8%和91.8%。在58（39.2％）AVM中观察到新发作的PH（50个消失，8个未消失）。治疗前变量或递送剂量与PH的发展之间没有关联。与1级PH相比，2级PH与发展症状的风险相关（37.5％vs4％，p=0.002)。有症状的PH在AVM较大的患者中更容易发展（p=0.05）。在多变量分析中，存在单个引流静脉（OR2.9,95%CI1.3-6.8），AVM中位数较低（OR0.97,95%CI0.6-0.89），平均边缘辐射剂量(OR1.29,95%CI1.02-1.64)和PH的存在(OR3.16,95%CI1.29-7.71)是AVM消失的独立预测因子.
结论：AVMSRS后PH的发生率为39.2%。PH是SRS后AVM消失的独立预测因子。2级PH和更大的AVM体积与症状性PH相关。
