Avaliação entre a correlação da ruptura da malformação arteriovenosa cerebral e a ressonância magnética com estudo de parede de vaso com black blood
Data
2022-06-27
Autores
Campos Filho, José Maria de 
Orientadores
Chaddad Neto, Feres Eduardo Aparecido
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
As malformações arteriovenosas cerebrais (MAVs) são um emaranhado de artérias e veias, sem interposição de capilares e sem a presença de tecido funcional em seu interior, que apresentam grande risco de hemorragia e consequentemente morbidade e mortalidade em adultos jovens e dessa forma, representando um desafio diagnóstico e terapêutico. Um dos principais desafios em relação as MAVs é diagnósticá-las antes que se rompam, e dessa forma, podendo se obter melhores resultados no tratamento. Diante disso, a ressonância magnética (RM) com estudo de parede de vasos com black blood (EPVbb) tem se mostrado uma técnica promissora para análise e entendimento dessa patogênese. O RM com EPVbb é um método útil para identificar processos inflamatórios que ocorrem nos vasos sanguíneos e que seriam indicativos de um possível rompimento das MAVs. Sendo assim, essa Tese tem como objetivo identificar o risco de ruptura de MAVs por meio da ressonância magnética com estudo de parede de vasos com black blood. Para isso, utilizamos 54 pacientes com MAV rota e não rota no qual avaliamos os exames de ressonância magnética de encéfalo com aquisição do estudo de parede de vasos com black blood. Como resultados, verificamos que não houve diferença significante no EPVbb de pacientes com MAV rota (26,7%) em relação aos pacientes aos com MAV não rota e que apresentaram realce positivo para o EPVbb (25,6%). Do mesmo modo, não houve diferença entre pacientes com MAV rota que apresentaram realce negativo para EPVbb (73,3%) em relação aos pacientes com MAV não rota que apresentaram realce negativo para EPVbb (74,4%). Finalmente, o teste exato de Fischer indicou que não houve associação entre as MAVs (rota ou não rota) e o fato de apresentar ou não realce positivo para EPVbb (X2(1) = 0,006; p = 1,0). Tomados em conjunto, os presentes achados fornecem evidências de que não há relação entre a positividade do EPVbb com o sangramento das malformações arteriovenosas cerebrais.
Cerebral arteriovenous malformations (AVMs) are a tangle of arteries and veins, without interposition of capillaries and without the presence of functional tissue inside, which present a great risk of hemorrahge and consequently morbidity and mortality in young adults, thus representing a diagnostic and therapeutic challenge. One of the main challenges in relation to AVMs is to diagnose them before they rupture, and in this way, better treatment results can be obtained. Therefore, magnetic resonance imaging with vessel wall study with black blood (bbMRI) has shown to be a promising technique for the analysis and understanding of this pathogenesis. bbMRI is a useful method to identify inflammatory processes that occur in blood vessels and that would be indicative of a possible rupture of AVMs. Therefore, the present study aimed to identify the risk of AVM rupture by means of bbMRI. For this purpose, we used 54 patients with ruptured and unruptured AVMs in which we evaluated brain bbMRI scans. As a result, we found that there was no significant difference in the bbMRI of patients with ruptured AVMs (26.7%) in relation to patients with unruptured AVMs and that showed positive enhancement for bbMRI (25.6%). Likewise, there was no difference between patients with ruptured AVMs who had negative bbMRI (73.3%) in relation to patients with unruptured AVMs who had negative bbMRI (74.4%). Finally, Fischer’s test indicated that there was no association between AVMs (ruptured or unruptured) and whether there was positive bbMRI (X2(1) = 0,006; p = 1,0). Taken together, the present findings provide evidence that there is no relationship between bbMRI positivity and bleeding from cerebral arteriovenous malformations.
Cerebral arteriovenous malformations (AVMs) are a tangle of arteries and veins, without interposition of capillaries and without the presence of functional tissue inside, which present a great risk of hemorrahge and consequently morbidity and mortality in young adults, thus representing a diagnostic and therapeutic challenge. One of the main challenges in relation to AVMs is to diagnose them before they rupture, and in this way, better treatment results can be obtained. Therefore, magnetic resonance imaging with vessel wall study with black blood (bbMRI) has shown to be a promising technique for the analysis and understanding of this pathogenesis. bbMRI is a useful method to identify inflammatory processes that occur in blood vessels and that would be indicative of a possible rupture of AVMs. Therefore, the present study aimed to identify the risk of AVM rupture by means of bbMRI. For this purpose, we used 54 patients with ruptured and unruptured AVMs in which we evaluated brain bbMRI scans. As a result, we found that there was no significant difference in the bbMRI of patients with ruptured AVMs (26.7%) in relation to patients with unruptured AVMs and that showed positive enhancement for bbMRI (25.6%). Likewise, there was no difference between patients with ruptured AVMs who had negative bbMRI (73.3%) in relation to patients with unruptured AVMs who had negative bbMRI (74.4%). Finally, Fischer’s test indicated that there was no association between AVMs (ruptured or unruptured) and whether there was positive bbMRI (X2(1) = 0,006; p = 1,0). Taken together, the present findings provide evidence that there is no relationship between bbMRI positivity and bleeding from cerebral arteriovenous malformations.