Arterial spin labeling (ASL) MRI for detection and prognostication of residual perfusion in adult brain AVMs after gamma knife radiosurgery: A multicenter study
Abstract
Background and purpose: Brain arteriovenous malformations (bAVMs) carry a variable risk of hemorrhage that persists until complete obliteration is achieved. Gamma-knife radiosurgery (GKRS) is an established treatment, yet delayed treatment effects necessitate reliable follow-up imaging. Digital subtraction angiography (DSA) remains the gold standard, but non-invasive alternatives are desirable. Arterial spin labeling (ASL) MRI, which quantifies cerebral blood flow, has shown promise in detecting residual bAVM perfusion. This study aims to assess the diagnostic performance and prognostic value of ASL compared to conventional MRI sequences and DSA for detecting residual bAVM perfusion in adult patients following GKRS. Materials and methods: We conducted a retrospective, multicenter study of adult patients with bAVMs treated with GKRS between 2015 and 2024 at two tertiary centers. Patients who underwent at least one follow-up brain MRI including ASL perfusion sequences were eligible. Imaging results were compared to conventional MRI sequences and DSA, used as the reference standard. Diagnostic accuracy metrics were calculated. Quantitative ASL perfusion ratios were analyzed to assess their prognostic value for nidus obliteration over time.
Results: A total of 99 patients (mean age 49.4 ± 16.3 years, 51% female) underwent 348 follow-up MRI examinations, including 97 with ASL. ASL demonstrated higher sensitivity (88.9%) and specificity (88.6%) than conventional MRI sequences. Quantitative ASL ratios reliably distinguished residual shunting and predicted time to obliteration. Serial reductions in ASL ratios were associated with progressive bAVM involution (p < 0.01).
Conclusion:ASL outperforms conventional MRI in detecting residual bAVM perfusion after GKRS and provides prognostic information on obliteration. Due to its ability to both identify incomplete obliteration and to predict complete nidal involution ASL may complement standard imaging to optimize DSA timing and reduce invasive procedures.
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BibTeX
@article{gruter2026arterial,
title = {{Arterial spin labeling (ASL) MRI for detection and prognostication of residual perfusion in adult brain AVMs after gamma knife radiosurgery: A multicenter study}},
author = {Basil E Grüter and Sivadji Vingadassalom and Joshua Hägler and Philipp Gruber and Jatta Berberat and Thibault Agripnidis and Xavier Carle and Basile Kerleroux and Anthony Reyre and Phillipe Dory Lautrec and Pierre Lehmann and Hervé Brunel and Romain Carron and Jean Regis and Lucas Troude and Jakob Heimer and Luca Remonda and Jean François Hak},
journal = {Journal de Neuroradiologie / Journal of Neuroradiology},
year = {2026},
month = sep,
doi = {10.1016/j.neurad.2026.101580},
url = {https://amu.hal.science/hal-05739807v1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Arterial spin labeling (ASL) MRI for detection and prognostication of residual perfusion in adult brain AVMs after gamma knife radiosurgery: A multicenter study
AU - Basil E Grüter
AU - Sivadji Vingadassalom
AU - Joshua Hägler
AU - Philipp Gruber
AU - Jatta Berberat
AU - Thibault Agripnidis
AU - Xavier Carle
AU - Basile Kerleroux
AU - Anthony Reyre
AU - Phillipe Dory Lautrec
AU - Pierre Lehmann
AU - Hervé Brunel
AU - Romain Carron
AU - Jean Regis
AU - Lucas Troude
AU - Jakob Heimer
AU - Luca Remonda
AU - Jean François Hak
PY - 2026
DA - 2026/09/05
JO - Journal de Neuroradiologie / Journal of Neuroradiology
DO - 10.1016/j.neurad.2026.101580
UR - https://amu.hal.science/hal-05739807v1
AB - Background and purpose: Brain arteriovenous malformations (bAVMs) carry a variable risk of hemorrhage that persists until complete obliteration is achieved. Gamma-knife radiosurgery (GKRS) is an established treatment, yet delayed treatment effects necessitate reliable follow-up imaging. Digital subtraction angiography (DSA) remains the gold standard, but non-invasive alternatives are desirable. Arterial spin labeling (ASL) MRI, which quantifies cerebral blood flow, has shown promise in detecting residual bAVM perfusion. This study aims to assess the diagnostic performance and prognostic value of ASL compared to conventional MRI sequences and DSA for detecting residual bAVM perfusion in adult patients following GKRS. Materials and methods: We conducted a retrospective, multicenter study of adult patients with bAVMs treated with GKRS between 2015 and 2024 at two tertiary centers. Patients who underwent at least one follow-up brain MRI including ASL perfusion sequences were eligible. Imaging results were compared to conventional MRI sequences and DSA, used as the reference standard. Diagnostic accuracy metrics were calculated. Quantitative ASL perfusion ratios were analyzed to assess their prognostic value for nidus obliteration over time. Results: A total of 99 patients (mean age 49.4 ± 16.3 years, 51% female) underwent 348 follow-up MRI examinations, including 97 with ASL. ASL demonstrated higher sensitivity (88.9%) and specificity (88.6%) than conventional MRI sequences. Quantitative ASL ratios reliably distinguished residual shunting and predicted time to obliteration. Serial reductions in ASL ratios were associated with progressive bAVM involution (p < 0.01). Conclusion:ASL outperforms conventional MRI in detecting residual bAVM perfusion after GKRS and provides prognostic information on obliteration. Due to its ability to both identify incomplete obliteration and to predict complete nidal involution ASL may complement standard imaging to optimize DSA timing and reduce invasive procedures.
SN - 0150-9861
ER -