Comparing Vascular Morphology and Hemodynamics in Patients with Vein of Galen Malformations Using Intracranial 4D Flow MRI

BACKGROUND AND PURPOSE: Vein of Galen malformation (VOGM) is the most common congenital cerebrovascular malformation, and many patients have high mortality rates and poor cognitive outcomes. Quantitative diagnostic tools are needed to improve clinical outcomes, and the purpose of this study was to characterize intracranial blood flow in VOGM using quantitative 4D flow MRI.

MATERIALS AND METHODS: A prospective study of children with VOGM was conducted by acquiring 4D flow MRI to quantify total blood inflow to the brain, flow in the pathologic falcine sinus, and flow in the superior sagittal sinus. Linear regression was used to test the relationships between these flows and age, clinical status, and the mediolateral diameter of the outflow tract of the lesion through the falcine or straight sinus diameter, which is a known morphologic prognostic metric.

RESULTS: In all 11 subjects (mean age, 22 [SD,17 ] weeks), total blood flow to the brain always exceeded normal levels (mean, 1063 [SD, 403] mL/minute). Significant correlations were observed between falcine sinus flow and the mediolateral diameter of the straight or falcine sinus, the posterior cerebral artery/MCA flow ratio and age at scanning, and superior sagittal sinus flow proximal to malformation inflow and age at scanning.

CONCLUSIONS: Using 4D flow MRI, we established the hemodynamic underpinnings of the mediolateral diameter of the straight or falcine sinus and investigated metrics representing parenchymal venous drainage that could be used to monitor the normalization of hemodynamics during embolization therapy.