Relationship between Abnormal Hyperintensity on T2-Weighted Images Around Developmental Venous Anomalies and Magnetic Susceptibility of Their Collecting Veins: In-Vivo Quantitative Susceptibility Mapping Study

OBJECTIVE: A developmental venous anomaly (DVA) is a vascular malformation of ambiguous clinical significance. We aimed to quantify the susceptibility of draining veins (χvein) in DVA and determine its significance with respect to oxygen metabolism using quantitative susceptibility mapping (QSM). MATERIALS AND METHODS: Brain magnetic resonance imaging of 27 consecutive patients with incidentally detected DVAs were retrospectively reviewed. Based on the presence of abnormal hyperintensity on T2-weighted images (T2WI) in the brain parenchyma adjacent to DVA, the patients were grouped into edema (E+, n = 9) and non-edema (E−, n = 18) groups. A 3T MR scanner was used to obtain fully flow-compensated gradient echo images for susceptibility-weighted imaging with source images used for QSM processing. The χvein was measured semi-automatically using QSM. The normalized χvein was also estimated. Clinical and MR measurements were compared between the E+ and E− groups using Student's t-test or Mann-Whitney U test. Correlations between the χvein and area of hyperintensity on T2WI and between χvein and diameter of the collecting veins were assessed. The correlation coefficient was also calculated using normalized veins. RESULTS: The DVAs of the E+ group had significantly higher χvein (196.5 ± 27.9 vs. 167.7 ± 33.6, p = 0.036) and larger diameter of the draining veins (p = 0.006), and patients were older (p = 0.006) than those in the E− group. The χvein was also linearly correlated with the hyperintense area on T2WI (r = 0.633, 95% confidence interval 0.333–0.817, p < 0.001). CONCLUSION: DVAs with abnormal hyperintensity on T2WI have higher susceptibility values for draining veins, indicating an increased oxygen extraction fraction that might be associated with venous congestion.

Image characteristics of DVA in different routine imaging sequence of MR and the diagnostic value of these different sequence / 中国医学装备

Objective: To explore the image characteristics of developmental venous anomaly (DVA) in different routine imaging sequence of magnetic resonance (MR) and the diagnostic value of these different sequence. Methods:The imaging data of 54 patients with DVA which were confirmed by using MR enhanced scan that was the contrasted standard were selected. The imaging features obtained from the T1WI, T2WI and FLAIR sequences were researched by using retrospective analysis, and the specificity and accuracy of diagnosis of each imaging sequence were calculated. Results: In the 54 patients, the accuracy of T1WI was 75.9% (41/54), and accuracy of T2WI was 68.5% (37/54), and that of FLAIR T2was 92.6% (50/54). The performance of MRI was that many of medullary vein drained into the central venous, and the shorter draining vein showed typical phenomenon of "jellyfish head"and many medullary vein of the longer draining vein showed the phenomenon of "centipede". The abnormal blood vessel on the T1WI showed strip low signal intensity, and many abnormal blood vessel on T2WI showed strip high signal intensity and minority of them showed strip low signal intensity. The larger central vein and peripherally scattered small medullary veins could be found on the sequence scan of T2FLAIR, and many of abnormal blood vessels showed strip high signal and a small part of abnormal blood vessels showed equisignal and low signal. Besides, the specificity of the diagnosis of sequence of T2FLAIR was 100% without false positive. And the accuracy of T2FLAIR was 92.6% that was higher than 75.9% of T1WI and 68.5% of T2WI. Conclusion: The sequence technique of T2FLAIR has higher accuracy for the detection of DVA and it can clearly display most abnormal blood vessel. Therefore, it has important reference value for diagnosing DVA of brain.

