Venous congestion: an MR finding in dural arteriovenous malformations with cortical venous drainage.
OBJECTIVE
To present the MR findings of intracranial dural arteriovenous malformations with cortical venous drainage, emphasizing the parenchymal changes.


METHODS
Conventional MR and x-ray angiograms in 13 patients with dural arteriovenous malformations and cortical venous reflux were reviewed. The site of the shunt, location of the venous reflux, and presence of venous stenosis were assessed on the angiograms. Parenchymal changes, dilated vessels, and venous occlusive disease were assessed on MR.


RESULTS
On MR, 10 of the 13 patients (77%) had dilated pial vessels. Two patients had hydrocephalus. Two patients presented with parenchymal bleeds, one with a subdural component, both remote from the nidus. Two patients presented with subarachnoid hemorrhage. One patient had a parenchymal bleed 9 months after presentation. Venous occlusion was evident on MR in 2 patients. Diffuse white matter edema in the cerebellar or cerebral hemispheres was present on MR in 4 patients and correlated with neurologic deficits. In 2 of these 4 patients, gadolinium enhancement was seen in the periphery of the involved hemisphere.


CONCLUSIONS
On MR a surplus of pial vessels suggests a dural arteriovenous malformation with cortical venous drainage. The MR finding of white matter edema deep in the cerebral or cerebellar hemispheres is direct evidence of a venous congestion.
Willinsky
R
R
Department of Radiology, Toronto Hospital, University of Toronto, Ontario, Canada.
Terbrugge
K
K
Montanera
W
W
Mikulis
D
D
Wallace
M C
MC
D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000473:pathology; D002526:Cerebellar Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000473:pathology; D002550:Cerebral Veins / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000000981:diagnostic imaging; D003287:Contrast Media; D004108:Dilatation, Pathologic / Q000175:diagnosis / Q000000981:diagnostic imaging; D004338:Drug Combinations; D004388:Dura Mater / Q000098:blood supply* / Q000000981:diagnostic imaging; D005260:Female; D005682:Gadolinium; D019786:Gadolinium DTPA; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000473:pathology; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D009942:Organometallic Compounds; D004369:Pentetic Acid / Q000031:analogs & derivatives; D010841:Pia Mater / Q000098:blood supply; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000473:pathology
D003287:Contrast Media; D004338:Drug Combinations; D009942:Organometallic Compounds; D008536:Meglumine; D004369:Pentetic Acid; D005682:Gadolinium; D019786:Gadolinium DTPA