Persistent nidus blood flow in cerebral arteriovenous malformation after stereotactic radiosurgery: MR imaging assessment.

Stereotactic radiosurgery has become a major force in the treatment of arteriovenous malformations (AVMs) of the brain. After treatment, obliteration of flow through the malformation occurs in 75%-85% of cases within 2 years, assuming the entire AVM nidus can be encompassed by the radiation field. Because the follow-up period is relatively long, a noninvasive means to assess residual transnidus blood flow is desirable. The authors report favorable findings after a comparative analysis of 85 posttreatment magnetic resonance images and 27 follow-up cerebral arteriograms in 34 patients treated with stereotactic radiosurgery. The authors found that transnidus flow can be determined from apparent signal intensity differences between tandem two-dimensional gradient-recalled echo images obtained first without and then with gradient moment nulling (flow compensation), with empirically derived pulse parameters. This method provides a means to monitor the reduction in AVM matrix size and to assess the extent of persistent arteriovenous shunting (ie, blood flow) across the nidus.