External Validation of the R2eD AVM Score to Predict the Likelihood of Rupture Presentation of Brain Arteriovenous Malformations.

BACKGROUND: The R2eD AVM scoring system has been recently proposed to predict the risk of hemorrhagic presentation of brain arteriovenous malformations (AVMs). OBJECTIVE: To perform the first external validation of this R2eD AVM score. METHODS: Over a retrospective 10-yr period from 2009 to 2019, 122 patients with brain AVMs fit the inclusion criteria. All components required to calculate the R2eD AVM score had to be available. Patient demographics and score calculations were recorded, as well as the circumstances of their presentation. Multivariable analysis was performed to assess predictors of rupture in the study cohort. Next, area under the receiver operating characteristics and linear-by-linear association were employed to assess the effectiveness of the models. RESULTS: The mean age of the entire cohort was 45.2 yr, and 8% of patients were nonwhite. A total of 48 (39.3%) patients presented with AVM rupture. In univariable analysis, all 5 categories demonstrated P < .15 association with rupture risk. In multivariable analysis, race (nonwhite), size <3 cm, and exclusive deep venous drainage remained in the model with an area under the curve (AUC) of 0.677. The utilization of the R2eD AVM score yielded an AUC of 0.711. CONCLUSION: Even though mitigated by sample size, this study demonstrated acceptable external validity of the R2eD AVM score.

An exploratory analysis linking neuropsychological testing to quantification of tractography using High Definition Fiber Tracking (HDFT) in military TBI.

To realize the potential value of tractography in traumatic brain injury (TBI), we must identify metrics that provide meaningful information about functional outcomes. The current study explores quantitative metrics describing the spatial properties of tractography from advanced diffusion imaging (High Definition Fiber Tracking, HDFT). In a small number of right-handed males from military TBI (N = 7) and civilian control (N = 6) samples, both tract homologue symmetry and tract spread (proportion of brain mask voxels contacted) differed for several tracts among civilian controls and extreme groups in the TBI sample (high scorers and low scorers) for verbal recall, serial reaction time, processing speed index, and trail-making. Notably, proportion of voxels contacted in the arcuate fasciculus distinguished high and low performers on the CVLT-II and PSI, potentially reflecting linguistic task demands, and GFA in the left corticospinal tract distinguished high and low performers in PSI and Trail Making Test Part A, potentially reflecting right hand motor response demands. The results suggest that, for advanced diffusion imaging, spatial properties of tractography may add analytic value to measures of tract anisotropy.