Fractal-based analysis of arteriovenous malformations (AVMs)

Antonio Di Ieva, Gernot Reishofer

Research output: Chapter in Book/Report/Conference proceedingChapter


Arteriovenous malformations (AVMs) are cerebrovascular lesions consisting of a pathologic tangle of the vessels characterized by a core termed the nidus, which is the “nest” where the fistulous connections occur. AVMs can cause headache, stroke, and/or seizures. Their treatment can be challenging requiring surgery, endovascular embolization, and/or radiosurgery as well. AVMs’ morphology varies greatly among patients, and there is still a lack of standardization of angioarchitectural parameters, which can be used as morphometric parameters as well as potential clinical biomarkers (e.g., related to prognosis). In search of new diagnostic and prognostic neuroimaging biomarkers of AVMs, computational fractal-based models have been proposed for describing and quantifying the angioarchitecture of the nidus. In fact, the fractal dimension (FD) can be used to quantify AVMs’ branching pattern. Higher FD values are related to AVMs characterized by an increased number and tortuosity of the intranidal vessels or to an increasing angioarchitectural complexity as a whole. Moreover, FD has been investigated in relation to the outcome after Gamma Knife radiosurgery, and an inverse relationship between FD and AVM obliteration was found. Taken altogether, FD is able to quantify in a single and objective value what neuroradiologists describe in qualitative and/or semiquantitative way, thus confirming FD as a reliable morphometric neuroimaging biomarker of AVMs and as a potential surrogate imaging biomarker. Moreover, computational fractal-based techniques are under investigation for the automatic segmentation and extraction of the edges of the nidus in neuroimaging, which can be relevant for surgery and/or radiosurgery planning.
Original languageEnglish
Title of host publicationThe Fractal geometry of the brain
EditorsAntonio Di Ieva
Place of PublicationNew York
PublisherSpringer, Springer Nature
Number of pages15
ISBN (Print)9781493939954
Publication statusPublished - 2016

Publication series

NameSpringer Series in Computational Neuroscience


  • angioarchitecture
  • arteriovenous malformation
  • AVM
  • box counting
  • fractal dimension
  • Gamma Knife radiosurgery
  • Minkowski dimension
  • outcome

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    Di Ieva, A., & Reishofer, G. (2016). Fractal-based analysis of arteriovenous malformations (AVMs). In A. Di Ieva (Ed.), The Fractal geometry of the brain (pp. 279-293). (Springer Series in Computational Neuroscience). New York: Springer, Springer Nature.