Retrospective analysis of imaging techniques for treatment planning and monitoring of obliteration for gamma knife treatment of cerebral arteriovenous malformation

Kwame Amponsah, Thomas L. Ellis, Michael D. Chan, James F. Lovato, J. Daniel Bourland, Allan F. Deguzman, Kenneth E. Ekstrand, Michael T. Munley, Kevin P. McMullen, Edward G. Shaw, Stephen B. Tatter

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

BACKGROUND: It has been well established that Gamma Knife radiosurgery (GKS) is an effective treatment for brain arteriovenous malformations (AVMs). OBJECTIVE: To evaluate complete obliteration rates for magnetic resonance imaging (MRI)-based GKS treatment planning performed with and without angiography and to conduct a preliminary assessment of the utility of using pulsed arterial spin labeling (PASL) magnetic resonance (MR) perfusion imaging to confirm complete obliteration. METHODS: Forty-six patients were identified who had undergone GKS without embolization with a minimum follow-up of 2 years. One group was planned with integrated stereotactic angiography and MR (spoiled gradient recalled) images obtained on the day of GKS. A second technique avoided the risk of arteriography by using only axial MR images. Beginning in 2007, PASL MR perfusion imaging was routinely performed as a portion of the follow-up MRI to assess the restoration of normal blood flow of the nidus and surrounding area. RESULTS: The overall obliteration rate for the angiography/MRI group was 88.0% (29 of 33). Patients in the MRI-only group had an obliteration rate of 61.5% (8 of 13), with P =.092 with the Fisher exact test, which is not statistically significant. A Kaplan-Meier analysis was also not statistically significant (log rank test, P =.474). Four of 9 patients with incomplete obliteration on angiography also had shown residual abnormal blood flow on PASL imaging. CONCLUSION: This retrospective analysis shows that treatment planning technique used in GKS does not play a role in the eventual obliteration of treated AVMs. PASL may have potential in the evaluation of AVM obliteration.

Original languageEnglish (US)
Pages (from-to)893-899
Number of pages7
JournalNeurosurgery
Volume71
Issue number4
DOIs
StatePublished - Oct 2012
Externally publishedYes

Fingerprint

Planning Techniques
Intracranial Arteriovenous Malformations
Radiosurgery
Magnetic Resonance Angiography
Arteriovenous Malformations
Angiography
Magnetic Resonance Imaging
Therapeutics
Kaplan-Meier Estimate
Magnetic Resonance Spectroscopy
Brain

Keywords

  • AVM
  • Gamma Knife
  • Radiosurgery
  • Technique

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Retrospective analysis of imaging techniques for treatment planning and monitoring of obliteration for gamma knife treatment of cerebral arteriovenous malformation. / Amponsah, Kwame; Ellis, Thomas L.; Chan, Michael D.; Lovato, James F.; Bourland, J. Daniel; Deguzman, Allan F.; Ekstrand, Kenneth E.; Munley, Michael T.; McMullen, Kevin P.; Shaw, Edward G.; Tatter, Stephen B.

In: Neurosurgery, Vol. 71, No. 4, 10.2012, p. 893-899.

Research output: Contribution to journalArticle

Amponsah, K, Ellis, TL, Chan, MD, Lovato, JF, Bourland, JD, Deguzman, AF, Ekstrand, KE, Munley, MT, McMullen, KP, Shaw, EG & Tatter, SB 2012, 'Retrospective analysis of imaging techniques for treatment planning and monitoring of obliteration for gamma knife treatment of cerebral arteriovenous malformation', Neurosurgery, vol. 71, no. 4, pp. 893-899. https://doi.org/10.1227/NEU.0b013e3182672a83
Amponsah, Kwame ; Ellis, Thomas L. ; Chan, Michael D. ; Lovato, James F. ; Bourland, J. Daniel ; Deguzman, Allan F. ; Ekstrand, Kenneth E. ; Munley, Michael T. ; McMullen, Kevin P. ; Shaw, Edward G. ; Tatter, Stephen B. / Retrospective analysis of imaging techniques for treatment planning and monitoring of obliteration for gamma knife treatment of cerebral arteriovenous malformation. In: Neurosurgery. 2012 ; Vol. 71, No. 4. pp. 893-899.
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abstract = "BACKGROUND: It has been well established that Gamma Knife radiosurgery (GKS) is an effective treatment for brain arteriovenous malformations (AVMs). OBJECTIVE: To evaluate complete obliteration rates for magnetic resonance imaging (MRI)-based GKS treatment planning performed with and without angiography and to conduct a preliminary assessment of the utility of using pulsed arterial spin labeling (PASL) magnetic resonance (MR) perfusion imaging to confirm complete obliteration. METHODS: Forty-six patients were identified who had undergone GKS without embolization with a minimum follow-up of 2 years. One group was planned with integrated stereotactic angiography and MR (spoiled gradient recalled) images obtained on the day of GKS. A second technique avoided the risk of arteriography by using only axial MR images. Beginning in 2007, PASL MR perfusion imaging was routinely performed as a portion of the follow-up MRI to assess the restoration of normal blood flow of the nidus and surrounding area. RESULTS: The overall obliteration rate for the angiography/MRI group was 88.0{\%} (29 of 33). Patients in the MRI-only group had an obliteration rate of 61.5{\%} (8 of 13), with P =.092 with the Fisher exact test, which is not statistically significant. A Kaplan-Meier analysis was also not statistically significant (log rank test, P =.474). Four of 9 patients with incomplete obliteration on angiography also had shown residual abnormal blood flow on PASL imaging. CONCLUSION: This retrospective analysis shows that treatment planning technique used in GKS does not play a role in the eventual obliteration of treated AVMs. PASL may have potential in the evaluation of AVM obliteration.",
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AU - Amponsah, Kwame

AU - Ellis, Thomas L.

AU - Chan, Michael D.

AU - Lovato, James F.

AU - Bourland, J. Daniel

AU - Deguzman, Allan F.

AU - Ekstrand, Kenneth E.

AU - Munley, Michael T.

AU - McMullen, Kevin P.

AU - Shaw, Edward G.

AU - Tatter, Stephen B.

PY - 2012/10

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N2 - BACKGROUND: It has been well established that Gamma Knife radiosurgery (GKS) is an effective treatment for brain arteriovenous malformations (AVMs). OBJECTIVE: To evaluate complete obliteration rates for magnetic resonance imaging (MRI)-based GKS treatment planning performed with and without angiography and to conduct a preliminary assessment of the utility of using pulsed arterial spin labeling (PASL) magnetic resonance (MR) perfusion imaging to confirm complete obliteration. METHODS: Forty-six patients were identified who had undergone GKS without embolization with a minimum follow-up of 2 years. One group was planned with integrated stereotactic angiography and MR (spoiled gradient recalled) images obtained on the day of GKS. A second technique avoided the risk of arteriography by using only axial MR images. Beginning in 2007, PASL MR perfusion imaging was routinely performed as a portion of the follow-up MRI to assess the restoration of normal blood flow of the nidus and surrounding area. RESULTS: The overall obliteration rate for the angiography/MRI group was 88.0% (29 of 33). Patients in the MRI-only group had an obliteration rate of 61.5% (8 of 13), with P =.092 with the Fisher exact test, which is not statistically significant. A Kaplan-Meier analysis was also not statistically significant (log rank test, P =.474). Four of 9 patients with incomplete obliteration on angiography also had shown residual abnormal blood flow on PASL imaging. CONCLUSION: This retrospective analysis shows that treatment planning technique used in GKS does not play a role in the eventual obliteration of treated AVMs. PASL may have potential in the evaluation of AVM obliteration.

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