Assessment of glucose metabolic changes associated with cerebral arteriovenous malformations before and after transarterial embolization using (18)fluoro-deoxyglucose positron-emission tomography

Purpose: The purpose of this study was to map glucose metabolism in patients with cerebral arteriovenous malformations before and after transarterial embolization. Methods: Sixteen patients with cerebral arteriovenous malformations (AVMs) and two patients with dural arteriovenous fistulas underwent preembolization positron-emission tomography (PET) scans with (18)fluorodeoxyglucose ((18)FDG). Of these, six patients also had postembolization PET studies completed. The PET data were correlated with structural (MRI) data and clinical findings. Results: All vascular malformations were well demarcated in the preembolization PET images as severely hypometabolic areas or metabolic defects, Additionally, various patterns and degrees of hypometabolism were detected adjacent to and remote from the malformations. In some cases significant postembolization depression was seen in adjacent and remote ipsilateral areas. A tendency to toward postembolization metabolic depression was noted within the contralateral remote tissue in cases of AVMs receiving blood from bilateral sources, as demonstrated by angiography. These functional changes were not associated with any structural abnormalities. Conclusions: Our data reveal widespread impairment of glucose metabolism in regions adjacent to and remote from a cerebral XVM, both in the ipsilateral and the contralateral hemispheres, These metabolic changes may indirectly substantiate the traditional theories of AVM-related hemodynamic conditions, Furthermore, embolization may accentuate existing metabolic depression in surrounding and remote areas.