Comprehensive Cardiac and Neurovascular 4D flow MRI for Improved Embolization Therapy in VGAM patients

Vein of Galen aneurysmal malformations (VGAMs) are rare congenital cerebral arteriovenous shunts often treated by staged endovascular embolization early in life. Treatment induced changes in intracranial hemodynamics and their impact on the clinical management of VGAM patients remain unclear. High flow arteriovenous malformations (AVMs) in infants are congenital lesions with many similarities to vein of Galen malformations. We propose the development of a comprehensive multi-modality exam using cerebral 4D flow MRI in conjunction with cardiac MR imaging and echocardiography. Imaging will be performed prior to intervention and following each embolization procedure to systematically characterize hemodynamic alterations in the arterial and venous cerebral vascular network. Simultaneously, cardiac MRI and echocardiography will determine the impact of each treatment stage. 3D flow visualization and quantification will show shunt flow reduction and complex flow redistribution following embolization. Using this new technique we will be able to better evaluate the efficacy of interventions and monitor treatment effects. The overall aim is to develop a better understanding of the precise shunt flow reduction (i.e. number and extent of embolization procedures) needed to improve patient outcome (neurodevelopment, hydrocephalus, congestive heart failure). In order to achieve this understanding we are planning to attain three specific aims with aim 1, being the technical development of the new employed dual-velocity encoding 4D flow MRI sequence. Also the specific comprehensive MRI protocol will be developed as well as the data analysis approach. In specific aim 2 we will concentrate on acquiring reference data of normal cardiac and cerebral flow distribution in the human body in a study with 70 pediatric normal controls across a wide range of ages (1 month - 21 years) and equally distributed for both genders. For specific aim 3 we will study 20 VGAM and high flow AVM patients t