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Nidus Compacity Determined by Semi-Automated Segmentation is a Strong Quantitative Predictor of Brain Arterio-Venous Malformation Cure

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Abstract

Background and Objective

A compact nidus is a well-known feature of good outcome after treatment in brain arteriovenous malformations (bAVM). This item, included in the “Supplementary AVM grading system” by Lawton, is subjectively evaluated on DSA. The present study aimed to assess whether quantitative nidus compacity along with other angio-architectural bAVM features were predictive of angiographic cure or the occurrence of procedure-related complications.

Materials and Methods

Retrospective analysis of 83 patients prospectively collected data base between 2003 to 2018 having underwent digital subtraction 3D rotation angiography (3D-RA) for pre-therapeutic assessment of bAVM. Angio-architectural features were analyzed. Nidus compacity was measured with a dedicated segmentation tool. Univariate and multivariate analyses were performed to test the association between these factors and complete obliteration or complication.

Results

Compacity was the only significant factor associated with complete obliteration in our predictive model using logistic multivariate regression; the area under the curve for compacity predicting complete obliteration was excellent (0.82; 95% CI 0.71–0.90; p < 0.0001). The threshold value maximizing the Youden index was a compacity > 23% (sensitivity 97%; specificity 52%; 95% CI 85.1–99.9; p = 0.055). No angio-architectural factor was associated with the occurrence of a complication.

Conclusion

Nidus high compacity quantitatively measured on 3D-RA, using a dedicated segmentation tool is predictive of bAVM cure. Further investigation and prospective studies are warranted to confirm these preliminary results.

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Abbreviations

3D-RA:

3D Rotational angiography

ADC:

Apparent diffusion coefficient

AUC:

Area under the curve

bAVM:

Brain arterio-venous malformation

DSA:

Digital subtraction angiography

EVOH:

Ethylene vinyl alcohol

ICH:

Intra-cerebral hemorrhage

ICP:

Intra-cranial pressure

mRS:

Modified Rankin scale

n‑BCA:

n‑butyl cyanoacrylate

ROC:

Receiver operating characteristics

SM:

Spetzler-Martin

SRS:

Stereotaxic radiosurgery

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Authors and Affiliations

  1. Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital. APHP, Paris, France

    Aurélien Pacini, Eimad Shotar, Atika Talbi, Kévin Premat, Stéphanie Lenck, Nader-Antoine Sourour & Frédéric Clarençon

  2. Department of Public Health, Pitié-Salpêtrière Hospital. APHP, Paris, France

    Benjamin Granger

  3. INSERM UMR 1136, Sorbonne University, Paris, France

    Benjamin Granger & Frédéric Clarençon

  4. University Pierre and Marie Curie, Paris, France

    Franck Maizeroi-Eugène

  5. Department of Neurosurgery, Colmar Hospital, Colmar, France

    Mariette Delaitre

  6. Department of Neurosurgery, Pitié-Salpêtrière Hospital. APHP, Paris, France

    Anne-Laure Boch & Charles-Ambroise Valéry

  7. Department of Neuro-intensive care, Pitié-Salpêtrière Hospital. APHP, Paris, France

    Mehdi Drir

  8. Department of Interventional Neuroradiology, Limoges University Hospital, Limoges, France

    Charbel Mounayer

  9. GRC BioFast, Sorbonne University, Paris, France

    Frédéric Clarençon

  10. Maizeroi-Eugène Society, Paris, France

    Franck Maizeroi-Eugène

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  1. Aurélien Pacini
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Corresponding author

Correspondence to Aurélien Pacini.

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Conflict of interest

N.-A. Sourour is consultant for Medtronic, Balt Extrusion, Microvention, Stock/Stock Options: Medina. F. Clarençon reports conflict of interest with Medtronic, Guerbet, Balt Extrusion, Penumbra (payment for readings; non-related to the study), Codman Neurovascular and Microvention (core lab; non-related to the study). A. Pacini, E. Shotar, B. Granger, F. Maizeroi-Eugène, M. Delaitre, A. Talbi, A.-L. Boch, C.-A. Valéry, K. Premat, M. Drir, S. Lenck and C. Mounayer report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. The manuscript is not supported by industry.

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Pacini, A., Shotar, E., Granger, B. et al. Nidus Compacity Determined by Semi-Automated Segmentation is a Strong Quantitative Predictor of Brain Arterio-Venous Malformation Cure. Clin Neuroradiol 33, 1095–1104 (2023). https://doi.org/10.1007/s00062-023-01313-y

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