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Conventional and advanced MRI evaluation of brain vascular malformations
Teodoro Martín-Noguerol,
Luis Concepción-Aramendia,
CC Tchoyoson Lim,
Eloísa Santos-Armentia,
Alberto Cabrera-Zubizarreta,
Antonio Luna,
Corresponding Author
Teodoro Martín-Noguerol
MRI Unit, Radiology Department, HT Medica, Jaén, Spain
Correspondence
Teodoro Martín-Noguerol, MD, MRI Section, Radiology Department, HT Medica, Carmelo Torres 2, 23007 Jaén, Spain.
Email: [email protected]
Search for more papers by this authorLuis Concepción-Aramendia
Servicio de Radiología, Hospital General Universitario de Alicante, Alicante, Spain
Search for more papers by this authorCC Tchoyoson Lim
Neuroradiology Department, National Neuroscience Institute and Duke-NUS Medical School, Singapore
Search for more papers by this authorEloísa Santos-Armentia
Department of Radiology, Povisa Hospital (Ribera Salud Group), Vigo, Spain
Search for more papers by this authorAlberto Cabrera-Zubizarreta
OSATEK, MR Unit, Hospital of Galdakao, Bilbao, Spain
Search for more papers by this authorAntonio Luna
MRI Unit, Radiology Department, HT Medica, Jaén, Spain
Search for more papers by this authorTeodoro Martín-Noguerol,
Luis Concepción-Aramendia,
CC Tchoyoson Lim,
Eloísa Santos-Armentia,
Alberto Cabrera-Zubizarreta,
Antonio Luna,
Corresponding Author
Teodoro Martín-Noguerol
MRI Unit, Radiology Department, HT Medica, Jaén, Spain
Correspondence
Teodoro Martín-Noguerol, MD, MRI Section, Radiology Department, HT Medica, Carmelo Torres 2, 23007 Jaén, Spain.
Email: [email protected]
Search for more papers by this authorLuis Concepción-Aramendia
Servicio de Radiología, Hospital General Universitario de Alicante, Alicante, Spain
Search for more papers by this authorCC Tchoyoson Lim
Neuroradiology Department, National Neuroscience Institute and Duke-NUS Medical School, Singapore
Search for more papers by this authorEloísa Santos-Armentia
Department of Radiology, Povisa Hospital (Ribera Salud Group), Vigo, Spain
Search for more papers by this authorAlberto Cabrera-Zubizarreta
OSATEK, MR Unit, Hospital of Galdakao, Bilbao, Spain
Search for more papers by this authorAntonio Luna
MRI Unit, Radiology Department, HT Medica, Jaén, Spain
Search for more papers by this authorAcknowledgments and Disclosure: Special thanks to Javier Royuela-del-Val, PhD, and Felix Paulano-Godino, PhD, for their valuable help with the imaging processing of Figures 16 and 17, respectively.
CC Tchoyoson Lim is part of the speakers bureau General Electric Medical Systems. Antonio Luna is occasional lecturer of Philips, Siemens Healthineers, Bracco and Canon, and receives royalties as book editor from Springer-Verlag.
No funding sources have supported this work.
Abstract
Vascular malformations (VMs) of the central nervous system (CNS) include a wide range of pathological conditions related to intra and extracranial vessel abnormalities. Although some VMs show typical neuroimaging features, other VMs share and overlap pathological and neuroimaging features that hinder an accurate differentiation between them. Hence, it is not uncommon to misclassify different types of VMs under the general heading of arteriovenous malformations. Thorough knowledge of the imaging findings of each type of VM is mandatory to avoid these inaccuracies. Conventional MRI sequences, including MR angiography, have allowed the evaluation of CNS VMs without using ionizing radiation. Newer MRI techniques, such as susceptibility-weighted imaging, black blood sequences, arterial spin labeling, and 4D flow imaging, have an added value of providing physiopathological data in real time regarding the hemodynamics of VMs. Beyond MR images, new insights using 3D printed models are being incorporated as part of the armamentarium for a noninvasive evaluation of VMs. In this paper, we briefly review the pathophysiology of CNS VMs, focusing on the MRI findings that may be helpful to differentiate them. We discuss the role of each conventional and advanced MRI sequence for VMs assessment and provide some insights about the value of structured reports of 3D printing to evaluate VMs.
Supporting Information
| Filename | Description |
|---|---|
| jon12853-sup-0001-videoS1.mp4663.8 KB | Video S1. AVM scheme. AVM is characterized by the presence of arteriovenous connections and vascular nidus which shunt normal capillary network. Brain tissue is identified between vascular structures. |
| jon12853-sup-0002-videoS2.mp4741.3 KB | Video S2. AV fistula scheme. AV fistulas are usually seen in the vicinity of great dural venous sinuses, including cavernous sinus. Presence of dural gaps conditions arteriovenous shunting that increases the blood pressure inside venous sinuses. |
| jon12853-sup-0003-videoS3.mp45.5 MB | Video S3. Cerebral proliferative angiopathy evaluated with MRA. A 42-year-old female with drug-resistant migraine underwent MRI examination. Time of flight (TOF) MRA video shows large AVM occupying right parietal and occipital lobes, including corpus callosum, right hippocampus, and thalamus, with the presence of brain parenchyma between vessels. TOF MRA demonstrates the dependence of arterial supply from right anterior and middle cerebral arteries (large arrows) and large tortuous right Trolard vein (short arrows). |
| jon12853-sup-0004-videoS4.mp4711.3 KB | Video S4. Scheme DVA. DVAs are frequently seen in routine MRI scans usually in the vicinity of ventricular system, at frontal lobes or posterior fossa. Venous drainage is usually connected to deep veins. |
| jon12853-sup-0005-videoS5.mp41.8 MB | Video S5. Scheme cavernous malformations. Cavernous malformations show multiple layers of thin capillaries without brain tissue inside associating hemosiderin deposition, which become more conspicuous by using T2*GRE or SWI sequences. |
| jon12853-sup-0006-videoS6.mp41.7 MB | Video S6. Scheme capillary telangiectasia. Capillary telangiectasias are commonly seen at pons, better visualized after gadolinium injection as faint hyperintense lesions, which becomes markedly hypointense on T2*GRE and SWI. |
| jon12853-sup-0007-videoS7.mp4515.7 KB | Video S7. Dural AV fistula assessed with 4D time-resolved MRA. (C) 4D time-resolved contrast-enhanced angiography allows a real-time evaluation of both arterial and venous systems (with each dynamic acquisition <2 s). A shunt between arterial and venous system is demonstrated with fast and asymmetric filling of left Trolard vein (white arrows). |
| jon12853-sup-0008-videoS8.mp42.7 MB | Video S8. AVM evaluated with noncontrast 4D MRA. (C) Noncontrast 4D time resolved MRA. Notice how 4D MRA approach allows to identify the distribution of labeled water spins from feeding artery to nidus and vein drainage not only in 3D but also in real time without need of administrate exogenous contrast agents. |
| jon12853-sup-0009-videoS9.mp41 MB | Video S9. AVM assessment with 4D flow. (C) Maximum intensity projection of MRA time of flight shows partial arterialization of flow within venous drainage. |
| jon12853-sup-0010-videoS10.mp46 MB | Video S10. AVM assessment with 4D flow. (D) 4D flow acquisition and advanced analysis of velocity magnitude allows not only to assess the morphological characteristics of AVM, but also its hemodynamic behavior showing areas with high velocity peak inside venous drainage. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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