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Agyemang K, Gómez Rodríguez R, Rocha Marussi VH, Marte Arias SA, Feliciano Vilcahuaman Paitań A, Campos Filho JM, Chaddad-Neto F. Case report: Delayed outflow obstruction of a DVA: A rare complication of brainstem cavernoma surgery. Front Neurol 2023; 14:1073366. [PMID: 36998781 PMCID: PMC10044343 DOI: 10.3389/fneur.2023.1073366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/03/2023] [Indexed: 03/16/2023] Open
Abstract
IntroductionDevelopmental venous anomalies (DVAs) are considered variants of normal transmedullary veins. Their association with cavernous malformations is reported to increase the risk of hemorrhage. Expert consensus recommends meticulous planning with MR imaging, use of anatomical “safe zones”, intraoperative monitoring of long tracts and cranial nerve nuclei, and preservation of the DVA as key to avoiding complications in brainstem cavernoma microsurgery. Symptomatic outflow restriction of DVA is rare, with the few reported cases in the literature restricted to DVAs in the supratentorial compartment.CaseWe present a case report of the resection of a pontine cavernoma complicated by delayed outflow obstruction of the associated DVA. A female patient in her 20's presented with progressive left-sided hemisensory disturbance and mild hemiparesis. MRI revealed two pontine cavernomas associated with interconnected DVA and hematoma. The symptomatic cavernoma was resected via the infrafacial corridor. Despite the preservation of the DVA, the patient developed delayed deterioration secondary to venous hemorrhagic infarction. We discuss the imaging and surgical anatomy pertinent to brainstem cavernoma surgery, as well as the literature exploring the management of symptomatic infratentorial DVA occlusion.ConclusionDelayed symptomatic pontine venous congestive edema is extremely rare following cavernoma surgery. DVA outflow restriction from a post-operative cavity, intraoperative manipulation, and intrinsic hypercoagulability from COVID-10 infection are potential pathophysiological factors. Improved knowledge of DVAs, brainstem venous anatomy, and “safe entry zones” will further elucidate the etiology of and the efficacious treatment for this complication.
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Affiliation(s)
- Kevin Agyemang
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Neurosurgery, Beneficência Portuguesa Hospital, São Paulo, Brazil
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | | | | | | | | | | | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Neurosurgery, Beneficência Portuguesa Hospital, São Paulo, Brazil
- *Correspondence: Feres Chaddad-Neto
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Lee S, Baek HJ. Pontocerebellar venous infarction caused by COVID-19 in a 13-year-old girl with underlying asymptomatic developmental venous anomaly. NEUROIMMUNOLOGY REPORTS 2022; 2. [PMCID: PMC9547657 DOI: 10.1016/j.nerep.2022.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction COVID-19-associated coagulopathy (CAC) presents as a highly activated thrombotic status, leading to severe clinical outcomes. We report a unique pediatric case of pontocerebellar venous infarction caused by COVID-19 (omicron mutation) and accompanied by abnormal brain venous structure. Case A 13-year-old unvaccinated girl with high-grade fever and altered mental status visited our emergency department. In her initial serologic results, all the inflammatory markers were elevated; interleukin-6 was remarkably elevated (above 5000 pg/mL). On brain CT, a suspicious subtle hypo-attenuated lesion in the right interior cerebellar hemisphere area was observed; brain MRI revealed bilateral asymmetric hyperintense lesions in the mid-pons, and extensive cerebellar hemorrhage and engorged venous structure. Despite intensive medications and treatments, the patient failed to maintain her vital signs with a mechanical ventilator because of aggravated pneumonia and bilateral pleural effusion, and she died ten days after her hospital admission. Conclusion In our patient, a rapid systemic cytokine storm reaction occurred, and presumably, the resulting inflammation sequentially caused the coagulopathy cascade. One of the significant risk factors was an asymptomatic developmental venous anomaly (DVA) of the cerebellum. The asymptomatic DVA concomitant with COVID-19 may be associated with thrombosis and needs further brain imaging studies.
