, Volume 56, Issue 3, pp 195–209 | Cite as

An approach to the symbolic representation of brain arteriovenous malformations for management and treatment planning

  • Piotr OrlowskiEmail author
  • Imran Mahmud
  • Mudassar Kamran
  • Paul Summers
  • Alison Noble
  • Yiannis Ventikos
  • James V. Byrne
Interventional Neuroradiology



There is currently no standardised approach to arteriovenous malformation (AVM) reporting. Existing AVM classification systems focuses on angioarchitectural features and omit haemodynamic, anatomical and topological parameters intuitively used by therapists.


We introduce a symbolic vocabulary to represent the state of an AVM of the brain at different stages of treatment. The vocabulary encompasses the main anatomic and haemodynamic features of interest in treatment planning and provides shorthand symbols to represent the interventions themselves in a schematic representation.


The method was presented to 50 neuroradiologists from14 countries during a workshop and graded 7.34 ± 1.92 out of ten for its usefulness as means of standardising and facilitating communication between clinicians and allowing comparisons between AVM cases. Feedback from the survey was used to revise the method and improve its completeness. For an AVM test case, participants were asked to produce a conventional written report and subsequently a diagrammatic report. The two required, on average, 6.19 ± 2.05 and 5.09 ± 3.01 min, respectively. Eighteen participants said that producing the diagram changed the way they thought about the AVM test case.


Introduced into routine practice, the diagrams would represent a step towards a standardised approach to AVM reporting with consequent benefits for comparative analysis and communication as well as for identifying best treatment strategies.


Arteriovenous malformations Cerebrovascular image analysis Embolisation Endovascular treatment Interventional neuroradiology 



We would like to thank the Sloane Robinson LLP and the Clarendon Fund for the financial support. We would also like to thank the ESI Group and Dr M. Megahed for the use of CFD-ACE + .

Conflict of interest

We declare that we have no conflict of interest.

Supplementary material

234_2013_1307_MOESM1_ESM.doc (20.4 mb)
ESM 1 (DOC 20931 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Piotr Orlowski
    • 1
    Email author
  • Imran Mahmud
    • 2
  • Mudassar Kamran
    • 2
  • Paul Summers
    • 2
    • 3
  • Alison Noble
    • 1
  • Yiannis Ventikos
    • 4
  • James V. Byrne
    • 2
  1. 1.Institute of Biomedical Engineering, Department of Engineering ScienceUniversity of OxfordOxfordUK
  2. 2.Nuffield Department of Surgical SciencesUniversity of Oxford, John Radcliffe HospitalOxfordUK
  3. 3.Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
  4. 4.Department of Mechanical EngineeringUniversity College LondonLondonUK

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