From the Departments of Radiology (D.H.Y., C.-H.S., Y.D.C.).
From the Departments of Radiology (D.H.Y., C.-H.S., Y.D.C.)
AJNR Am J Neuroradiol. 2023 Aug;44(8):916-921. doi: 10.3174/ajnr.A7922. Epub 2023 Jun 29.
Venous-predominant AVMs are almost identical in appearance to developmental venous anomalies on conventional MR imaging. Herein, we compared and analyzed arterial spin-labeling findings in patients with developmental venous anomalies or venous-predominant AVMs, using DSA as the criterion standard.
We retrospectively collected patients with either DVAs or venous-predominant AVMs, each available on both DSA and arterial spin-labeling images. Arterial spin-labeling imaging was visually assessed for the presence of hyperintense signal. CBF measured at the most representative section was normalized to the contralateral gray matter. The temporal phase of developmental venous anomalies or venous-predominant AVMs was measured on DSA as a delay between the first appearance of the intracranial artery and the lesion. Correlation between the normalized CBF and the temporal phase was evaluated.
Analysis of 15 lesions (13 patients) resulted in categorization into 3 groups: typical venous-predominant AVMs (temporal phase, <2 seconds), intermediate group (temporal phase between 2.5 and 5 seconds), and classic developmental venous anomalies (temporal phase, >10 seconds). Arterial spin-labeling signal was markedly increased in the typical venous-predominant AVM group, while there was no discernible signal in the classic developmental venous anomaly group. In the intermediate group, however, 3 of 6 lesions showed mildly increased arterial spin-labeling signal. The normalized CBF on arterial spin-labeling and the temporal phase on DSA were moderately negatively correlated: (13) = 0.66, = .008.
Arterial spin-labeling may predict the presence and amount of arteriovenous shunting in venous-predominant AVMs, and using arterial spin-labeling enables confirmation of typical venous-predominant AVMs without DSA. However, lesions with an intermediate amount of shunting suggest a spectrum of vascular malformations ranging from purely vein-draining developmental venous anomalies to venous-predominant AVMs with overt arteriovenous shunting.
静脉优势型动静脉畸形在常规 MR 成像上与发育性静脉异常几乎完全相同。在此，我们使用 DSA 作为金标准，比较并分析了发育性静脉异常或静脉优势型动静脉畸形患者的动脉自旋标记发现。
我们回顾性收集了具有 DVA 或静脉优势型动静脉畸形的患者，每位患者均有 DSA 和动脉自旋标记图像。通过视觉评估动脉自旋标记图像是否存在高信号。在最具代表性的层面上测量的 CBF 被归一化为对侧灰质。在 DSA 上测量发育性静脉异常或静脉优势型动静脉畸形的时相，作为颅内动脉首次出现与病变之间的延迟。评估归一化 CBF 与时相之间的相关性。
对 15 个病变（13 名患者）的分析结果分为 3 组：典型静脉优势型动静脉畸形（时相<2 秒）、中间组（时相在 2.5 至 5 秒之间）和经典发育性静脉异常（时相>10 秒）。典型静脉优势型动静脉畸形组动脉自旋标记信号明显增加，而经典发育性静脉异常组则没有可识别的信号。然而，在中间组中，6 个病变中的 3 个显示轻度增加的动脉自旋标记信号。动脉自旋标记上的归一化 CBF 与 DSA 上的时相呈中度负相关：r（13）=0.66，p=0.008。
动脉自旋标记术可能预测静脉优势型动静脉畸形中存在和程度的动静脉分流，并且使用动脉自旋标记术可以在无需 DSA 的情况下确认典型的静脉优势型动静脉畸形。然而，具有中等分流程度的病变提示血管畸形的范围从单纯静脉引流的发育性静脉异常到具有明显动静脉分流的静脉优势型动静脉畸形。
