2022/23 Recipient

Michael Lustig, UC Berkeley
Department of Electrical Engineering and Computer Sciences

Title: Non-Invasive Risk Assessment of Dural Arteriovenous Fistulas using Displacement Spectrum (DiSpect) MRI

Michael Lustig

Dural arteriovenous fistulas (DAVFs) is a dangerous acquired vascular condition in the brain where several arteries with high blood pressure directly connect to the typically low-pressure veins and can cause life-threatening intracranial hemorrhage. DAVFs account for 10-15% of intracranial vascular malformations, commonly a result of head trauma, that are notoriously challenging to diagnose and impossible to risk stratify with conventional noninvasive imaging. X-Ray based Digital subtraction angiography (DSA) remains the gold standard for diagnosis and the only means for grading risk. However, DSA is an invasive procedure that has risks including life-threatening stroke. When DAVFs are present, pressures in the draining veins of the head elevate and can result in flow reversal in the cortical veins – the signature of a particularly high-risk condition. In recent years, there has been much progress in developing non-invasive MRI methods for determining vasculature structure, flow and perfusion. Despite these recent advances, noninvasive imaging is ill-suited for determining drainage patterns which, when dysfunctional, can have a profound clinical impact. 

In this project, Professor Lustig and PhD candidate Ekin Karasan from UC Berkeley together with Professors Matthew Amans and David Saloner from UC San Francisco will develop non-invasive MRI methods for evaluating the risk of DAVFs. We have been developing uniquely suited MRI techniques that have huge potential for untangling the complex drainage of DAVFs. The aim of this proposal is clinical translation and application of these novel techniques to patients with DAVFs to identify not only the connections between the major draining veins and their tributaries, but also the presence of normal draining flow and high-risk reverse flow. Establishing the prevailing flow conditions will provide a non-invasive, decision-making tool for the neurointerventionalist that can guide if and when treatment is needed.