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Association of developmental venous anomalies with perfusion abnormalities on arterial spin labeling and bolus
Michael Iv1, Nancy J Fischbein1, Greg Zaharchuk1
1Department of Radiology, Stanford University and Stanford University Medical Center, Stanford, CA.
Background And Purpose:
To investigate the frequency and characteristics of developmental venous anomaly (DVA)-associated perfusion abnormalities on arterial spin labeling (ASL) and bolus perfusion-weighted imaging (PWI) and discuss their potential causes.
Methods:
We reviewed brain MR reports to identify all DVAs reported on studies performed between 2009 and 2012. DVA location and findings on PWI and/or ASL imaging were assessed by visual inspection. Sizes of DVAs were categorized as small (<15 mm), medium (15-25 mm), and large (>25 mm). For ASL, signal in the DVA, surrounding parenchyma, or associated draining vein was recorded. For PWI, changes on hemodynamic maps (cerebral blood volume [CBV], cerebral blood flow [CBF], mean transit time [MTT], and normalized time-to-peak of the residue function [Tmax]) were evaluated. Coexisting vascular malformations in association with DVAs were also identified.
Results:
Six hundred and fifty-two DVAs were identified in 632 subjects. Of these, 121 underwent both perfusion modalities, 15 only PWI, and 127 only ASL. ASL abnormalities were seen in 21/248 (8%), including signal in a draining vein (2/21, 10%), in the DVA (11/21, 52%), and in the parenchyma (8/21, 38%). On PWI, the majority of DVAs demonstrated abnormalities (108/136, 79%), typically increased CBF, CBV, MTT, and Tmax. There was no association between DVA size and presence of ASL signal (P = .836). Borderline statistical significance was found between DVA size and presence of PWI abnormality (P = .046). No relationship was found between the presence of a coexisting vascular malformation and presence of ASL (P = .468) or PWI abnormality (P = .745).
Conclusions:
Perfusion changes with DVAs are common on PWI but uncommon on ASL. PWI findings are expected based on the anatomy and physiology of DVAs and are accentuated by gradient echo acquisition. DVAs with intrinsic ASL signal or signal in draining veins may be associated with arteriovenous shunting (transitional lesions).
Insights
Perfusion-weighted imaging (PWI) commonly shows abnormalities in developmental venous anomalies (DVAs), while arterial spin labeling (ASL) rarely does. PWI findings align with DVA anatomy, but ASL signals may indicate arteriovenous shunting.
Area of Science:
- Neuroradiology
- Vascular Imaging
- Neuroscience
Background:
- Developmental venous anomalies (DVAs) are common congenital vascular malformations.
- Perfusion abnormalities associated with DVAs are not well characterized.
- Arterial spin labeling (ASL) and bolus perfusion-weighted imaging (PWI) are advanced MRI techniques for assessing cerebral blood flow.
Purpose of the Study:
- To determine the frequency and characteristics of perfusion abnormalities in DVAs using ASL and PWI.
- To explore potential causes of these perfusion changes.
- To correlate imaging findings with DVA size and coexisting vascular malformations.
Main Methods:
- Retrospective review of brain MR reports to identify DVAs (2009-2012).
- Assessment of DVA location, size, and findings on ASL and PWI by visual inspection.
- Evaluation of hemodynamic parameters (CBV, CBF, MTT, Tmax) on PWI and signal characteristics on ASL.
Main Results:
- 652 DVAs identified in 632 subjects; 136 and 248 underwent PWI and ASL, respectively.
- PWI showed abnormalities in 79% of DVAs (increased CBF, CBV, MTT, Tmax).
- ASL abnormalities were less common (8%), including signals in the DVA, surrounding parenchyma, or draining vein.
Conclusions:
- Perfusion changes are frequent on PWI but rare on ASL in DVAs.
- PWI findings are consistent with DVA anatomy and physiology.
- ASL signals in DVAs or draining veins may suggest arteriovenous shunting, indicating transitional lesions.
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