An analysis of lesions associated with developmental venous anomalies

Abstract

Objective: The aim of this study was to describe different lesions and features associated with developmental venous anomalies (DVAs).

Methods: The records and magnetic resonance imaging (MRI) images of 1,722 patients who underwent cranial MRI between 2010 and 2017 were retrospectively reviewed. It was found that 124 (7.2%) patients had DVAs, and 48 of these patients (38.7%) had additional anomalies accompanying DVAs. Of the patients with DVAs, 25 were female and 23 were male, with a mean age of 39.3 years (range, 3-77 years). MRI was performed in all the patients.

Results: In addition to DVAs, cavernomas were present in 30 patients (62.5%), haematomas in 7 (14.5%), gliosis in 6 (12.5%), demyelinating plaques in 4 (8.3%) and a glioblastoma in 1 (2.2%). The mean diameter of the DVAs was 1.1mm and the mean diameter of the lesions was 17.4mm. The susceptibility weighted imaging (SWI) sequence was also applied to 12 patients with cavernomas. The relevant sequence in all of these patients contributed to the diagnosis.

Conclusion: Our study shows that DVAs can accompany a wide spectrum of lesions, especially cavernomas. Although their pathophysiology has not yet been clearly established, these lesions may have a common aetiology.

Keywords: Cavernoma; Developmental venous anomaly; Magnetic resonance imaging.

Figure 1

Fluid-attenuated inversion recovery (FLAIR) (a) and susceptibility weighted imaging (SWI) (b) sequences showing a developmental venous anomaly (DVA) (dashed arrow) and an associated cavernoma (arrow) in the left supratentorial frontal lobe. Dynamic contrast enhanced (c) and maximum intensity projection (MIP) (d) magnetic resonance (MR) venography images clearly revealing the DVA (dashed arrow) draining into the superior sagittal sinus.

Figure 2

Conventional (a–c) and susceptibility weighted imaging (SWI) (f–g) magnetic resonance imaging (MRI) sequences showing haemorrhagic signal intensities (asterisk) in the left putamen. Dynamic contrast-enhanced (d) and maximum intensity projection (MIP) MR venography (h) images clearly revealing a developmental venous anomaly (DVA) (arrow) draining into the cisternal venous system. Post-contrast dynamic susceptibility contrast (DSC) T2-weighted perfusion (e) MRI sequence (rCBV) revealing putaminal hyperperfusion.

Figure 3

Pre-contrast conventional (a–c) magnetic resonance imaging (MRI) sequences showing a gliotic focus (asterisk) in left centrum semiovale level. Post-contrast axial (d) and coronal (e) T1-weighted and susceptibility weighted imaging (SWI) (f) sequences showing a developmental venous anomaly (DVA) (arrow) extending into gliosis. On post-contrast DSC T2-weighted perfusion MRI (g and h), the rCBF map reveals hypoperfusion at lesion level. The mean transit time (MTT) map reveals a longer transition time (square brackets).

Figure 4

Axial fluid-attenuated inversion recovery (FLAIR) (a) and sagittal T2-weighted (b) magnetic resonance imaging (MRI) sequences demonstrating multiple demyelinating white matter lesions (dashed arrows) in the periventricular region. Post-contrast axial (c) and sagittal (d) T1-weighted MRI sequences showing a developmental venous anomaly (DVA) (arrow) in the demyelination area.

Figure 5

Pre-contrast axial fluid-attenuated inversion recovery (FLAIR) (a) and T1 (b)-weighted and post-contrast T1 (c–e)-weighted magnetic resonance imaging (MRI) sequences in three planes showing a histopathologically confirmed glioblastoma (asterisk). On MIP MR venography (f), a developmental venous anomaly (DVA) (arrow) is observed to drain into the subependymal venous structure in the central of the lesion.