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Case Reports
. 2020 Mar 24;6(3):20200021.
doi: 10.1259/bjrcr.20200021. eCollection 2020 Sep 1.

Novel use of arterial spin labelling in the imaging of peripheral vascular malformations

Sanjeev Ramachandran  1 , Jonathan Delf  1 , Jocelyn Brookes  2 , William Adair  1 , Harjeet Rayt  1 , Matthew Bown  1 , Neghal Kandiyil  1
Affiliations
Case Reports

Novel use of arterial spin labelling in the imaging of peripheral vascular malformations

Sanjeev Ramachandran et al. BJR Case Rep. .

Abstract

We present a novel use of arterial spin labelling (ASL), a MRI perfusion technique, to assess a high-flow, peripheral vascular malformation (PVM), specifically a large arteriovenous malformation in the left forearm of a 20-year-old female. While there has been experience with ASL in the assessment of intracranial vascular malformations, there has been no known use of ASL in the evaluation of PVMs. We also discuss the potential benefits and limitations of ASL in the imaging of PVMs. The promising results from this case warrant further research on ASL in the investigation of PVMs.

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Figures

Figure 1.
Figure 1.
Axial STIR demonstrating a large AVM measuring 8 × 6 × 20 cm in the flexor compartment of the left forearm, extending from proximal to the elbow joint to the distal forearm. This was surrounded by a large volume of connective tissue. No intraosseous involvement is demonstrated. AVM, arteriovenous malformation; STIR, short-tau inversion recovery.
Figure 2.
Figure 2.
Coronal 3D time-resolved gadolinium enhanced MR angiography (TWIST) demonstrating the presence of an AVM with avid contrast enhancement. The brachial artery is dilated and there are large venous lakes and dilated draining veins are noted in the arm. 3D, three-dimensional; AVM, arteriovenous malformation.
Figure 3.
Figure 3.
Axial ASL images. (a) RBG image demonstrates perfusion characteristics of labelled inflowing arterial blood, with higher flow indicated by red followed by yellow and green, and no flow indicated by blue. (b) Black/white image presents perfusion with signal intensity proportional to blood flow. Together, these confirm the presence of a high-flow lesion with a focus of maximal flow suggestive of the nidus (white arrows). ASL, arterial spin labelling.
Figure 4.
Figure 4.
Comparison between coronal TWIST MR angiography (a) and coronal ASL (b) images in approximately the same anatomical plane. A focus of maximal flow identified on ASL correlated with a cluster of vessels demonstrating maximal signal intensity on MR angiography (white arrows), indicative of the nidus. ASL, arterial spin labelling.
See this image and copyright information in PMC

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