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Paper title High-Resolution MRI with Black Blood Sequence Increases Physician Confidence in Identification of Rupture Site in Cerebral AVMs: Application to Treatment Strategies
Paper code P47
  1. Samuel Sommaruga Geneva University Hospitals (HUG) Speaker
  2. Branden Cord Yale University School of Medicine Speaker
  3. Frank Minja Yale University
  4. Ajay Malhotra Yale University
  5. Michele Johnson Yale University
  6. Philippe Bijlenga Hôpitaux Universitaires de Genève HUG
  7. Karl Schaller HUG Hôpitaux Universitaires Genève
  8. Charles Matouk Yale University
Form of presentation Poster
  • Joint SSNR | SSNS
Abstract text Aims:Partial targeted embolization of ruptured brain arteriovenous malformations (AVMs) has met with mixed success at reducing short-term re-hemorrhage 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 arteriovenous malformations (AVMs) in an effort to inform clinical decision making.

Methods: 20 consecutive patients presenting to Yale New Haven Hospital between January 2012, and July 2015 with ruptured AVMs underwent 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 re-rupture rate.