Abstract 12401: In-vivo Assessment of the Impact of Endovascular Embolization on 3D Intracranial Hemodynamics in Pediatric Patients With Vein of Galen Aneurysmal Malformations
Objective: To investigate the feasibility of serial 4D flow MRI for the in-vivo monitoring of 3D intracranial hemodynamic alterations in pediatric patients with rare vein of Galen aneurysmal malformations (VGAM) treated by staged embolization.
Methods: Serial 4D flow MRI data were acquired in 4 VGAM patients (1±1 years; 13 scans) and 10 controls (4±3 years). Time-integrated pathlines were used to visualize intracranial 3D blood flow characteristics and blood flow was quantified in manually positioned 2D planes (Fig. 1a), i.e. internal carotid artery (ICA), basilar artery (BA), and straight sinus (StrS). Arterial inflow (ICAs+BA) and shunt flow to the StrS were compared between patients and controls.
Results: Intracranial blood flow characteristics demonstrated substantially altered flow patterns and increased arterial velocities as illustrated in a VGAM patient at pre-treatment (Fig. 1b) compared to a normal control (Fig. 1a). Considerable hemodynamic alterations and lesion shrinkage were found after embolization of the feeding right posterior choroidal artery (RPChA) (Fig. 1c). Arterial inflow and shunt flow decreased from pre- to post-2nd embolization by 52% and 93%, respectively (Fig. 1d). For the other 3 VGAM patients, post-interventional shunt flow decreased by 57%/37%/50% and arterial inflow was altered by -7%/+37%/-36%. Figure 1e illustrates the age and distribution of arterial inflow for controls and patients. In addition, VGAM patients exhibited higher flow through the StrS than controls (6.7±2.3 vs. 1.5±1.3 ml/cycle, P=0.001) (Fig. 1f) indicating increased shunting of blood through the VGAM.
Conclusions: Embolization of VGAMs induced shunt reduction and substantial intracranial hemodynamic alterations (changes in arterial inflow up to 50%). Further studies are needed to evaluate the potential of 4D flow to complement existing diagnostic tools to better determine optimal embolization timing and prediction of hemodynamic outcome.
Author Disclosures: C. Wu: None. S.E. Schoeneman: None. A.R. Honarmand: None. M. Messina: None. J. Deng: None. S.A. Ansari: None. A. Shaibani: None. M. Markl: None.
This research has received full or partial funding support from the American Heart Association
- © 2014 by American Heart Association, Inc.