Atypical parkinsonism with marked asymmetry due to a superimposed developmental venous anomaly

@#Intracranial developmental venous anomalies (DVAs) are the most common cerebral vascular malformation and are usually asymptomatic. Movement disorders are rarely associated with DVAs within basal ganglia regions. We report a case of markedly asymmetric parkinsonism due to unilateral DVA in the basal ganglia, which occurred together with symmetrical nigrostriatal dopaminergic deficits. A 57-year-old woman presented with resting tremor in the right hand lasting for 6 months. She also experienced problems with gait and started falling while walking one month ago. The neurological examination found a resting tremor in the right hand and moderate rigidity and bradykinesia in the right extremities. She reported light headedness on standing up. The patient displayed minimal response to treatment with 300 mg levodopa. The FP-CIT PET scan revealed symmetrical decrease of radiotracer uptake in bilateral basal ganglia. Brain MRI and cerebral angiography identified a large DVA draining the basal ganglia, thalamus, and surrounding deep white matter in the left side. Conclusion: A DVA may contribute to the prominent asymmetrical manifestation in our patient, in combination with symmetrical dopaminergic loss from neurodegenerative Parkinsonian syndrome. A marked asymmetry in patients with signs of atypical Parkinsonism can be a clue for further imaging investigation to exclude superimposed structural lesions such as DVAs.

Angiomas venosos y cefalea en pediatría: un caso clínico / Venous angiomas and headache in children: A case report

Introducción: Los angiomas venosos (AV) son entidades benignas que infrecuentemente presentan síntomas. Objetivo: Reporte de un caso y revisión del tema. Caso clínico: Escolar, de sexo femenino, 6 años, que inicia cefaleas bifrontales frecuentes 3-4 veces por semana, en relación con trabajo académico, de carácter opresivo, no pulsátil, sin náuseas ni vómitos, rango de intensidad entre 4-6/10. Se inició manejo con calendario de cefaleas, apoyo escolar y evaluación psicológica. La tomografía computarizada cerebral solicitada informó de angioma venoso de núcleo caudado izquierdo, razón por la cual se realizó una resonancia magnética cerebral más angiorresonancia que confirmó angioma venoso y excluyó complicación o asociación a otra malformación vascular. La cefalea respondió bien a terapia psicopedagógica y psicológica. La frecuencia de cefaleas disminuyó a 10-12 al año, agrupadas en periodos de mayores demandas académicas. La paciente es controlada durante 12 años, hasta el egreso de la enseñanza media, sin complicaciones y con un buen manejo de la cefalea tensional. Conclusión: En el estudio de una cefalea el hallazgo de un AV puede ser incidental; una vez reunidos los criterios internacionales de cefalea tensional e iniciado el tratamiento para ello, la monitorización de los AV debe ser clínica. Las complicaciones del AV son infrecuentes y el tratamiento quirúrgico es excepcional.

Introduction: Venous angiomas (VA) are benign entities; however infrequent symptomatic cases may occur. Objective: Case report and literature review. Case report: A 6 year old girl was referred with a history of bi-frontal, non-pulsatile, headache with no nausea or vomiting. Headache intensity was 4-6/10. The episodes were frequent, 3-4 times per week. Triggers include academic work. Computed tomography showed a small VA in left caudate nucleus, which was confirmed by a brain MRI, with no evidence of inflammatory or ischaemic changes, or another vascular malformation. Psychological and psycho-pedagogic techniques were used, combined with relaxation and cognitive-behavioural techniques to reduce the intensity and frequency. There was a good outcome, and the headache decreased to 10 episodes per year. The patient was monitored for 12 years until graduation from high school. The VA remained without complications. Conclusions: In the study of a headache, a VA usually is an incidental finding. The International Classification of Headache Disorders III provides specific criteria of frequent episodic tension-type headache, and allows us begin specific therapy for it. Monitoring of non-symptomatic VA cases should be clinical. The surgical management of these entities is exceptional.

