Volumetric analysis of arteriovenous malformation using computed tomographic angiography

Abstract

An arteriovenous malformation (AVM) is an abnormal collection of blood vessels in which arterial blood flows directly into the draining vein without the normal interposed capillaries. It is an important and growing public healthcare problem affecting millions of Americans and many more people internationally. There are several potential treatment options for the AVM, and the best treatment depends on the maximum length of nidus based on the Spetzler- Martin grading system. However, this grading system is insensitive to volume, because it was designed on the basis of two dimensional digital subtraction angiography images. Here, we report a method using computed tomographic angiography to measure the volume of AVM nidus, as a means for noninvasively assessment. The initial results show statistically significant differences between healthy and AVM subject groups in the direct comparisons of the volume (cm3) through the method we suggested (2.456 ± 1.482, 12.478 ± 5.743 and 53.963 ± 9.338 (mean ± stdev.); Normal (No AVM), Small (< 3cm), Medium (3 ~ 6 cm) respectively; P < 0.005 for all), and they also show the exponential correlation between the AVM volume and the maximum length of a nidus (trend-line: y = 4.4183e0.536x with R2 = 0.945). These results provide more accurate volumetric information. Therefore, this noninvasive imaging-based method is a promising means to measure the volume of AVM using clinically available imaging tools.