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Affiliation(s)
- Sunho Lee
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do 51472, Republic of Korea,Corresponding author
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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Hassankhani A, Stein JM, Haboosheh AG, Vossough A, Loevner LA, Nabavizadeh SA. Anatomical Variations, Mimics, and Pitfalls in Imaging of Patients with Epilepsy. J Neuroimaging 2020; 31:20-34. [PMID: 33314527 DOI: 10.1111/jon.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022] Open
Abstract
Epilepsy is among one of the most common neurologic disorders. The role of magnetic resonance imaging (MRI) in the diagnosis and management of patients with epilepsy is well established, and most patients with epilepsy are likely to undergo at least one or more MRI examinations in the course of their disease. Recent advances in high-field MRI have enabled high resolution in vivo visualization of small and intricate anatomic structures that are of great importance in the assessment of seizure disorders. Familiarity with normal anatomic variations is essential in the accurate diagnosis and image interpretation, as these variations may be mistaken for epileptogenic foci, leading to unnecessary follow-up imaging, or worse, unnecessary treatment. After a brief overview of normal imaging anatomy of the mesial temporal lobe, this article will review a few important common and uncommon anatomic variations, mimics, and pitfalls that may be encountered in the imaging evaluation of patients with epilepsy.
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Affiliation(s)
- Alvand Hassankhani
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Joel M Stein
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amit G Haboosheh
- Department of Radiology, Hadassah Ein Karem Hospital, Jerusalem, Israel
| | - Arastoo Vossough
- Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Laurie A Loevner
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Seyed Ali Nabavizadeh
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Grigoryan G, Sitnikov A, Grigoryan Y. Hemifacial spasm caused by the brainstem developmental venous anomaly: A case report and review of the literature. Surg Neurol Int 2020; 11:141. [PMID: 32547828 PMCID: PMC7294170 DOI: 10.25259/sni_56_2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/16/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Hemifacial spasm (HFS) is usually caused by vascular compression of the root exit zone (REZ) of the facial nerve. Dual compression of the REZ by veins and arteries is also associated with HFS, but venous origin alone is rarely reported. We present a rare case of HFS caused by the brainstem developmental venous anomaly (DVA) treated with microvascular decompression (MVD). Case Description: A 30-year-old women presented with the left-sided HFS since the age of 18 years. The brainstem DVA was diagnosed by magnetic resonance imaging (MRI) and followed by two attempts of MVD at some other clinics without any improvement. At our hospital, MVD was performed through a left retromastoid craniotomy. Intraoperatively, after detaching the strong adhesions between the cerebellar hemisphere, petrosal dura and lower cranial nerves, and removing the Teflon sponge inserted during the previous operations, the compressing large vein was found, separated from facial nerve REZ and MVD was completed. The postoperative computed tomography angiography and MRI showed the thrombosis of the main trunk of DVA and decompression of the facial nerve REZ. Complete cessation of HFS with hearing preservation was observed with only slight weakness of mimic muscles which disappeared within 3 months after surgery. Conclusion: HFS associated with brainstem DVA is a very rare condition. MVD of the facial nerve REZ with transposition of the large draining vein should be considered as an effective treatment option.
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Affiliation(s)
- George Grigoryan
- Department of Neurosurgery, Treatment and Rehabilitation Center, Moscow, Russian Federation
| | - Andrey Sitnikov
- Department of Neurosurgery, Treatment and Rehabilitation Center, Moscow, Russian Federation
| | - Yuri Grigoryan
- Department of Neurosurgery, Treatment and Rehabilitation Center, Moscow, Russian Federation
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Isolated hemorrhagic arterialized DVAs: revisiting symptomatic DVAs. Neurol Sci 2020; 41:2147-2155. [PMID: 32128649 DOI: 10.1007/s10072-020-04294-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/11/2020] [Indexed: 10/24/2022]
Abstract
We aim to present here a small case series of symptomatic isolated hemorrhagic arterialized developmental venous anomalies (sDVAs) with a larger goal of revisiting the classification based on patho-mechanisms plus emphasizing angiographic features coupled with CT and MRI. Typically, DVA is an incidental and silent abnormality on neuroimaging. Understanding its morphology in terms of arterialization and relationship with other entities is crucial for management. One adult and two pediatric cases presented with acute or sub-acute hemorrhage in the cerebellum or thalamus. Morphologic characterization on cross-sectional imaging and catheter angiography confirmed the integrated diagnosis of "symptomatic isolated hemorrhagic arterialized DVAs with deeper or superficial venous drainage". Conservative management was adopted in all cases. We emphasize the following classification and approach for symptomatic DVAs: (1) congestive isolated arterialized sDVAs, (2) congestive isolated resistive sDVAs, (3) coexisting sDVAs (with AVM or cavernous malformation), (4) compressive sDVAs (compressive effects), and (5) idiopathic DVAs. Like our three cases, ganglionic and infratentorial DVAs have higher propensity of hemorrhage, compressive effects, and usually harbor deeper venous drainage. Typical "caput medusae" as dominant collector vein on cross-sectional imaging is crucial to complement and even confirm the diagnosis of DVA before catheter angiography in sDVAs. Capillary stain or early opacification of DVAs is a marker of arteriovenous shunting in arterialized sDVAs. Recognition of this entity is crucial as treatment is usually conservative.
