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. 2021 Jul 21:15:697432.
doi: 10.3389/fnins.2021.697432. eCollection 2021.

Presence of Vessel Wall Hyperintensity in Unruptured Arteriovenous Malformations on Vessel Wall Magnetic Resonance Imaging: Pilot Study of AVM Vessel Wall "Enhancement"

Laura B Eisenmenger  1 , Jacqueline C Junn  2 , Daniel Cooke  3 , Steven Hetts  3 , Chengcheng Zhu  4 , Kevin M Johnson  5 , Jesse M Manunga  6 , David Saloner  3 , Christopher Hess  3 , Helen Kim  7
Affiliations

Presence of Vessel Wall Hyperintensity in Unruptured Arteriovenous Malformations on Vessel Wall Magnetic Resonance Imaging: Pilot Study of AVM Vessel Wall "Enhancement"

Laura B Eisenmenger et al. Front Neurosci. .

Abstract

Purpose: High-resolution vessel wall magnetic resonance imaging (VW-MRI) could provide a way to identify high risk arteriovenous malformation (AVM) features. We present the first pilot study of clinically unruptured AVMs evaluated by high-resolution VW-MRI. Methods: A retrospective review of clinically unruptured AVMs with VW-MRI between January 1, 2016 and December 31, 2018 was performed documenting the presence or absence of vessel wall "hyperintensity," or enhancement, within the nidus as well as perivascular enhancement and evidence of old hemorrhage (EOOH). The extent of nidal vessel wall "hyperintensity" was approximated into five groups: 0, 1-25, 26-50, 51-75, and 76-100%. Results: Of the nine cases, eight demonstrated at least some degree of vessel wall nidus "hyperintensity." Of those eight cases, four demonstrated greater than 50% of the nidus with hyperintensity at the vessel wall, and three cases had perivascular enhancement adjacent to nidal vessels. Although none of the subjects had prior clinical hemorrhage/AVM rupture, of the six patients with available susceptibility weighted imaging to assess for remote hemorrhage, only two had subtle siderosis to suggest prior sub-clinical bleeds. Conclusion: Vessel wall "enhancement" occurs in AVMs with no prior clinical rupture. Additional studies are needed to further investigate the implication of these findings.

Keywords: MRI; arteriovenous malformation; unruptured AVM; vessel wall enhancement; vessel wall imaging.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
51-year-old man with a large AVM centered in the right temporoparietal lobe. On pre-contrast VW-MRI (A), no intrinsic T1 hyperintensity is present. On post-contrast VW-MRI (B), there were multiple areas of hyperintensity at the vessel wall within the nidus (yellow arrows).
FIGURE 2
FIGURE 2
63-year-old female with a predominantly left frontal AVM. On pre-contrast VW-MRI (A), no intrinsic T1 hyperintensity is present. On post-contrast VW-MRI (B), there were multiple areas of hyperintensity at the vessel wall as well as perivascular hyperintensity within the nidus (yellow arrows).
FIGURE 3
FIGURE 3
20-year-old female with a right temporoparietal AVM with a small area of sub-clinical evidence of prior hemorrhage on susceptibility-weighted imaging (A, red arrow). On post-contrast VW-MRI (B), there were multiple areas of hyperintensity at the vessel wall (yellow arrows).
See this image and copyright information in PMC

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