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Vessel wall MRI in ruptured cranial dural arteriovenous fistulas
Branden J Cord1, Daniela Renedo2, Corrado Santarosa3
1Department of Neurosurgery, University of California (Davis), Sacramento, USA.
Abstract:
Intracranial high-resolution vessel wall MRI (VW-MRI) is an imaging paradigm that is useful in site-of-rupture identification in patients presenting with spontaneous subarachnoid hemorrhage and multiple intracranial aneurysms. Only a handful of case reports describe its potential utility in the evaluation of more complex brain vascular malformations. We report for the first time three patients with ruptured cranial dural arteriovenous fistulas (dAVFs) that were evaluated with high-resolution VW-MRI. The presumed site-of-rupture was identified based on contiguity of a venous ectasia with adjacent blood products and thick, concentric wall enhancement. This preliminary experience suggests a role for high-resolution VW-MRI in the evaluation of ruptured cranial dAVFs, in particular, site-of-rupture identification. It also supports an emerging hypothesis that all spontaneously ruptured, macrovascular lesions demonstrate avid vessel wall enhancement.
Insights
High-resolution vessel wall MRI (VW-MRI) can identify the rupture site in cranial dural arteriovenous fistulas (dAVFs). This imaging technique shows potential for evaluating complex vascular malformations and identifying the source of bleeding.
Area of Science:
- Neuroradiology
- Vascular Imaging
- Neurointerventional Radiology
Background:
- High-resolution vessel wall MRI (VW-MRI) is established for identifying rupture sites in aneurysms causing subarachnoid hemorrhage.
- Its utility in complex vascular malformations, like dural arteriovenous fistulas, is less understood.
Purpose of the Study:
- To evaluate the role of high-resolution VW-MRI in identifying the site-of-rupture in patients with ruptured cranial dural arteriovenous fistulas (dAVFs).
Main Methods:
- Three patients with ruptured dAVFs underwent high-resolution VW-MRI.
- The presumed rupture site was identified by specific imaging features.
Main Results:
- High-resolution VW-MRI successfully identified the presumed site-of-rupture in all three patients with ruptured dAVFs.
- Key findings included venous ectasia contiguous to blood products and characteristic thick, concentric vessel wall enhancement.
Conclusions:
- High-resolution VW-MRI shows promise for evaluating ruptured dAVFs, particularly in pinpointing the site of rupture.
- Findings support the hypothesis that ruptured macrovascular lesions exhibit avid vessel wall enhancement.
