Research area · TARGET AVM
AVM Radiosurgery
Large arteriovenous malformations respond poorly to uniform, staged radiosurgery. Can imaging of feeding vessels and blood flow guide higher dose where it matters while sparing functional brain?
R01TARGET AVM · NIH R01 application · [status to confirm]Approach
Vessel-guided adaptive radiosurgery
Four-dimensional angiography is combined with ferumoxytol-enhanced flow MRI to measure feeding vessel size, blood flow and functional regions over time. Radiosurgery plans then intensify dose to the vascular pillars of the nidus while limiting dose to eloquent brain.
Treatment is delivered through the UCSF Gamma Knife program, with in-house inverse optimization and proton therapy compared in simulation.
Aims
Three aims
Aim 1Quantify AVM vessels and flowIntegrate 4D angiography with ferumoxytol-enhanced flow MRI to measure feeding vessel location, size and nidus flow at baseline, 12 and 36 months, in 20 patients with large AVMs.
Aim 2Compare adaptive planningRe-plan 50 previously treated large AVMs: delivered plan, next-generation Gamma Knife inverse optimization, and intensity-modulated proton therapy.
Aim 3Phase I trialSingle-institution trial of 20 patients with AVMs larger than 3 cm, testing the safety and feasibility of dose intensification to inflow vessels.
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