Susceptibility-weighted angiography for the detection of high-flow intracranial vascular lesions: preliminary study

• Published in: European radiology 2013-04, Vol.23 (4), p.1122-1130
• Main Authors: Hodel, Jérôme, Blanc, Raphaël, Rodallec, Mathieu, Guillonnet, Antoine, Gerber, Sophie, Pistocchi, Silvia, Sitta, Rémi, Rabrait, Cécile, Zuber, Mathieu, Pruvo, Jean-Pierre, Zins, Marc, Leclerc, Xavier
• Format: Article
• Language: English
• Subjects: Adult; Aged; Algorithms; Clinical medicine; Diagnostic Radiology; Female; Fistula; Flow velocity; Humans; Image Enhancement - methods; Image Interpretation, Computer-Assisted - methods; Imaging; Internal Medicine; Interventional Radiology; Intracranial Arteriovenous Malformations - pathology; Magnetic Resonance Angiography - methods; Magnetic resonance imaging; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neuro; Neuroradiology; Patients; Pilot Projects; Radiology; Reproducibility of Results; Sensitivity and Specificity; Ultrasound; Veins & arteries; Young Adult
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-012-2690-0

Objectives Susceptibility-weighted magnetic resonance imaging (MRI) sequences may demonstrate various signal intensities of draining veins in cases of high-flow vascular malformation (HFVM), including arteriovenous malformation (AVM) and dural arteriovenous fistula (dAVF). Our objective was to evaluate susceptibility-weighted angiography (SWAN) for the detection of HFVM. Methods Fifty-eight consecutive patients with a suspected intracranial vascular malformation were explored with SWAN and post-contrast MRI sequences at 3 T. The diagnosis of slow-flow vascular malformation (SFVM), including developmental venous anomaly (DVA) or brain capillary telangiectasia (BCT), was based on MRI. Patients with suspected HFVM underwent digital subtraction angiography (DSA). SWAN images were analysed by three blinded readers according to a three-point scale of the venous signal. Results Thirty-one patients presented 35 SFVM (26 DVA and 9 BCT) that systematically appeared hypointense on SWAN images. In patients with atypical MRI findings, DSA revealed one patient with an atypical DVA and 26 patients with HFVM (22 AVM and 4 dAVF). SWAN revealed at least one venous hyperintensity in all patients with HFVM. Agreement between readers was excellent. Conclusions SWAN appears reliable for characterising blood flow dynamics in brain veins. In clinical practice, SWAN can routinely rule out HFVM in patients with atypical brain veins. Key Points • Susceptibility - weighted angiography (SWAN) offers new perspectives for detecting intracranial vascular malformations. • SWAN sequence provides non - invasive characterisation of blood flow dynamics. • SWAN can differentiate between high and slow flowing venous blood. • SWAN can routinely rule out high - flow vascular malformations.