Abstract
Advancement in imaging and biomedical technology has improved the use of catheter-based transarterial embolization (occlusive therapy) of cerebral arteriovenous malformations (AVMs). Among a variety of embolic agents, liquid adhesives (acrylates) have proven to be more successful in permanent obliteration of AVMs. The use of liquid adhesives requires the experience and skill of the operator. However, acquiring accurate information on blood flow and transit times through the AVM prior to embolization can optimize the treatment. In addition, knowledge of the polymerization time and behavior of the acrylate enables a complete and safe occlusion of the arteriovenous transition within the AVM nidus. Standard commercially available iodine-based contrast agents seem to be insufficient to determine AVM transit times from angiograms. For a more accurate assessment of AVM transit times, the use of a nonsoluble contrast agent (Ethiodol) and a high-speed digital subtraction angiography (DSA) is suggested. Small amounts (<20 μl) of Ethiodol were infused to create microdroplets and traced using DSA at 15 fps. Transit time, defined as the time interval required for a droplet to reach the venous part of the AVM after being flushed from the tip of the catheter, could be accurately calculated. Postprocessing was used to calculate trajectories and velocities of microdroplets. © 2001 Biomedical Engineering Society.
PAC01: 8719Uv, 4755Dz, 8719La, 8759Bh
Similar content being viewed by others
REFERENCES
Bennett, M., M. D. Stein, M. Samuel, and M. D. Wolpert. Arteriovenous malformation of the brain: Current concepts and treatment. Arch. Neurol. 3: 1–5, 1980.
Berenstein, A., and Lasjaunias. Surgical Neuroangiography. Berlin: Springer, 1992, p. 236.
Brothers, M. F., J. C. Kaufmann, A. J. Fox, and J. P. Deveikis. n-Butyl 2-cyanoacrylate—Substitute for IBCA in interventional neuroradiology: Histopathologic and polymerization time studies. AJNR Am. J. Neuroradiol. 1: 777–786, 1989.
Canty, J. M. Jr., R. M. Judd, A. S. Brody, and F. J. Klocke. First-pass entry of nonionic contrast agent into the myocardial extravascular space. Effects on radiographic estimates of transit time and blood volume. Circulation 8: 2071–2078, 1991.
Coard, K., M. D. Silver, G. Perkins, A. J. Fox, and E. V. Vinuela. Isobutyl-2-cyanoacrylate pulmonary emboli associated with occlusive embolotherapy of cerebral arteriovenous malformations. Histopathology: 917–926, 1984.
Colombo, F., F. Pozza, G. Chierego, L. Casentini, G. De Luca, and P. Francescon. Linear accelerator radiosurgery of cerebral arteriovenous malformations: an update [see comments]. Neurosurgery 3: 14–20, 1994.
Debrun, G., F. Vinuela, A. Fox, and C. G. Drake. Embolization of cerebral arteriovenous malformations with bucrylate. J. Neurosurg. 5: 615–627, 1982.
Deruty, R., I. Pelissou-Guyotat, C. Mottolese, Y. Bascoulergue, and D. Amat. The combined management of cerebral arteriovenous malformations. Experience with 100 cases and review of the literature. Acta. Neurochir. 12: 101–112, 1993.
Deveikis, J. P., H. J. Manz, A. J. Luessenhop, A. J. Caputy, A. I. Kobrine, D. Schellinger, and N. Patronas. A clinical and neuropathologic study of silk suture as an embolic agent for brain arteriovenous malformations. AJNR Am. J. Neuroradiol. 1: 263–271, 1994.
Divani, A. A. Injection of micro-droplets for flow characterization in arteriovenous malformations prior to embolization. Master thesis. Buffalo: SUNY at Buffalo, 1999, p. 128.
Ersahin, A., S. Y. Molloi, and J. W. Hicks. Absolute phasic blood flow measurement in the brain using digital subtraction angiography. Invest. Radiol. 3: 244–253, 1995.
Frank, O., and W. Alwens. —Kreislaufstudien am rongtgen-schirm. Munch. Med. 5: 950, 1910.
Goldman, M. L., M. S. Sarrafizadeh, P. K. Philip, A. M. Karmody, R. P. Leather, N. Parikh, and S. R. Powers. Bucrylate embolization of abdominal aortic aneurysms: an adjunct to nonresective therapy. AJR, Am. J. Roentgenol. 13: 1195–1200, 1980.
Gruber, A., P. R. Mazal, G. Bavinzski, M. Killer, H. Budka, and B. Richling. Repermeation of partially embolized cerebral arteriovenous malformations: a clinical, radiologic, and histologic study. AJNR Am. J. Neuroradiol. 1: 1323–1331, 1996.
Hessel, S. J., D. F. Adams, and H. L. Abrams. Complications of angiography. Radiology 13: 273–281, 1981.
