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Clinically documented hemorrhage in cerebral arteriovenous malformations: MR characteristics
P M Chappell1, G K Steinberg, M P Marks
1Department of Radiology, Stanford University Medical Center, CA 94305.
Abstract:
This study assessed the ability of magnetic resonance (MR) imaging to identify vascular characteristics of cerebral arteriovenous malformations (AVMs) which are predictive of hemorrhage. The study also evaluated the sensitivity and specificity of spin-echo (SE) and gradient-recalled-echo (GRE) imaging in the detection of prior clinical hemorrhage on the basis of location of the hemorrhage (parenchymal, intraventricular, or subarachnoid). Fifty patients with high-flow AVMs were evaluated. Twenty-four (48%) patients had prior clinical hemorrhage documented at computed tomography or MR imaging at the time of bleeding. Central venous drainage (P less than .001), central AVM location (P less than .001), and peri- or intraventricular AVM location (P less than .01) correlated positively with prior clinical hemorrhage. Intranidus aneurysms and angiomatous change could not be detected with MR. Nineteen of the 24 patients with prior hemorrhage underwent both SE and GRE imaging. Hypointensity, indicating the presence of iron from prior hemorrhage, was demonstrated in 14 of 19 T2-weighted SE images (sensitivity, 74%) and in 18 of 19 GRE images (sensitivity, 95%). No patient without a prior episode of clinical bleeding demonstrated evidence of iron deposition at MR imaging (specificity, 100%).
Insights
Magnetic resonance imaging can identify cerebral arteriovenous malformations (AVMs) predictive of hemorrhage. Gradient-recalled-echo (GRE) imaging shows high sensitivity (95%) in detecting prior hemorrhage in AVM patients.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Cerebral arteriovenous malformations (AVMs) are complex vascular abnormalities.
- Identifying AVMs predictive of hemorrhage is crucial for patient management.
- Previous hemorrhage is a significant risk factor for rebleeding.
Purpose of the Study:
- To assess magnetic resonance (MR) imaging's ability to identify vascular characteristics of AVMs predictive of hemorrhage.
- To evaluate the sensitivity and specificity of spin-echo (SE) and gradient-recalled-echo (GRE) imaging in detecting prior hemorrhage.
Main Methods:
- Fifty patients with high-flow AVMs were evaluated using MR imaging.
- Vascular characteristics and hemorrhage locations were analyzed.
- SE and GRE imaging were used to detect evidence of prior hemorrhage (hypointensity indicating iron deposition).
Main Results:
- Central venous drainage, central AVM location, and peri- or intraventricular AVM location correlated positively with prior hemorrhage.
- GRE imaging demonstrated 95% sensitivity in detecting prior hemorrhage, compared to 74% for SE imaging.
- MR imaging showed 100% specificity in ruling out prior hemorrhage in patients without a history of bleeding.
Conclusions:
- MR imaging can identify AVM features associated with hemorrhage risk.
- GRE imaging is highly sensitive for detecting prior hemorrhage in AVM patients.
- MR imaging is valuable for assessing hemorrhage history in AVMs.