Korean J Radiol.  2002 Dec;3(4):271-275. 10.3348/kjr.2002.3.4.271.

Non-Invasive Follow-up Evaluation of Post-Embolized AVM with Time-Resolved MRA: A Case Report

• Shim YW
• Chung TS
• Kang WS
• Joo JY
• Strecker R
• Hennig J

• KMID: 1118797
• DOI: http://doi.org/10.3348/kjr.2002.3.4.271

Abstract

We report the hemodynamic assessment in a patient with cerebral arteriovenous malformation using time-resolved magnetic resonance angiography (TRMRA), a non-invasive modality, and catheter-based digital subtraction angiography (DSA), before and after embolization. Comparison of the results showed that TR-MRA produced very fast dynamic images and the findings closely matched those obtained at DSA. For initial work-up and follow-up studies in patients with vascular lesions, TR-MRA and DSA are therefore comparable.

Keyword

Arteriovenous malformation, cerebral; Contrast-enhanced MRA; Hemodynamics; Magnetic resonance(MR)

MeSH Terms

Adult
Angiography, Digital Subtraction
Case Report
Cerebrovascular Circulation
Comparative Study
*Embolization, Therapeutic
Follow-Up Studies
Human
Intracranial Arteriovenous Malformations/diagnosis/physiopathology/*therapy
*Magnetic Resonance Angiography
Male
Support, Non-U.S. Gov't
Time Factors

Figure

• 

  Fig. 1 Multiple round and linear signal-void structures, which form a wedge-shape defect, are present in the left temporal lobe, suggesting the presence of an AVM in a 36-year-old man. A, B, C. T1-(A), T2-(B), and enhanced T1-weighted (C) axial MR images are shown (TR/TE = 600/14 for T1WI and enhanced T1WI; TR/TE/acquisition = 4500/120/2 for TSE T2WI). After the injection of contrast medium, enhancement was minimal. D. Prior to embolization, a large AVM nidus fed from a branch of the left middle cerebral artery is apparent, and there is early drainage, mainly to the distal left sigmoid sinus, via a dilated vein. Note early visualization of the left internal jugular vein. During the capillary phase, decreased opacity of contrast medium in the rest of the cerebral parenchyma was also noted. E. After embolization with 5-0 silk suture, the previously noted dilated vein has completely disappeared and contrast filling in the remaining part of the brain is almost normal. A small part of the AVM, seen inferomedially, remains, and the filling time and density of the superior sagittal sinus and left internal jugular vein have normalized. F. TR-MRA acquired prior to embolization shows, as does DSA, early visualization of the AVM nidus and dilated draining vein, and delayed visualization of the weakly enhanced superior sagittal sinus. Additionally, as in DSA, the left internal jugular vein is visualized during the early arterial phase. G. TR-MRA obtained immediately after embolization shows that visualization of the dilated draining vein and remaining part of the AVM nidus, seen inferomedially, is delayed. Early visualization and normal filling of the superior sagittal sinus is noted, suggesting the regulation of blood flow in the remaining part.

Reference

1. Huston J III, Rufenacht DA, Ehman RL, Wiebers DO. Intracranial aneurysms and vascular malformations: comparison of time-of-flight and phase-contrast MR angiography. Radiology. 1991. 181:721–730.

2. Marks MP, Pelc MJ, Ross MR, Enzmann DR. Determination of cerebral blood flow with a phase-contrast cine MR imaging technique: evaluation of normal subjects and patients with arteriovenous malformation. Radiology. 1992. 182:467–476.

3. Oppenheim C, Meder JF, Trystram D, et al. Radiosurgery of cerebral arteriovenous malformations: is an early angiogram needed? AJNR Am J Neuroradiol. 1990. 20:475–481.

4. Hennig J, Scheffler K, Laubenberger J, Strecker R. Time-resolved projection angiography after bolus injection of contrast agent. Magn Reson Med. 1997. 37:341–345.

5. Wang Y, Johnston DL, Breen JF, et al. Dynamic MR digital subtraction angiography using contrast enhancement, fast data acquisition, and complex subtraction. Magn Reson Med. 1996. 36:551–556.

6. DeMeritt JS, Pile-Spellman J, Mast H, et al. Outcome analysis of preoperative embolization with N-butyl cyanoacrylate in cerebral arteriovenous malformations. AJNR Am J Neuroradiol. 1995. 16:1801–1807.

7. Jafar JJ, Davis AJ, Berenstein A, Choi IS, Kupersmith MJ. The effect of embolization with N-butyl cyanoacrylate prior to surgical resection of cerebral arteriovenous malformations. J Neurosurg. 1993. 78:60–69.

8. Dobson MJ, Hartley RWJ, Ashleigh R, Watson Y, Hawnaur JM. MR angiography and MR imaging of symptomatic vascular malformations. Clinical Radiology. 1997. 52:595–602.