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Freeman CW, Lazor JW, Loevner LA, Nabavizadeh SA. Variations of the CNS Venous System Mimicking Pathology: Spectrum of Imaging Findings. J Neuroimaging 2019; 29:673-688. [DOI: 10.1111/jon.12664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Colbey W. Freeman
- Department of RadiologyHospital of the University of Pennsylvania Philadelphia PA
| | - Jillian W. Lazor
- Division of Neuroradiology, Department of RadiologyHospital of the University of Pennsylvania Philadelphia PA
| | - Laurie A. Loevner
- Division of Neuroradiology, Department of RadiologyHospital of the University of Pennsylvania Philadelphia PA
| | - Seyed Ali Nabavizadeh
- Division of Neuroradiology, Department of RadiologyHospital of the University of Pennsylvania Philadelphia PA
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Monique B, Sandra C, Marie-Cécile HF, Jean-Pierre L. Serial imaging and SWAN sequence of developmental venous anomaly thrombosis with hematoma: Diagnosis and follow-up. J Clin Neurosci 2017. [PMID: 28624141 DOI: 10.1016/j.jocn.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Developmental venous anomalies (DVAs) are usually asymptomatic. We report a case of DVA thrombosis with recurrent tiny frontal hematoma in a 24-year-old man. The contribution of T2-GRE and SWAN sequences are discussed. Follow-up attested complete recanalization after anticoagulation.
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Affiliation(s)
- Boukobza Monique
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 46 rue Henri Huchard, 75018, France.
| | - Calvez Sandra
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | | | - Laissy Jean-Pierre
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; University Paris 7, Bichat Hospital, Paris, France
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Agarwal N, Zuccoli G, Murdoch G, Jankowitz BT, Greene S. Developmental venous anomaly presenting as a spontaneous intraparenchymal hematoma without thrombosis. Neuroradiol J 2016; 29:465-469. [PMID: 27613246 DOI: 10.1177/1971400916665387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Developmental venous anomalies (DVAs) are cited as the most common cerebral vascular malformations. Still, intracerebral hematomas are rarely thought to be caused by DVAs. In this report, the authors present a unique case of a DVA that hemorrhaged spontaneously, rather than hemorrhaging into a venous infarction following DVA thrombosis as has been more commonly reported. CLINICAL PRESENTATION A 22-year-old previously healthy male presented to the emergency department with a severe headache, confusion, and progressive hemiparesis. A computed tomography (CT) scan demonstrated a spontaneous left parietal intraparenchymal hemorrhage (IPH), with intraventricular extension and acute hydrocephalus. CT angiography did not demonstrate an underlying vascular malformation. The patient was taken emergently to the operating room for a left parietal craniotomy for evacuation of the hematoma. Intraoperative pathology was consistent with a DVA Postoperative magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and magnetic resonance venography (MRV) did not demonstrate a mass lesion, ischemic stroke, or underlying vascular malformation. An MRI obtained three years previously for headaches was normal. A postoperative diagnostic cerebral angiogram was normal. An MRI/MRA performed six months postoperatively demonstrated two foci of abnormal vessels on susceptibility-weighted imaging (SWI), suggesting the presence of a venous vascular malformation. A diagnostic cerebral angiogram obtained six months postoperatively was again normal, including delayed imaging. CONCLUSION Few reports have cited DVA as the sole cause of intracerebral hemorrhage. While very rare, these reports suggest hemorrhagic conversion of a venous infarction secondary to a thrombosed DVA as a possible etiology, and several provide imaging consistent with this diagnosis. This case study demonstrates a unique presentation of a hemorrhagic DVA in the absence of thrombosis or stroke.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, USA
| | - Giulio Zuccoli
- Department of Radiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, USA
| | - Geoffrey Murdoch
- Department of Pathology, University of Pittsburgh Medical Center, USA
| | - Brian T Jankowitz
- Department of Neurological Surgery, University of Pittsburgh Medical Center, USA
| | - Stephanie Greene
