Clinical and Arterial Spin Labeling Brain MRI Features of Transitional Venous Anomalies

Abstract

A DVA-like lesion with increased ASL signal likely represents a TVA with arteriovenous shunting. Our study indicates that these lesions are usually incidentally detected and have a lower risk of hemorrhage than AVMs. ASL-MRI may be a useful tool to identify TVAs and guide further management of patients with TVAs.

Unique enlarging cavernous malformation secondary to abnormal arteriovenous shunting through an associated developmental venous anomaly

“…Some theories include de novo CM formation secondary to increased venous pressure in a DVA, leading to recurrent microhemorrhages, eventually forming a CM. 1,2 Anecdotally, and in the literature, examples of enlarging CMs generally reveal intermittent enlargement of discrete hemorrhagic locules, supporting the episodic microhemorrhage theory. We present an unusual case of a gradually enlarging CM -without typical enlarging hemorrhagic locules -associated with a DVA with arteriovenous shunting, and propose the theory that the arterialized venous drainage system caused the rapid and atypical-appearing growth of this lesion.…”

“…4,6,7 The natural history and associated risk of such malformations have therefore been difficult to assess, and they are postulated to represent some type of cross between classical DVAs and arteriovenous malformations on the clinical spectrum. 2…”

“…4,6,7 The natural history and associated risk of such malformations have therefore been difficult to assess, and they are postulated to represent some type of cross between classical DVAs and arteriovenous malformations on the clinical spectrum. 2 CMs and DVAs frequently coexist as mixed vascular malformations, in which the DVA is in close proximity to the CM and provides the primary venous drainage. 6 This relationship assists accurate diagnosis of CMs when their radiologic appearance is atypical.…”

“…Some theories include de novo CM formation secondary to increased venous pressure in a DVA, leading to recurrent microhemorrhages, eventually forming a CM. 1,2…”

Symptomatic Developmental Venous Anomaly: State-of-the-Art Review on Genetics, Pathophysiology, and Imaging Approach to Diagnosis

“…MR imaging perfusion techniques such as DSC and arterial spin-labeling can better characterize the microcirculation of a DVA. [26][27][28][29] On DSC perfusion, normal DVAs follow the cerebral vein and dural venous sinus hemodynamics, with elevated relative CBV and CBF. DVAs with venous outflow impairment may reveal an elevated MTT (Fig 8).…”