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Hak JF, Boulouis G, Kerleroux B, Benichi S, Stricker S, Gariel F, Garzelli L, Meyer P, Kossorotoff M, Boddaert N, Girard N, Vidal V, Dangouloff Ros V, Blauwblomme T, Naggara O. Noninvasive Follow-up Imaging of Ruptured Pediatric Brain AVMs Using Arterial Spin-Labeling. AJNR Am J Neuroradiol 2022; 43:1363-1368. [PMID: 36007951 PMCID: PMC9451641 DOI: 10.3174/ajnr.a7612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Brain AVMs represent the main etiology of pediatric intracranial hemorrhage. Noninvasive imaging techniques to monitor the treatment effect of brain AVMs remain an unmet need. In a large cohort of pediatric ruptured brain AVMs, we aimed to investigate the role of arterial spin-labeling for the longitudinal follow-up during treatment and after complete obliteration by analyzing CBF variations across treatment sessions. MATERIALS AND METHODS Consecutive patients with ruptured brain AVMs referred to a pediatric quaternary care center were prospectively included in a registry that was retrospectively queried for children treated between 2011 and 2019 with unimodal or multimodal treatment (surgery, radiosurgery, embolization). We included children who underwent an arterial spin-labeling sequence before and after treatment and a follow-up DSA. CBF variations were analyzed in univariable analyses. RESULTS Fifty-nine children with 105 distinct treatment sessions were included. The median CBF variation after treatment was -43 mL/100 mg/min (interquartile range, -102-5.5), significantly lower after complete nidal surgical resection. Following radiosurgery, patients who were healed on the last DSA follow-up demonstrated a greater CBF decrease on intercurrent MR imaging, compared with patients with a persisting shunt at last follow-up (mean, -62 [SD, 61] mL/100 mg/min versus -17 [SD, 40.1] mL/100 mg/min; P = .02). In children with obliterated AVMs, recurrences occurred in 12% and resulted in a constant increase in CBF (mean, +89 [SD, 77] mL/100 mg/min). CONCLUSIONS Our results contribute data on the role of noninvasive arterial spin-labeling monitoring of the response to treatment or follow-up after obliteration of pediatric AVMs. Future research may help to better delineate how arterial spin-labeling can assist in decisions regarding the optimal timing for DSA.
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Affiliation(s)
- J F Hak
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France
- L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France
| | - G Boulouis
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France
- L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France
| | - B Kerleroux
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France
- L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France
| | - S Benichi
- Department of Pediatric Neurosurgery (S.B., S.S., T.B.), Institut Imagine, L'Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Assistance Publique-Hôpitaux de Paris, Necker Hospital-Sick Children, Paris, France
| | - S Stricker
- Department of Pediatric Neurosurgery (S.B., S.S., T.B.), Institut Imagine, L'Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Assistance Publique-Hôpitaux de Paris, Necker Hospital-Sick Children, Paris, France
| | - F Gariel
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (F.G.), University Hospital of Bordeaux, Bordeaux, France
| | - L Garzelli
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
| | - P Meyer
- Pediatric Neurointensive Care Unit (P.M.)
| | - M Kossorotoff
- Department of Pediatric Neurology (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire, Necker Hospital-Sick Children, Paris, France
- INSERM U894, French Center for Pediatric Stroke (M.K., T.B., O.N.), L'Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - N Boddaert
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Université de Paris (N.B., V.D.R.), L'Institut National de la Santé et de la Recherche Médicale, ERL, Paris, France
- Institut Imagine (N.B., V.D.R.),Université de Paris,Unité Mixte de Recherche 1163, Paris, France
| | - N Girard
- Departments of Neuroradiology (N.G.)
