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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 - Korean J Radiol (2002 Oct-Dec)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology and Research Institute of Radiological Science, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, YongDong Severance Hospital, Seoul, Korea.

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.

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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.
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Figure 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.

Mentions: T1- and T2-weighted images depicted a wedge-shaped lesion containing multiple, variable-sized, linear or round signal void structures in the left temporal lobe, while Gd-DTPA-enhanced T1-weighted images showed minimal enhancement (Figs. 1A-C). Before embolization, DSA demonstrated a large AVM nidus fed from a branch of the left middle cerebral artery, and early drainage via a dilated vein, mainly to the distal left sigmoid sinus, was observed. There was early visualization of the nidus and left internal jugular vein, and at delayed imaging, decreased opacity of contrast material in the unaffected part of brain was noted. After embolization of the AVM nidus, visualization of the previously noted dilated vein was delayed, and contrast filling of the unaffected part of brain was almost normal, as was the appearance of the left internal jugular vein (Figs. 1D, E). The inferomedial part of the nidus still remained after embolization, but visualization was delayed more than before.


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 - Korean J Radiol (2002 Oct-Dec)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2713852&req=5

Figure 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.
Mentions: T1- and T2-weighted images depicted a wedge-shaped lesion containing multiple, variable-sized, linear or round signal void structures in the left temporal lobe, while Gd-DTPA-enhanced T1-weighted images showed minimal enhancement (Figs. 1A-C). Before embolization, DSA demonstrated a large AVM nidus fed from a branch of the left middle cerebral artery, and early drainage via a dilated vein, mainly to the distal left sigmoid sinus, was observed. There was early visualization of the nidus and left internal jugular vein, and at delayed imaging, decreased opacity of contrast material in the unaffected part of brain was noted. After embolization of the AVM nidus, visualization of the previously noted dilated vein was delayed, and contrast filling of the unaffected part of brain was almost normal, as was the appearance of the left internal jugular vein (Figs. 1D, E). The inferomedial part of the nidus still remained after embolization, but visualization was delayed more than before.

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology and Research Institute of Radiological Science, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, YongDong Severance Hospital, Seoul, Korea.

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.

Show MeSH
Related in: MedlinePlus