Luessenhop, A. J., and W. T. Spence. Artificial embolization of cerebral arteries: Report of use in a case of arteriovenous malformation. J. Am. Med. Assoc. 17: 1153–1155, 1960.
Martin, N. A., and H. V. Vinters. Arteriovenous malformations. In: Neurovascular Surgery. New York: McGraw-Hill, 1994, pp. 875–903.
Massoud, T. F., C. Ji, G. Guglielmi, and F. Vinuela. Endovascular treatment of arteriovenous malformations with selective intranidal occlusion by detachable platinum electrodes: Technical feasibility in a swine model. AJNR Am. J. Neuro-radiol. 1: 1459–1466, 1996.
Mygind, T. Particulate radiographic contrast material for quantitative representation of blood-flow patterns. II. Theoretical considerations. Invest. Radiol.: 27–39, 1971.
Mygind, T., H. Busch, and G. Salomon. Soluble contrast particles for intravascular use. First clinical experience. Invest. Radiol.: 178–185, 1969.
Mygind, T., A. Oigaard, M. Sovak, and S. Dorph. Particulate radiographic contrast material for quantitative representation of blood-flow patterns. I. Experimental studies. Invest. Radiol.: 548–558, 1970.
Mygind, T., M. Sovak, A. Oigaard, O. Christensen, and A. Jarlov. Soluble contrast particles for radiographic analysis of blood flow. Determination of cardiac output in dogs. Invest. Radiol.: 1–12, 1970.
Nakstad, P. H., S. J. Bakke, and J. K. Hald. Embolization of intracranial arteriovenous malformations and fistulas with polyvinyl alcohol particles and platinum fibre coils. Neuroradiology 3: 348–351, 1992.
Nishi, S., W. Taki, I. Nakahara, K. Yamashita, A. Sadatoh, H. Kikuchi, H. Hondo, K. Matsumoto, H. Iwata, and Y. Shimada. Embolization of cerebral aneurysms with a liquid embolus, EVAL mixture: report of three cases. Acta. Neurochir. 13: 294–300, 1996.
Ohnishi, K., M. Saito, H. Koen, T. Nakayama, F. Nomura, and K. Okuda. Pulsed Doppler flow as a criterion of portal venous velocity: Comparison with cineangiographic measurements. Radiology 15: 495–498, 1985.
Reichle, F. A., M. Sovak, R. L. Soulen, and G. P. Rosemond. Portal vein blood flow determination in the unanesthetized human by umbilicoportal cannulation. J. Surg. Res. 1: 146–150, 1972.
Rudin, S., A. Divani, A. K. Wakhloo, and B. B. Lieber. Factors affecting the accurate determination of cerebrovascular blood flow using high speed droplet imaging. Proc. SPIE 333: 232–241, 1998.
Rudin, S., L. R. Guterman, W. E. Granger, D. R. Bednarek, and L. N. Hopkins. Application of region-of-interest imaging techniques to neurointerventional radiology. Radiology 19: 870–873, 1996.
Rudin, S., B. B. Lieber, A. K. Wakhloo, D. R. Bednarek, L. R. Guterman, and L. N. Hopkins. Quantitative flow velocity measurements in vessels, aneurysms, and arteriovenous malformations (AVMs) using droplet path tracing with a biplane pulsed fluoroscopy system. Proc. SPIE 303: 268–279, 1997.
Sovak, M., M. C. Ziskin, A. Oigaard, and T. Mygind. Lipiodol droplets in cineradiographic quantitation of pulsatile and non-pulsatile blood flow. Model experiments. Invest. Radiol.: 141–145, 1971.
Spetzler, R. F., and N. A. Martin. A proposed grading system for arteriovenous malformations. J. Neurosurg. 6: 476–483, 1986.
Taylor, G. Dispersion of soluble matter in solvent flowing slowly through a tube. Proc. R. Soc. London, Ser. A 21: 186–203, 1953.
Taylor, G. The dispersion of the matter in turbulent flow through a pipe. Proc. R. Soc. London, Ser. A 22: 446–448, 1954.
Wakhloo, A. K., B. B. Lieber, S. Rudin, M. D. Fronckowiak, R. A. Mericle, and L. N. n. Hopkins. A novel approach to flow quantification in brain arteriovenous malformations prior to enbucrilate embolization: Use of insoluble contrast Ethiodol droplet! angiography. J. Neurosurg. 8: 395–404, 1998.
Wikholm, G., C. Lundqvist, and P. Svendsen. Embolization of cerebral arteriovenous malformations: Part I—Technique, morphology, and complications. Neurosurgery 3: 448–457, 1996.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Divani, A.A., Lieber, B.B., Wakhloo, A.K. et al. Determination of Blood Flow Velocity and Transit Time in Cerebral Arteriovenous Malformation using Microdroplet Angiography. Annals of Biomedical Engineering 29, 135–144 (2001). https://doi.org/10.1114/1.1349696
Issue Date:
DOI: https://doi.org/10.1114/1.1349696