Waheed Khawaja B, Al Orf Ali, Al Zahrani Faisal, Ulhassan Muhammad Z, Al Jubair Nawaf N, Arulanatham Zechariah J
From the Department of Radiology (Waheed, Al Orf, Al Zahrani, Ulhassan, Al Jubair), Deanship of Post-graduate and Research (Arulanatham), Prince Sultan Military College of Health Science, Dhahran, Kingdom of Saudi Arabia.
Neurosciences (Riyadh). 2025 Jul;30(3):189-192. doi: 10.17712/nsj.2025.3.20240103.
To evaluate the use of susceptibility-enhanced sequence with conventional magnetic resonance imaging (MRI) of the brain for identification of venous angiomas in epilepsy work up.
A record-based study was performed retrospectively in Radiology department at our Hospital in Eastern region of Saudi Arabia, from Jan. 2019-2024. Adult patients for whom MRI brains were conducted for epilepsy work-up with added SWAN (susceptibility weighted angiography) sequence were considered. Imaging proven cases of space occupying lesions in the brain, post-injury, and post-interventional cases were not taken. A venous angioma (or malformation) was documented when a tuft of veins drained to a larger vein (traversing through cortex or reaching under ependymal layer), appeared low signal structure on SWAN image, and enhanced on contrast-enhanced sequence. Consensus reporting was made by 2 experienced neuroradiologists. The usefulness of the SWAN sequence in the detection of venous malformation determined if the visualized abnormality was found to be related to a focus resulting in abnormal waves on the brain electroencephalography. This observation was compared to the accidently found such malformations that were seen in epileptic patients with normal EEGs (control group). Fisher's Exact test was applied and a -value of <0.05 was taken as statistically significant for an association.
Total number of patients was 114; 65 females (57%) and 49 males (43%), with an average age of 31.4 (range, 15-50). The SWAN found venous angiomas in 34 (29.8%), and 8 were responsible for abnormal electroencephalograms while neither of the 3 accidently detected venous malformations in the control with normal EEGs (-value=0.001).
An added SWAN sequence with conventional MRI brain imaging for patients with seizures can assist to visualize symptomatic venous angiomas leading to focal seizures.
评估在癫痫检查中，利用敏感性增强序列结合传统脑磁共振成像（MRI）来识别静脉血管瘤。
2019年1月至2024年，在沙特阿拉伯东部地区我们医院的放射科进行了一项基于记录的回顾性研究。纳入因癫痫检查而进行脑部MRI并附加了SWAN（敏感性加权血管造影）序列的成年患者。排除影像学证实的脑内占位性病变、损伤后及介入后病例。当一束静脉引流至一条较大静脉（穿过皮质或到达室管膜下层），在SWAN图像上呈低信号结构，并在增强序列上强化时，记录为静脉血管瘤（或畸形）。由2名经验丰富的神经放射科医生进行共识报告。如果发现可视化异常与导致脑电图异常波的病灶相关，则确定SWAN序列在检测静脉畸形中的有用性。将这一观察结果与在脑电图正常的癫痫患者中偶然发现的此类畸形（对照组）进行比较。应用Fisher精确检验，P值<0.05被视为具有统计学意义的关联。
患者总数为114例；女性65例（57%），男性49例（约43%），平均年龄31.4岁（范围15 - 50岁）。SWAN发现34例（29.8%）静脉血管瘤，其中8例导致脑电图异常，而对照组脑电图正常的3例偶然发现的静脉畸形均未导致脑电图异常（P值=0.001）。
对于癫痫患者，在传统脑MRI成像中附加SWAN序列有助于可视化导致局灶性癫痫发作的有症状静脉血管瘤。