- Department of Neurological Surgery, University of Pittsburgh Medical Center, USA
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Amuluru K, Al-Mufti F, Hannaford S, Singh IP, Prestigiacomo CJ, Gandhi CD. Symptomatic Infratentorial Thrombosed Developmental Venous Anomaly: Case Report and Review of the Literature. INTERVENTIONAL NEUROLOGY 2016; 4:130-7. [PMID: 27051409 DOI: 10.1159/000444028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Developmental venous anomalies (DVAs) are variations of normal transmedullary veins draining white and gray matter. In the vast majority of cases, DVAs are diagnosed incidentally and should be considered as benign entities. In extremely rare circumstances, DVAs may become symptomatic due to mechanical or flow-related etiologies. Thrombosis of the collector vein of a DVA is a rare type of a flow-related complication with only 29 cases reported in the literature, the majority of which are supratentorial. Infratentorial thrombosed DVAs are thus extremely rare and the few cases reported have typically caused symptoms due to venous ischemic infarctions. SUMMARY We report a case of an infratentorial DVA with a thrombosed drainage vein in a patient with nonhemorrhagic, noninfarcted venous congestive edema, which was successfully treated with high-dose glucocorticoids and short-term anticoagulation. We review the pertinent venous anatomy of the posterior fossa as well as the literature of symptomatic infratentorial thrombosed DVAs. KEY MESSAGE The presented case of an infratentorial thrombosed DVA with cerebellar and pontine venous congestive edema is extremely rare. A working knowledge of posterior fossa venous anatomy and possible pathomechanisms responsible for the rarely symptomatic lesion will aid in the timely and efficacious treatment of such lesions.
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Affiliation(s)
- Krishna Amuluru
- Departments of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA
| | - Fawaz Al-Mufti
- Departments of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA
| | - Stephen Hannaford
- Departments of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA
| | - Inder Paul Singh
- Departments of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA; Departments of Neurology, Rutgers University School of Medicine, Newark, N.J., USA
| | - Charles J Prestigiacomo
- Departments of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA; Departments of Neurology, Rutgers University School of Medicine, Newark, N.J., USA; Departments of Radiology, Rutgers University School of Medicine, Newark, N.J., USA
| | - Chirag D Gandhi
- Departments of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA; Departments of Neurology, Rutgers University School of Medicine, Newark, N.J., USA; Departments of Radiology, Rutgers University School of Medicine, Newark, N.J., USA
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Surgical Cavernous Malformations and Venous Anomalies. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Patel VJ, Lall RR, Desai S, Mohanty A. Spontaneous Thrombosis and Subsequent Recanalization of a Developmental Venous Anomaly. Cureus 2015; 7:e334. [PMID: 26543692 PMCID: PMC4627833 DOI: 10.7759/cureus.334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Developmental venous anomalies (DVA) are among the most common congenital malformations of the cerebral angioarchitecture. Spontaneous thrombosis of this entity is rare, and our review of the literature found only 31 reported cases of symptomatic spontaneous thrombosis of developmental venous anomalies. Here, we report a unique case describing the spontaneous thrombosis of a DVA leading to venous infarction and subsequent recanalization. The patient was a previously healthy 21-year-old male who presented with an acute onset of partial seizures. Following negative hypercoagulability studies and along with CT (computed tomography) and MR (magnetic resonance) imaging, the patient was treated with anticoagulant therapy and demonstrated complete functional recovery. Knowledge from our literature review of similar cases combined with the experience gained from this patient’s treatment leads us to suggest that spontaneous DVA thrombosis and venous infarction generally has a good outcome despite initially devastating neurologic deficits. Additionally, the rarity of spontaneous DVA thromboses lends itself to the need to identify possible predisposing risk factors, chief amongst these being hypercoagulopathies.
