Monitoring Treatment Effectiveness in Intracranial Arteriovenous Shunt Lesions: Emerging Role of Quantitative Magnetic Resonance Venography for Intracranial Arteriovenous Shunts.

Abstract

Quantitative magnetic resonance angiography (qMRA) using noninvasive optimal vessel analysis (NOVA) is a novel noninvasive imaging technique that is being increasingly used to measure blood flow in extracranial and intracranial arteries. By providing important quantitative flow data, NOVA qMRA can facilitate the management of cerebrovascular disease. While the same technology can also be applied to measure flow in intracranial and extracranial veins, NOVA quantitative MRV (qMRV) is only rarely used in neurovascular practice. We report interesting qMRV data in 2 patients with symptomatic intracranial arteriovenous shunts: a 61-year-old man with a left transverse-sigmoid dural arteriovenous fistula and a 40-year-old woman with a left parietal arteriovenous malformation. In each patient, NOVA qMRV demonstrated significant reduction of intracranial venous outflow after therapeutic obliteration of the shunt lesion, heralding marked clinical improvement. To the best of our knowledge, this is the first report of successful clinical application of NOVA qMRV in adult patients with intracranial arteriovenous malformations or dural arteriovenous fistulas. We propose that NOVA qMRV is a promising technique for noninvasive measurement of intracranial and extracranial venous blood flow and for monitoring treatment effectiveness in patients with intracranial arteriovenous shunt lesions.