Associated Brain Parenchymal Abnormalities in Developmental Venous Anomalies: Evaluation with Susceptibility-weighted MR Imaging

PURPOSE: The purpose of this study was to evaluate the associated brain parenchymal abnormalities of developmental venous anomalies (DVA) with susceptibility-weighted image (SWI). MATERIALS AND METHODS: Between January 2012 and June 2013, 2356 patients underwent brain MR examinations with contrast enhancement. We retrospectively reviewed their MR examinations and data were collected as per the following criteria: incidence, locations, and associated parenchymal signal abnormalities of DVAs on T2-weighted image, fluid-attenuated inversion recovery (FLAIR), and SWI. Contrast enhanced T1-weighted image was used to diagnose DVA. RESULTS: Of the 2356 patients examined, 57 DVAs were detected in 57 patients (2.4%); 47 (82.4%) were in either lobe of the supratentorial brain, 9 (15.7%) were in the cerebellum, and 1 (1.7%) was in the pons. Of the 57 DVAs identified, 20 (35.1%) had associated parenchymal abnormalities in the drainage area. Among the 20 DVAs which had associated parenchymal abnormalities, 13 showed hemorrhagic foci on SWI, and 7 demonstrated only increased parenchymal signal abnormalities on T2-weighted and FLAIR images. In 5 of the 13 patients (38.5%) who had hemorrhagic foci, the hemorrhagic lesions were demonstrated only on SWI. CONCLUSION: The overall incidence of DVAs was 2.4%. Parenchymal abnormalities were associated with DVAs in 35.1% of the cases. On SWI, hemorrhage was detected in 22.8% of DVAs. Thus, we conclude that SWI might give a potential for understanding of the pathophysiology of parenchymal abnormalities in DVAs.

MR manifestations and diagnostic value in cerebral developmental venous anomaly / 实用放射学杂志

Objective To study MRI manifestations of cerebral developmental venous anomaly (DVA)and to analyze the diagnos-tic value of different sequences.Methods Conventional MRI and contrast enhancement 3D-T1 WI were performed in all 10 patients who were collected in our hospital.Among the 10 cases,6 patients underwent MRA and 4 patients underwent MRV.The diaplay of the draining veins and medullary veins were assessed.Results All 10 cases were sporadic lesion,the lesions of 9 cases were located in supra tentorium and which of 1 case was located in infra tentorium.Abnormal signals without characteristics of draining veins in 6 cases and dilated medullary veins in 4 cases were found in conventional MRI,while 6 draining veins showed flow void signal on T2 WI and 3 of the 4 medullary veins showed hypointensity on T1 WI and hyperintensity on T2 WI.Contrast enhancement 3D-T1 WI displayed the markedly enhanced draining veins and dilated medullary veins in all 10 cases of DVA.Numerous medullary veins gath-ered together into large draining veins radially and flowed into superficial or deeper veins,so-called“caput medusae”appearance were found as the characteristics in all cases.MRA and MRV revealed draining veins only partially but no medullary veins.Conclusion MRI could diagnose DVA clearly,the sensitivity of detecting DVA on conventional MRI is low and there are no characteristics ap-pearances.Contrast enhancement 3D-T1 WI is the most accurate and sensitive method,MRA and MRV are not highly worthwhile for diagnosing DVA.

The Diagnostic Value of Digital Subtraction Angiography Considering the Pathomechanism of Symptomatic Cerebral Developmental Venous Anomaly

Cerebral developmental venous anomaly (DVA) is generally benign. However, we have experienced two cases of DVA causing symptoms. In the first case, the patient demonstrated DVA with venous infarction. DVA was visualized in the arterial phase using digital subtraction angiography (DSA), and was diagnosed as arterialized DVA. The second case presented as transient right homonymous hemianopia. DSA revealed venous congestion; the transient aggravation of venous congestion may have caused the symptom. DSA is useful for diagnosing the pathomechanism of symptomatic DVAs.

