MRI of angiographically occult vascular malformations

Eleven patients with 15 angiographically occult arteriovenous malformations were studied by magnetic resonance (MR) imaging and computed tomography (CT). Five patients had biopsy proof; six were clinically diagnosed from the long-term clinical follow-up (more than 3 years) and imaging features. Of the 15 lesions, 11 were recognized by both CT and MR. Each method was falsely negative for two lesions. The most useful contribution of MR in the characterization of angiographically occult arteriovenous malformations was the depiction of hemorrhagic foci in 12 of 13 lesions seen on MR. High-attenuation foci indicative of hematomas were seen in only five lesions on CT; the rest were iso- or hypoattenuating. CT detected two very small lesions, in one case as punctate foci of enhancement and in the other as punctate calcification, that were not seen with MR. MR complements CT in characterizing angiographically occult arteriovenous malformations and in distinguishing them from similar-appearing lesions, in particular, small neoplasms. However, when such lesions are seen with only focal calcification and subtle enhancement on CT, routine MR may miss them.