High-Resolution MRI with Black Blood Sequence Increases Physician Confidence in Identification of Rupture Site in Cerebral AVMs: Application to Treatment Strategies

Aims: Partial targeted embolization of ruptured brain arteriovenous malformations (AVMs) has met with mixed success at reducing short-term rehemorrhage rates, likely stemming from uncertainty in accurately identifying the rupture site. Recent work has demonstrated the ability of high-resolution magnetic resonance vessel wall imaging (MR-VWI) to determine the site of rupture in patients with aneurysmal subarachnoid hemorrhage; the present study aims to assess the generalizability of high-resolution MR-VWI to other ruptured vascular structures, namely brain AVMs in an effort to inform clinical decision making.

Methods: Twenty consecutive patients presenting to Yale New Haven Hospital between January 2012 and July 2015 with ruptured AVMs underwent computed tomography/computed tomography angiography (CT/CTA), digital subtraction cerebral angiography, and high-resolution MR-VWI. Blinded reviewers were asked to describe the hemorrhage location, AVM characteristics, and most likely point of hemorrhage with their degree of confidence in their assessment for each case first with traditional imaging (CT/CTA and cerebral angiogram) and then again with the added high-resolution MRI.

Results: High-resolution MR-VWI led to increased individual physician confidence in assigning a point of rupture, and increased concordance of rupture point identification between physicians.

Conclusions: High-resolution MR-VWI with black blood sequence provides a mechanism for more accurately identifying the rupture point of AVMs and may allow for more accurate partial targeted embolization to decrease their short-term rerupture rate.

No conflict of interest has been declared by the author(s).