Susceptibility-Weighted MR Imaging for the Detection of Developmental Venous Anomaly: Comparison with T2 and FLAIR Imaging

PURPOSE: We evaluated the diagnostic value of susceptibility-weighted imaging (SWI) for the detection of developmental venous anomaly (DVA). MATERIALS AND METHODS: Retrospective review of 1068 brain MR examinations found 28 DVAs in 28 patients (2.6%) on contrast-enhanced T1-weighted images. SWI, T2, and FLAIR images of 28 patients with DVA and 28 sex- and age-matched control patients without DVA were analyzed by blinded readers on each type of sequences. All images were independently reviewed by two radiologists who were blinded to other MR imaging finding. In cases of discrepancy, two reviewers reached a consensus later. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each MR sequence for the detection of DVA were determined. Statistical analysis was performed by using the Mcnemar test. The significance level was p < 0.05. RESULTS: The sensitivity, specificity, PPV, and NPV of SWI for the detection of DVA were 85.7%, 92.9%, 92.3%, and 86.7%, respectively. T2 and FLAIR images showed sensitivity of 35.7% and 35.7%, specificity of 92.9% and 96.4%, PPV of 83.3% and 90.9%, and NPV of 59.1% and 60.0%, respectively. On SWI, the sensitivity and NPV for the detection of DVAs were significantly higher than those of T2 and FLAIR images (p < 0.05). CONCLUSION: SWI was sensitive and specific for the detection of DVA.

Multimodal Imaging Follow-up of a Thrombosed Developmental Venous Anomaly: CT, CT Angiography and Digital Subtraction Angiography / 신경중재치료의학

We report a rare case of thrombosed developmental venous anomaly (DVA) in a 31-year old male with hemorrhagic cerebral venous infarction at the initial clinical presentation. In this case, sequential CT, CT angiography and digital subtraction angiography demonstrated thrombotic obstruction of the venous drainage from DVA, its progressive recanalization and temporal evolution of the affected brain parenchyma. The relevant previous literatures were reviewed and summarized.

Atypical Developmental Venous Anomaly Associated with Single Arteriovenous Fistula and Intracerebral Hemorrhage: a Case Demonstrated by Superselective Angiography

We present a case of developmental venous anomaly associated with arteriovenous fistula supplied by a single arterial feeder adjacent to a large acute intracerebral hemorrhage. The arteriovenous fistula was successfully obliterated by superselective embolization while completely preserving the developmental venous anomaly. Two similar cases, including superselective angiographic findings, have been reported in the literature; however, we describe herein superselective angiographic findings in more detail and demonstrate the arteriovenous shunt more clearly than the previous reports. In addition, a literature review was performed to discuss the association of a developmental venous anomaly with vascular lesions.

Repeated Intracerebral Hemorrhage from Developmental Venous Anomaly Alone

Developmental venous anomalies (DVAs) are hemodynamically low flow, low resistance vascular malformations without clinical significance. Although most DVAs are asymptomatic and are found incidentally, sometimes they can be symptomatic with intracerebral hemorrhage, many of which are usually caused by associated cavernous malformations (CMs) rather than the DVAs themselves. Only a few cases have been reported in the literature where an intracerebral hemorrhage has been caused by a DVA alone. This report describes a case of an intracerebral hemorrhage due to DVA alone with review of the literature.

The Course of Brainstem Cavernous Malformations according to Management Strategies / 대한뇌혈관외과학회지

The outcome and the rate of rebleeding of brainstem cavernous malformationss were analyzed following conservative treatment, microsurgical excision and Gamma Knife radiosurgery (GKS). We especially concentrated on the role of radiosurgery. We treated 39 patients with brainstem cavernous malformations using conservative treatment, microsurgical removal or GKS from April 1993 to November 2003. Follow up duration was 7 to 132 months (mean 45.8, median 30.6). The lesion location included pons, midbrain, medulla oblongata and cerebellarpeduncle. Conservative management was performed in 14 patients, GKS in 18 patients and microsurgical removal in 7 patients. The annual rate of rebleeding was 22.2% in conservative group and 22.7% in GKS group. Good and moderate outcome were obtained in 70% of conservative group, 75% of GKS group and 85.6% of surgical group. Overall mortality rate was 5.1%. Microsurgical excision tended to be resulted in good outcome. GKS and conservative managements were accompanied by a risk of recurrent bleeding, even death. There was no statistical difference in outcome and the rate of rebleeding between conservatively managed group and GKS treated group.