VASCULAR MALFORMATIONS GALLERY Flashcards
What are the parts of the AVM

Graphic depicts AVM nidus with intranidal aneurysm , feeding artery (“pedicle”) aneurysm , and enlarged draining veins
Dx?

NECT scan (upper left) and CTA images in a patient with spontaneous cerebellar hemorrhage demonstrate an underlying AVM . Approximately 15% of AVMs are infratentorial
Describe the classic MRI findings of AVM

Axial T1WI in a 32-yearold man with headache shows a classic wedge-shaped left parietal AVM with multiple serpentine “flow voids” .
A few linear foci of T1 shortening represent thrombosed vessels within the nidus. T2WI in the same patient nicely demonstrates the wedge of “flow voids” . The broad base toward the cortex with apex pointing toward the lateral ventricle is a typical configuration for
brain AVMs.
FLAIR findings of AVM

FLAIR scan demonstrates minimal hyperintensity within and around the AVM , suggesting small foci of gliotic brain.. T1 C+ scan shows some linear and serpentine areas of enhancement that are mostly in draining veins.
What is your dx?

DSA of selective internal carotid angiogram in a patient with cerebral proliferative angiopathy shows
innumerable dilated vascular spaces with no dominant feeding arteries
Describe the parts of the DAVF

Graphic depicts dAVF with thrombosed transverse sinus with multiple tiny arteriovenous in the
dural wall . Lesion is mostly supplied by transosseous feeders from the external carotid artery
What is your dx?

Contrast-enhanced MRA source image shows dural sinus thrombosis , multiple enhancing vascular channels characteristic of posterior fossa dAVF. . MRA in the same patient shows innumerable tiny feeding arteries supplying a dAVF at the transverse-sigmoid sinus junction. The sinus has partially recanalized , and the distal sigmoid sinus and jugular bulb are partially opacified
What is your dx?

Autopsy case of direct CCF with dissection of the cavernous sinus (CS) and adjacent structures shows
that the right CS is enlarged by numerous dilated vascular channels
What is shown?

Clinical photograph of a patient with a CCF shows numerous enlarged scleral vessels . 7-17. CECT
scan shows classic findings of CCF. The right cavernous sinus is enlarged , and the ipsilateral superior
ophthalmic vein is more than 4 times the size of the left superior ophthalmic vein
Describe the MRI

T2WI shows typical MR findings of CCF with an enlarged right cavernous sinus containing numerous abnormal “flow voids” . Lateral DSA in a case of direct CCF in a 21-year-old woman with multiple skull base fractures shows that the ICA narrows before terminating in a large venous pouch . High-pressure venous reflux into the superior and inferior ophthalmic veins and the sphenoparietal sinus is present.
What is shown?

Pial AVF with slightly enlarged ACA branches connecting to a venous varix , dilated cortical
draining vein .
Describe the draining vessels of the AVF

Coronal T1 C+ scan shows a pial AVF in the posterior fossa. A small cerebellar artery connects
directly to a venous pouch , which in turn drains into a subependymal vein near the fourth
ventricle.
What is shown?

Graphic illustrates vein of Galen malformation. Enlarged choroid arteries drain directly into
dilated median prosencephalic vein (MPV) , falcine sinus . Torcular herophili (venous sinus
confluence) is massively enlarged.
What is the dx?

CECT scan in a newborn demonstrates a massive VGAM draining into an enlarged falcine sinus
, causing obstructive hydrocephalus
What is shown?

CECT, CTA depict classic DVA in the left cerebellar hemisphere
Where do the veins collect?

T1 C+ scan shows a classic DVA with enlarged WM veins and a collector vein draining into the anterior aspect of the superior sagittal sinus. SWI scan shows the DVA and collector vein as hypointense structures clearly different in configuration from the normal cortical veins. A focal hemorrhage adjacent to the left frontal horn is secondary to a small cavernous malformation. DVAs are often
histologically mixed lesions.
Describe the medullary veins

3D SSD demonstrates a classic DVA with enlarged medullary veins draining into the collector vein
. The appearance resembles a “Medusa head,” “upside-down willow tree” or “umbrella.”
What is shown?

T2WI shows classic “popcorn ball” appearance with locules of blood in different stages of evolution
surrounded by hemosiderin rim
What type of Cavernoma is shown?

Zabramski type 1 CCM is illustrated. (Left) T1WI shows that the lesion is hyperintense and surrounded by a hypointense hemosiderin rim .
(Right) T2* GRE scan shows “blooming” hypointensity both around and within the lesion. Microscopic section from the resected specimen in the same case shows a blood-filled cavity surrounded by thin endothelium-lined vascular channels
What type of Cavernoma is shown?

T2WI in a patient with multiple cerebral cavernous malformations shows a large left frontal lesion
with a fluid-fluid level . Multiple other hypointense lesions are present . 7-42B. T2* SWI shows
innumerable “blooming black dots” characteristic of Zabramski type 4 CCM (punctate microhemorrhages).
T2* scans are much more sensitive than FSE T2WI in depicting field inhomogeneities
What is shown?

Series of images demonstrates classic findings of pontine capillary telangiectasia. Axial T1WI is normal. Axial T2WI in the same patient likewise shows no abnormality.
FLAIR scan shows faint patchy hyperintensity in the pons. T2* GRE scan shows susceptibility effect with grayish hypointensity in the mid pons
What is your dx?

T1 C+ scan shows the brush-like faint enhancement that is characteristic of capillary telangiectasia. 7-47F. DTI fiber tracking is normal. The transverse pontine fibers cross undisturbed through the lesion
This figure is characteristic of?

(Top) Axial and (bottom) coronal T1 C+ scans show that the lesion enhances in a brush-like fashion. A prominent central draining vein is present . Imaging findings are characteristic of capillary telangiectasia

A patient with a history of whole brain radiation 5 years earlier for a WHO grade III anaplastic astrocytoma developed seizures. T2* GRE scan shows multiple “blooming” hypointensities.
T2* SWI scan in the same patient shows innumerable punctate microhemorrhages. Findings are
consistent with radiation-induced capillary telangiectasias







































