Tracking Brain Network and Cognitive Recovery in DAVF: A Longitudinal rsfMRI Study of Low-Frequency Fluctuations

Abstract

Background:

Intracranial dural arteriovenous fistula (DAVF) disrupts cerebral hemodynamics and can lead to widespread alterations in brain network connectivity and cognitive function. This study aimed to evaluate spontaneous brain activity and cognitive changes in DAVF patients using resting-state functional MRI (rsfMRI) and neuropsychological assessment, with evaluations conducted at baseline, 1 month, and 1 year postembolization to capture dynamic recovery-related changes in brain function and cognition.

Methods:

Fifty DAVF patients and 50 age and sex-matched healthy controls underwent rsfMRI. Amplitude of low-frequency fluctuation (ALFF) and fractional ALFF (fALFF) metrics were computed at both whole-brain and network levels. Cognitive performance was assessed using Addenbrooke’s Cognitive Examination (ACE). All patients underwent embolization, followed by rsfMRI and ACE evaluations at 1 month and 1 year. ACE scores were included as covariates to explore cognitive-network associations.

Results:

Compared with controls, DAVF patients showed significantly increased ALFF in cerebellar regions and decreased ALFF/fALFF in frontal, insular, and parietal areas, especially within the Default Mode Network (DMN) and Dorsal Attention Network (DAN). Postembolization, rsfMRI metrics showed normalization trends, especially in DMN and DAN, mirroring improvements in ACE scores. ACE-based covariate analysis revealed domain-specific correlations: memory scores correlated with ALFF in the DMN (r = 0.62), and visuospatial scores with DAN (r = 0.55).

Conclusions:

This study provides longitudinal evidence that DAVF disrupts brain network integrity and cognition, with partial recovery following treatment. rsfMRI-derived ALFF and fALFF measures, particularly when analyzed alongside cognitive scores, may provide preliminary support for future clinical applications in DAVF prognosis and monitoring.

Impact Statement

This study provides the first longitudinal evidence integrating rsfMRI-based ALFF/fALFF metrics with neuropsychological assessment in DAVF patients. By linking network-level brain dysfunction with domain-specific cognitive impairments, it offers a robust framework for tracking treatment response and recovery. The findings highlight the potential of rsfMRI as a noninvasive biomarker for diagnosis, prognosis, and individualized monitoring in DAVF, with broader implications for functional neurovascular imaging in cerebrovascular disorders.

Keywords

ALFF fractional ALFF intracranial DAVF resting state fMRI

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