Association of developmental venous anomalies with perfusion abnormalities on arterial spin labeling and bolus perfusion-weighted imaging.
OBJECTIVE
To investigate the frequency and characteristics of developmental venous anomaly (DVA)-associated perfusion abnormalities on arterial spin labeling (ASL) and bolus perfusion-weighted imaging (PWI) and discuss their potential causes.


METHODS
We reviewed brain MR reports to identify all DVAs reported on studies performed between 2009 and 2012. DVA location and findings on PWI and/or ASL imaging were assessed by visual inspection. Sizes of DVAs were categorized as small (<15 mm), medium (15-25 mm), and large (>25 mm). For ASL, signal in the DVA, surrounding parenchyma, or associated draining vein was recorded. For PWI, changes on hemodynamic maps (cerebral blood volume [CBV], cerebral blood flow [CBF], mean transit time [MTT], and normalized time-to-peak of the residue function [Tmax]) were evaluated. Coexisting vascular malformations in association with DVAs were also identified.


RESULTS
Six hundred and fifty-two DVAs were identified in 632 subjects. Of these, 121 underwent both perfusion modalities, 15 only PWI, and 127 only ASL. ASL abnormalities were seen in 21/248 (8%), including signal in a draining vein (2/21, 10%), in the DVA (11/21, 52%), and in the parenchyma (8/21, 38%). On PWI, the majority of DVAs demonstrated abnormalities (108/136, 79%), typically increased CBF, CBV, MTT, and Tmax. There was no association between DVA size and presence of ASL signal (P = .836). Borderline statistical significance was found between DVA size and presence of PWI abnormality (P = .046). No relationship was found between the presence of a coexisting vascular malformation and presence of ASL (P = .468) or PWI abnormality (P = .745).


CONCLUSIONS
Perfusion changes with DVAs are common on PWI but uncommon on ASL. PWI findings are expected based on the anatomy and physiology of DVAs and are accentuated by gradient echo acquisition. DVAs with intrinsic ASL signal or signal in draining veins may be associated with arteriovenous shunting (transitional lesions).
Department of Radiology, Stanford University and Stanford University Medical Center, Stanford, CA.
Michael
M
Iv
Department of Radiology, Stanford University and Stanford University Medical Center, Stanford, CA.
Nancy J
NJ
Fischbein
Department of Radiology, Stanford University and Stanford University Medical Center, Stanford, CA.
Greg
G
Zaharchuk
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000175:diagnosis*; D002550:Cerebral Veins / Q000002:abnormalities* / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000209:etiology*; D003287:Contrast Media / Q000008:administration & dosage; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013113:Spin Labels; D055815:Young Adult
D003287:Contrast Media; D013113:Spin Labels
DVA; arterial spin labeling; bolus perfusion-weighted imaging; developmental venous anomaly; dynamic susceptibility contrast