| | - V Vidal
- Radiology (V.V.), University Hospital La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - V Dangouloff Ros
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Université de Paris (N.B., V.D.R.), L'Institut National de la Santé et de la Recherche Médicale, ERL, Paris, France
- Institut Imagine (N.B., V.D.R.),Université de Paris,Unité Mixte de Recherche 1163, Paris, France
| | - T Blauwblomme
- Department of Pediatric Neurosurgery (S.B., S.S., T.B.), Institut Imagine, L'Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Assistance Publique-Hôpitaux de Paris, Necker Hospital-Sick Children, Paris, France
- INSERM U894, French Center for Pediatric Stroke (M.K., T.B., O.N.), L'Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - O Naggara
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France
- L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France
- INSERM U894, French Center for Pediatric Stroke (M.K., T.B., O.N.), L'Institut National de la Santé et de la Recherche Médicale, Paris, France
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Lognon P, Gariel F, Marnat G, Darcourt J, Constant Dit Beaufils P, Burel J, Shotar E, Hak JF, Fauché C, Kerleroux B, Guédon A, Ognard J, Forestier G, Pop R, Paya C, Veyrières JB, Sporns P, Girot JB, Zannoni R, Zhu F, Crespy A, L'Allinec V, Mihoc D, Rouchaud A, Gentric JC, Ben Hassen W, Raynaud N, Testud B, Clarençon F, Kaczmarek B, Bourcier R, Bellanger G, Boulouis G, Janot K. Prospective assessment of aneurysmal rupture risk scores in patients with subarachnoid hemorrhage: a multicentric cohort. Neuroradiology 2022; 64:2363-2371. [PMID: 35695927 DOI: 10.1007/s00234-022-02987-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/20/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE The natural evolution of unruptured intracranial aneurysms (UIA) is indeed difficult to predict at the individual level. OBJECTIVE In a large prospective multicentric European cohort, we aimed to evaluate whether the PHASES, UCAS, and ELPASS scores in patients with aneurysmal subarachnoid hemorrhage would have predicted a high risk of aneurysmal rupture or growth. METHODS Academic centers treating patients with intracranial aneurysms were invited to prospectively collect de-identified data from all patients admitted at their institution for a subarachnoid hemorrhage-related to intracranial aneurysmal rupture between January 1 and March 31, 2021 through a trainee-led research collaborative network. Each responding center was provided with an electronic case record form (CRF) which collected all the elements of the PHASES, ELAPSS, and UCAS scores. RESULTS A total of 319 patients with aneurysmal subarachnoid hemorrhage were included at 17 centers during a 3-month period. One hundred eighty-three aneurysms (57%) were less than 7 mm. The majority of aneurysms were located on the anterior communicating artery (n = 131, 41%). One hundred eighty-four patients (57%), 103 patients (32%), and 58 (18%) were classified as having a low risk of rupture or growth, according to the PHASES, UCAS, and ELAPSS scores, respectively. CONCLUSION In a prospective study of European patients with aneurysmal subarachnoid hemorrhage, we showed that 3 common risk-assessment tools designed for patients with unruptured intracranial aneurysms would have not identified most patients to be at high or intermediate risk for rupture, questioning their use for decision-making in the setting of unruptured aneurysms.
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Affiliation(s)
- P Lognon
- University Hospital of Tours, Tours, France
| | - F Gariel
- University Hospital of Bordeaux, Bordeaux, France
| | - G Marnat
- University Hospital of Bordeaux, Bordeaux, France
| | - J Darcourt
- University Hospital of Toulouse, Toulouse, France
| | - P Constant Dit Beaufils
- L'institut du Thorax, University of Nantes, INSERM, CNRS, Nantes, France.,University Hospital of Nantes, Nantes, France
| | - J Burel
- University Hospital of Rouen, Rouen, France
| | - E Shotar
- Pitié Salpêtrière Hospital, Paris, France
| | - J F Hak
- University Hospital of Marseille, Marseille, France
| | - C Fauché
- University Hospital of Poitiers, Poitiers, France
| | | | - A Guédon
- Lariboisière Hospital, Paris, France
| | - J Ognard
- University Hospital of Brest, Brest, France
| | - G Forestier
- University Hospital of Limoges, Limoges, France
| | - R Pop
- University Hospital of Strasbourg, Strasbourg, France
| | - C Paya
- University Hospital of Saint-Pierre, Saint-Pierre, La Réunion, France
| | - J B Veyrières
- University Hospital of Saint-Pierre, Saint-Pierre, La Réunion, France
| | - P Sporns
- University Hospital of Basel, Basel, Switzerland.,University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | - J B Girot
- University Hospital of Angers, Angers, France
| | - R Zannoni
- University Hospital of Saint-Etienne, Saint-Etienne, France
| | - F Zhu
- University Hospital of Nancy, Nancy, France
| | - A Crespy
- University Hospital of Tours, Tours, France
| | - V L'Allinec
- University Hospital of Angers, Angers, France
| | - D Mihoc
- University Hospital of Strasbourg, Strasbourg, France
| | - A Rouchaud
- University Hospital of Limoges, Limoges, France
| | | | | | - N Raynaud
- University Hospital of Poitiers, Poitiers, France
| | - B Testud
- University Hospital of Marseille, Marseille, France
| | | | | | - R Bourcier
- L'institut du Thorax, University of Nantes, INSERM, CNRS, Nantes, France.,University Hospital of Nantes, Nantes, France
| | - G Bellanger
- University Hospital of Toulouse, Toulouse, France
| | - G Boulouis
- University Hospital of Tours, Tours, France
| | - Kevin Janot
- University Hospital of Tours, Tours, France.
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