• Maogui Li, Qingyuan Liu, Rui Guo, Shuzhe Yang, Pengjun Jiang, Xin Chen, Jun Wu, Yong Cao, and WangShuoS0000-0001-7339-4758Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.China National Clinical Research Center for Neurological Diseases, Beijing, China.Center of Stroke, Beijing Institute for Brain Di.
• Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
• J Magn Reson Imaging. 2021 Jul 1; 54 (1): 186-196.

BackgroundPotential neurovascular uncoupling (NVU) related to perinidal angiogenesis (PA) of brain arteriovenous malformations (AVMs) may cause inappropriate presurgical mapping using functional magnetic resonance imaging (fMRI), resulting in overconfident resection and postoperative morbidity.PurposeTo evaluate the potential impact of PA upon fMRI blood oxygen level-dependent signal in the periphery of AVMs.Study TypeProspective.PopulationTwenty-one patients with AVMs located in the primary sensorimotor cortex (SM1) undergoing task-based fMRI (hand motor), and 19 patients with supratentorial AVMs undergoing resting-state fMRI.Field Strength/Sequence3.0T, echo-planar, time-of-flight, and magnetization-prepared rapid gradient-echo.AssessmentThe presence of PA was determined by three observers (Y.C., J.W., and X.C.) according to digital subtraction angiography and MR angiography. Interhemispheric asymmetry of fMRI activations contralateral to hand movements was evaluated with the interhemispheric ratio of the average t-value within ipsilesional SM1 to contralesional SM1. Regional homogeneity (ReHo) and fractional amplitude of low-frequency fluctuations (fALFF) were extracted from ring-shaped perinidal regions and contralateral homologous regions, and the corresponding interhemispheric ratios were calculated. The effect of PA on the interhemispheric asymmetry of motor activations, ReHo, and fALFF was estimated.Statistical TestsPearson analysis, paired and independent t-test, multiple linear regression, Friedman test, and factorial analysis of variance were used.ResultsMotor activations were significantly reduced in ipsilesional SM1 compared to contralesional SM1 (P < 0.05). The presence of PA was the independent predictor of activation loss in ipsilateral SM1(P < 0.05). Furthermore, perinidal regions exhibited reduced ReHo compared to the homologous regions (P < 0.05). PA was significantly associated with the decline of ReHo and fALFF in perinidal regions (P < 0.05, for both).Data ConclusionThe presence of PA can predict perinidal NVU that may confound the interpretation of both task-based and resting-state fMRI, highlighting the importance of alternative approaches of brain functional localization in improving treatment of AVMs.Level Of Evidence2 TECHNICAL EFFICACY STAGE: 2.© 2020 International Society for Magnetic Resonance in Medicine.

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