Value of susceptibility-weighted MR imaging (SWI) in the detection of developmental venous anomaly

Abstract

Background Developmental venous anomaly (DVA) is probably the most common anomaly of the intracranial vasculature. DVAs consist of multiple, radially oriented dilated medullary veins that converge into a transcerebral vein. Susceptibility-weighted imaging (SWI) is a high spatial resolution 3D gradient-echo MRI sequence with phase post-processing that accentuates the paramagnetic properties of blood products such as deoxyhemoglobin, intracellular methemoglobin, and hemosiderin. Its high sensitivity to hemorrhagic particles by means of susceptibility dephasing effects within the veins allow for the accurate detection, grading, and monitoring of brain venous anomalies. In this review, we evaluated the prevalence of the brain DVAs identified by SWI in many patients who had undergone magnetic resonance imaging (MRI) with contrast administration. All images were independently reviewed by two radiologists who were blinded to other MR imaging finding. It is hoped that as SWI becomes more widely available, it will provide additional diagnostic and prognostic information that will improve the care and outcome of patients with DVAs. Results A total of 29 DVAs were observed with its prevalence 2.8%. The DVA caputs had mostly deep localization in about 44.8% of our DVA cases. SWI proved excellent demonstration of DVAs with the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were significantly higher than the other non-contrast MR sequences. On SWI, DVA is delineated as a signal void lesion with the normal cerebral veins. Conclusion Susceptibility-weighted imaging (SWI) is valuable in the diagnosis of DVA and should be included in routine MR assessment of the brain.

Aqueductal developmental venous anomaly causing obstructive hydrocephalus: A case report and review of the literature

“…Reflecting the current hypothesis that DVA is formed primarily as compensatory drainage veins due to congenital hypoplasia or occlusion of the original medullary veins [6] , DVA is composed of medullary veins and a large collector vein that assembles these veins radially. This finding is referred to as the caput medusae appearance [1] or umbrella-like appearance [2] , which is beneficial to differentiating DVA from other causes of aqueductal stenosis. The performance of SWI and postcontrast MRI would be a practical approach to detecting this appearance because both sequences are suitable for visualizing the venous system due to their high contrast.…”

“…Developmental venous anomalies (DVAs) are the most common cerebrovascular malformations, occurring in 2%-3% of the population [1 , 2] . This malformation was previously known as venous angioma, venous malformation, or medullary venous malformation [3] .…”

Incidence of Developmental Venous Anomalies in Patients With Multiple Sclerosis: A 3 Tesla MRI Study

“…However, we acknowledge that high-resolution 3D susceptibility-weighted imaging (SWI) might have a higher sensitivity for DVA detection. Interestingly, studies using SWI in this context are sparse ( 18 , 27 , 28 ). Cho et al ( 12 ) compared the detection rate of T1 post-contrast images (gold standard) with SWI, T2, and FLAIR in a total of 28 patients and found a high sensitivity of more than 85.7% in detecting DVA with SWI and a much lower sensitivity with T2 and FLAIR (35.7%).…”

Susceptibility‐Weighted Imaging in Neurodegenerative Disorders: A Review

“…Third, the susceptibility behavior of any area can be influenced by the surrounding areas. In this regard, areas of high susceptibility diffrence can be distorted on imaging 50 . Next, the phase and SW images depend on the orientation of structures relative to the applied field.…”