Can angiogenesis be reliably determined on digital subtraction angiography in cerebral arteriovenous malformations?

IF 1 4区医学 Q4 CLINICAL NEUROLOGY British Journal of Neurosurgery Pub Date : 2024-11-08 DOI:10.1080/02688697.2024.2424850

Suparna Das, Helen Raffalli-Ebezant, Paul R Kasher, Adrian Parry-Jones, Hiren C Patel

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Abstract

Background: Angiogenesis and nascent blood vessel formation is thought to be important in cerebral arteriovenous malformation (cAVM) development and maintenance, of which little is known. Digital subtraction angiogram (DSA) features of angiogenesis in cAVMs are poorly described and the aim of this study was to describe the frequency of angiogenesis in patients who had a DSA showing a cAVM. We also sought to evaluate the intra- and inter-observer agreement of a diagnosis of angiogenesis and explore which angioarchitectural features were associated with angiogenesis.

Method: Patients that underwent a DSA were identified from the database of referred cAVM patients at the Manchester Centre for Clinical Neurosciences. Data were collected from 100 patients (102 cAVMs). cAVM angioarchitecture, including the presence of angiogenesis, was described after reviewing cAVM patient angiograms. The association of angioarchitectural features with angiogenesis was determined using univariate analysis. Ten cases were distributed amongst two other observers for reporting (inter-observer agreement). Twenty cases (including the previous 10) were reported twice by the first author, after a six-month interval (intra-observer agreement).

Results: Angiogenesis was observed in 39 cAVMs (38.2%), with 12 having a complete border (11.8%). Most intra-observer agreement was strong (ranging from κ = 1 to 0.2), but inter-observer agreement was moderate (κ = 1 to -0.316). There was a significant association between angiogenesis and venous reflux (OR 2.52 [95% CI = 1.08-5.88]), venous congestion (OR 4.47 [95% CI = .671-2.52]), arterial ectasia (OR 16.6 [95% CI = 4.65-59.6]), and artery: vein ratio (4.28 [95% CI = .956-19.15]).

Conclusion: We have demonstrated perinidal angiogenesis can be visualised on angiograms with moderate reliability, and that it may be related to angioarchitectural characteristics associated with venous hypertension.

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数字减影血管造影术能否可靠地确定脑动静脉畸形的血管生成？

背景：血管生成和新生血管形成被认为是脑动静脉畸形（cAVM）发生和维持的重要因素，但人们对此知之甚少。数字减影血管造影（DSA）对脑动静脉畸形血管生成特征的描述很少，本研究旨在描述在 DSA 显示脑动静脉畸形的患者中血管生成的频率。我们还试图评估观察者内部和观察者之间对血管生成诊断的一致性，并探索哪些血管结构特征与血管生成有关：方法：从曼彻斯特临床神经科学中心的转诊 cAVM 患者数据库中确定接受 DSA 的患者。方法：从曼彻斯特临床神经科学中心转诊的cAVM患者数据库中确定接受DSA检查的患者，收集了100名患者（102例cAVM）的数据。通过单变量分析确定了血管结构特征与血管生成的关系。10 个病例分配给另外两名观察者进行报告（观察者之间的一致性）。20 个病例（包括前 10 个病例）由第一作者在间隔 6 个月后报告两次（观察者内部一致）：结果：39 例 cAVM（38.2%）观察到血管生成，其中 12 例边界完整（11.8%）。大多数观察者内部的一致性很强（从κ = 1到0.2），但观察者之间的一致性一般（κ = 1到-0.316）。血管生成与静脉回流（OR 2.52 [95% CI = 1.08-5.88]）、静脉充血（OR 4.47 [95% CI = .671-2.52]）、动脉异位（OR 16.6 [95% CI = 4.65-59.6]）和动脉：静脉比率（4.28 [95% CI = .956-19.15]）之间存在明显关联：结论：我们的研究表明，潮周血管生成可在血管造影上观察到，其可靠性适中，而且可能与静脉高压相关的血管结构特征有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British Journal of Neurosurgery 医学-临床神经学

CiteScore

2.30

自引率

9.10%

发文量

139

审稿时长

3-8 weeks

期刊介绍： The British Journal of Neurosurgery is a leading international forum for debate in the field of neurosurgery, publishing original peer-reviewed articles of the highest quality, along with comment and correspondence on all topics of current interest to neurosurgeons worldwide. Coverage includes all aspects of case assessment and surgical practice, as well as wide-ranging research, with an emphasis on clinical rather than experimental material. Special emphasis is placed on postgraduate education with review articles on basic neurosciences and on the theory behind advances in techniques, investigation and clinical management. All papers are submitted to rigorous and independent peer-review, ensuring the journal’s wide citation and its appearance in the major abstracting and indexing services.