• Yong-Sin Hu, Huai-Che Yang, Chung-Jung Lin, Cheng-Chia Lee, Wan-Yuo Guo, Chao-Bao Luo, Kang-Du Liu, Wen-Yuh Chung, and Hsiu-Mei Wu.
• Department of Radiology, Taoyuan Branch, Taipei Veterans General Hospital, Taoyuan, Taiwan.
• Neurosurgery. 2022 Apr 1; 90 (4): 464474464-474.

BackgroundRadiation-induced changes (RICs) in brain tissue, seen as increased perinidal T2-weighted hyperintensity on MRI, are commonly observed in patients with brain arteriovenous malformations (BAVMs) within 2 years after Gamma Knife (Elekta) radiosurgery (GKRS).ObjectiveTo explore the imaging markers associated with RICs in patients with BAVMs.MethodsWe retrospectively included 106 treatment-naïve patients with BAVMs who received GKRS alone between 2011 and 2018 and had ≥24 months of clinical and MRI follow-up. Pre-GKRS angiography and MRIs were analyzed for morphological characteristics and quantitative digital subtraction angiography parameters. RIC severity was categorized as mild (grade I), moderate (grade II), or severe (grade III). Firth logistic regression analysis was conducted to determine the associations between the parameters and RICs.ResultsAmong the 106 patients, 83 (78.3%) developed RICs, with 16 categorized as grade I, 62 as grade II, and 5 as grade III. RICs were symptomatic in 19 patients (17.9%). In multivariable models, BAVMs with a volume of >5 cm3 (odds ratio [OR]: 4.322, P = .024) and neoangiogenesis on angiography before treatment (OR: 3.846, P = .029), and thrombus within nidus or drainage vein on follow-up MRI (OR: 3.679, P = .001) were independently associated with grade II or III RICs. Symptomatic RICs were more likely to develop in basal ganglia or brainstem.ConclusionLarge BAVMs and neoangiogenesis were associated with moderate to severe RICs in treatment-naïve patients with BAVMs. Our findings may assist with the complication risk assessment for these patients.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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