T2 reversed fast spin-echo image and enhanced three-dimensional surface MR angiography for the diagnosis of cerebral arteriovenous malformations

Although conventional neuro-imaging of cerebral arteriovenous malformation (AVM) supports preoperative evaluation, it is still difficult to visualise the detailed anatomical conformation of the AVM, the point of nidus, the feeding arteries or draining veins, and the three-dimensional configuration of nidus in the sulcus or gyrus. In the present study, we investigated the efficacy of enhanced three-dimensional surface MR angiography (surface MRA) and T2 reversed imaging (T2R imaging) in diagnosis and surgical planning for cerebral AVMs. Surface MRA clearly demonstrated nidus adjacent to eloquent area and three-dimensional figures of feeding arteries and draining veins. T2R imaging was useful to differentiate sulcal AVM from gyral AVM, and to estimate the depth of the nidus in the parenchyma. Although it has generally been assumed that nidus is present in the gyrus, T2R imaging clearly demonstrates that most of the nidus is in the sulcus and is possible to be dissected and removed without damaging parenchyma. Indeed, these imaging methods supply clinically relevant data that is difficult to obtain with conventional neuro-imaging and provide better details of lesions, informing surgical planning and decision-making.