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Affiliation(s)
- Vishal J Patel
- Division of Neurosurgery, University of Texas Medical Branch at Galveston
| | - Rishi R Lall
- Division of Neurosurgery, University of Texas Medical Branch at Galveston
| | - Sohum Desai
- Division of Neurosurgery, University of Texas Medical Branch at Galveston
| | - Aaron Mohanty
- Division of Neurosurgery, University of Texas Medical Branch at Galveston
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Harrison G, Lunsford LD, Monaco Iii EA. Gamma Knife Stereotactic Radiosurgery for Trigeminal Neuralgia Caused by a Developmental Venous Anomaly. Stereotact Funct Neurosurg 2015; 93:110-113. [PMID: 25721130 DOI: 10.1159/000369562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 11/04/2014] [Indexed: 11/19/2022]
Abstract
Background: Trigeminal neuralgia (TN) is mostly caused by vascular compression of the nerve's root entry zone due to an ectatic artery. Rarer causes include compression from tumors, vascular malformations or multiple sclerosis plaques. Developmental venous anomalies (DVAs) are benign, aberrantly appearing venous structures that drain normal cerebral tissue. DVAs are a rare etiology of TN. The management of TN caused by a DVA is controversial as disruption of the DVA can be catastrophic. Methods: We report a case of a young man with severe medically refractory TN related to a brachium pontis DVA who was successfully treated by gamma knife stereotactic radiosurgery (GKSR) to the trigeminal nerve. Results: Within 2 weeks of GKSR, the patient reported experiencing 60% pain relief; 5 years postoperatively, he remains completely pain free with some mild sensory loss in the V2 and V3 areas. Conclusions: GKSR has an established role in the management of TN. This is the first reported case of using GKSR to treat TN caused by a DVA. In the setting of a DVA, GKSR should be an initial consideration for TN therapy after medical failure because of the high surgical risk related to disrupting the DVA. © 2015 S. Karger AG, Basel.
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Affiliation(s)
- Gillian Harrison
- Department of Neurosurgery, New York University Langone Medical Center, New York, N.Y., USA
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Larvie M, Timerman D, Thum JA. Brain metabolic abnormalities associated with developmental venous anomalies. AJNR Am J Neuroradiol 2014; 36:475-80. [PMID: 25477358 DOI: 10.3174/ajnr.a4172] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Developmental venous anomalies are the most common intracranial vascular malformation and are typically regarded as inconsequential, especially when small. While there are data regarding the prevalence of MR imaging findings associated with developmental venous anomalies, FDG-PET findings have not been well-characterized. MATERIALS AND METHODS Clinical information systems were used to retrospectively identify patients with developmental venous anomalies depicted on MR imaging examinations who had also undergone FDG-PET. Both the MR imaging and FDG-PET scans were analyzed to characterize the developmental venous anomalies and associated findings on the structural and functional scans. Qualitative and quantitative assessments were performed, including evaluation of the size of the developmental venous anomaly, associated MR imaging findings, and characterization of the FDG uptake in the region of the developmental venous anomaly. RESULTS Twenty-five developmental venous anomalies in 22 patients were identified that had been characterized with both MR imaging and FDG-PET, of which 76% (19/25) were associated with significant metabolic abnormality in the adjacent brain parenchyma, most commonly hypometabolism. Patients with moderate and severe hypometabolism were significantly older (moderate: mean age, 65 ± 7.4 years, P = .001; severe: mean age, 61 ± 8.9 years, P = .008) than patients with developmental venous aberrancies that did not have abnormal metabolic activity (none: mean age, 29 ± 14 years). CONCLUSIONS Most (more than three-quarters) developmental venous anomalies in our series of 25 cases were associated with metabolic abnormality in the adjacent brain parenchyma, often in the absence of any other structural abnormality. Consequently, we suggest that developmental venous anomalies may be better regarded as developmental venous aberrancies.
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Affiliation(s)
- M Larvie
- From the Harvard Medical School (M.L.), Boston, Massachusetts Divisions of Neuroradiology and Nuclear Medicine and Molecular Imaging (M.L., D.T., J.A.T.), Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - D Timerman
- Divisions of Neuroradiology and Nuclear Medicine and Molecular Imaging (M.L., D.T., J.A.T.), Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts Division of Health Sciences and Technology (D.T., J.A.T.), Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - J A Thum
- Divisions of Neuroradiology and Nuclear Medicine and Molecular Imaging (M.L., D.T., J.A.T.), Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts Division of Health Sciences and Technology (D.T., J.A.T.), Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts
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