Author:
Thomas J. Ward
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NECT |
CECT |
MRI - T1 |
MRI - T2 |
MRI - T1 post-contrast |
Digital Subtraction Angiography |
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Cerebral Arteriovenous Malformation (AVM) |
mostly present as an acute bleed, possibly as calcifications
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strong enhancement, dilated vesels
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hemorrhage, flow voids, feeding artery, nidus, and draining vein
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hemorrhage, flow voids, feeding artery, nidus, and draining vein
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strong enhancement, feeding artery, nidus, and draining vein
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dilated feeding artery, nidus (possibly compressed by hematoma), and early draining vein
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Arteriovenous Fistula |
dilated vascular channels, possibly with calcifications
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tortuous vessel, often to dural sinus
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flow voids, possibly with thrombosed dural sinus
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flow voids, possivly with thrombosed dural sinus or hyperintense adjacent brain
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reformatted MRA demonstrates dilated tortuous vessel draining into sinus without nidus
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fistula between branch of ECA and dural sinus is most common, may see outflow stenosis
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Developmental Venous Anomaly |
often see dilated vein, may only see calcification
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enlarged drainaing vein, no nidus
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possibly normal, possibly with flow void
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possibly with flow void, blood products
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dilated vein drains into dural sinus/ependymal vein
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usually normal on arterial and capillary phase with dilated draining vein, "Medusa Head" seen on more delayed phase
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Glomus Jugulare |
soft tissue mass expanding jugular foramen
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diffuse enhancement
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intense, possibly with "salt and pepper" appearance related to blood products
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intense, possibly with "salt and pepper" appearance related to blood products
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avid enhancement
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Hypervascular mass with enlarged feeding arteries, rapid, intense tumor blush & early draining veins
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| Hemangioma |
well-defined soft tissue mass
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prominent enhancement
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circumscribed isointense mass
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iso- to hyperintnese circumscribed mass
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avid enhancement
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confirms vascular nature
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| Sturge-Weber |
cerebral volume loss, calcifications
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choroid plexus enlargement (arrow), volume loss
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volume loss
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volume loss, hyperintense signal may be seen in areas of gliosis
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leptomeningeal enhancement
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pial blush, numerous medullary and deep collaterals
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| Aneurysm |
often presents as subarachnoid hemorrhage, may present as calcified mass
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saccular or fusiform vessel dilitation, often multiple aneurysms are identified
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flow voids or heterogeneous signal related to slow flow, possibly thrombus
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typically demonstrate flow voids
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fusiform or saccular vessel dilation, less sensitive than CTA
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Active extravasation is rarely seen, bilateral ICA and vertebral injections need to be performed to evaluate for multiple aneurysms
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