European Radiology

, Volume 27, Issue 7, pp 2868–2876 | Cite as

Subsequent haemorrhage in children with untreated brain arteriovenous malformation: Higher risk with unbalanced inflow and outflow angioarchitecture

  • Li Ma
  • Xiao-Lin Chen
  • Yu Chen
  • Chun-Xue Wu
  • Jun Ma
  • Yuan-Li Zhao



Children with brain arteriovenous malformations (bAVMs) are at risk of life-threatening haemorrhage in their early lives. Our aim was to analyse various angioarchitectural features of bAVM to predict the risk of subsequent haemorrhage during follow-up in children.


We identified all consecutive children admitted to our institution for bAVMs between July 2009 and September 2015. Children with at least 1 month of treatment-free follow-up after diagnosis were included in further analysis. Annual rates of AVM rupture as well as several potential risk factors for subsequent haemorrhage were analysed using Kaplan-Meier analyses and Cox proportional hazards regression models.


We identified 110 paediatric patients with a mean follow-up period of 2.1 years (range, 1 month–15.4 years). The average annual risk of haemorrhage from untreated AVMs was 4.3 % in children. No generalised venous ectasia in conjunction with fast arteriovenous shunt was predictive of subsequent haemorrhage (RR, 7.55; 95 % CI 1.96–29.06). The annual rupture risk was 11.1 % in bAVMs without generalised venous ectasia but with fast arteriovenous shunt.


bAVM angiographic features suggesting unbalanced inflow and outflow might be helpful to identify children at higher risk for future haemorrhage.

Key Points

Haemorrhage risk stratification is important for children with untreated brain AVM.

Angiographic features suggesting unbalanced inflow and outflow predict paediatric brain AVM haemorrhage.

Identifying AVMs with high rupture risk help patient selection and tailoring treatment.


Intracranial arteriovenous malformation Child Intracranial haemorrhage Cerebral angiography Risk assessment 





Brain arteriovenous malformation


Confidence interval


Cerebrospinal fluid


Relative risk


Intracranial haemorrhage


Odds ratio



The authors would like to thank Professor Helen Kim of the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, Department of Epidemiology and Biostatistics at the University of California San Francisco for her assistance with the statistical analysis and Professor Shuo Wang of the Department of Neurosurgery at Beijing Tiantan Hospital for supervision and administration of our study and Dr. Gu Wei-Bin of the Department of Neuroradiology at Beijing Tiantan Hospital for his assistance with the image preparation.

The scientific guarantor of this publication is Shuo Wang, Vice President of Department of Neurosurgery and Dean of Cerebrovascular Neurosurgery Section, Beijing Tiantan Hospital, Capital Medical University. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This project was supported by the Ministry of Science and Technology of China, National Key Technology Research and Development Program (2015BAI12B04, 2013BAI09B03, 2012CB720704); Beijing Institute for Brain Disorders grant (BIBD-PXM2013_014226_07_000084); National Natural Science Foundation of China (H0906 81271313 and H0906 81571110 to Y.L. Zhao); National Institutes of Health grant (R01 NS034949 to Y.L. Zhao); Health Industry Special Scientific Research Project (No. 201402019 to J. Ma); and China Scholarship Council (No. 201508110252 to L. Ma). Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. None of the study subjects or cohorts have been previously reported. Methodology: retrospective, observational, performed at one institution.

Supplementary material

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ESM 1 (DOCX 1094 kb)


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  1. 1.Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingPeople’s Republic of China
  2. 2.Center for Cerebrovascular Research, Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoUSA
  3. 3.China National Clinical Research Center for Neurological DiseasesBeijingPeople’s Republic of China
  4. 4.Department of Neuroradiology, Beijing Tiantan HospitalCapital Medical UniversityBeijingPeople’s Republic of China
  5. 5.Stroke Center, Beijing Institute for Brain DisordersBeijingPeople’s Republic of China
  6. 6.Beijing Key Laboratory of Translational Medicine for Cerebrovascular DiseaseBeijingPeople’s Republic of China

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