TY - JOUR
T1 - Compactness index: a radiosurgery outcome predictor for patients with unruptured brain arteriovenous malformations
AU - Huang, Po-Wei
AU - Peng, Syu-Jyun
AU - Pan, David Hung-Chi
AU - Yang, Huai-Che
AU - Tsai, Jo-Ting
AU - Shiau, Cheng-Ying
AU - Su, I-Chang
AU - Chen, Ching-Jen
AU - Wu, Hsiu-Mei
AU - Lin, Chung Jung
AU - Chung, Wen-Yuh
AU - Guo, Wan-Yuo
AU - Lo, Wei-Lun
AU - Lai, Shao-Wen
AU - Lee, Cheng-Chia
PY - 2023/1
Y1 - 2023/1
N2 - OBJECTIVE: The goal of the study was to define and quantify brain arteriovenous malformation (bAVM) compactness and to assess its effect on outcomes after Gamma Knife radiosurgery (GKRS) for unruptured bAVMs. METHODS: Unsupervised machine learning with fuzzy c-means clustering was used to differentiate the tissue constituents of bAVMs on T2-weighted MR images. The percentages of vessel, brain, and CSF were quantified. The proposed compactness index, defined as the ratio of vasculature tissue to brain tissue, categorized bAVM morphology into compact, intermediate, and diffuse types according to the tertiles of this index. The outcomes of interest were complete obliteration and radiation-induced changes (RICs). RESULTS: A total of 209 unruptured bAVMs treated with GKRS were retrospectively included. The median imaging and clinical follow-up periods were 49.2 and 72.3 months, respectively. One hundred seventy-three bAVMs (82.8%) achieved complete obliteration after a median latency period of 43.3 months. The rates of RIC and permanent RIC were 76.1% and 3.8%, respectively. Post-GKRS hemorrhage occurred in 14 patients (6.7%), resulting in an annual bleeding risk of 1.0%. Compact bAVM, smaller bAVM volume, and exclusively superficial venous drainage were independent predictors of complete obliteration. Diffuse bAVM morphology, larger bAVM volume, and higher margin dose were independently associated with RICs. CONCLUSIONS: The compactness index quantitatively describes the compactness of unruptured bAVMs. Moreover, compact bAVMs may have a higher obliteration rate and a smaller risk of RICs than diffuse bAVMs. This finding could help guide decision-making regarding GKRS treatment for patients with unruptured bAVMs.
AB - OBJECTIVE: The goal of the study was to define and quantify brain arteriovenous malformation (bAVM) compactness and to assess its effect on outcomes after Gamma Knife radiosurgery (GKRS) for unruptured bAVMs. METHODS: Unsupervised machine learning with fuzzy c-means clustering was used to differentiate the tissue constituents of bAVMs on T2-weighted MR images. The percentages of vessel, brain, and CSF were quantified. The proposed compactness index, defined as the ratio of vasculature tissue to brain tissue, categorized bAVM morphology into compact, intermediate, and diffuse types according to the tertiles of this index. The outcomes of interest were complete obliteration and radiation-induced changes (RICs). RESULTS: A total of 209 unruptured bAVMs treated with GKRS were retrospectively included. The median imaging and clinical follow-up periods were 49.2 and 72.3 months, respectively. One hundred seventy-three bAVMs (82.8%) achieved complete obliteration after a median latency period of 43.3 months. The rates of RIC and permanent RIC were 76.1% and 3.8%, respectively. Post-GKRS hemorrhage occurred in 14 patients (6.7%), resulting in an annual bleeding risk of 1.0%. Compact bAVM, smaller bAVM volume, and exclusively superficial venous drainage were independent predictors of complete obliteration. Diffuse bAVM morphology, larger bAVM volume, and higher margin dose were independently associated with RICs. CONCLUSIONS: The compactness index quantitatively describes the compactness of unruptured bAVMs. Moreover, compact bAVMs may have a higher obliteration rate and a smaller risk of RICs than diffuse bAVMs. This finding could help guide decision-making regarding GKRS treatment for patients with unruptured bAVMs.
KW - Gamma Knife
KW - adverse radiation effect
KW - arteriovenous malformation compactness
KW - automated segmentation
KW - complete obliteration
KW - fuzzy c-means clustering
KW - radiation-induced change
KW - stereotactic radiosurgery
KW - vascular disorders
UR - https://www.scopus.com/pages/publications/85145424728
UR - https://www.scopus.com/pages/publications/85145424728#tab=citedBy
U2 - 10.3171/2022.4.JNS212369
DO - 10.3171/2022.4.JNS212369
M3 - Article
SN - 0022-3085
VL - 138
SP - 241
EP - 250
JO - Journal of Neurosurgery
JF - Journal of Neurosurgery
IS - 1
ER -