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July 01, 2014; 83 (1) NeuroImages

Low-flow vascular malformation

Contribution of sequential postcontrast MRI acquisitions

Olivier Heck, Alexandre Krainik, Kamel Boubagra, Florence Tahon, Arnaud Attye, Jean François Le Bas, Jean Boutonnat, Sylvie Grand
First published June 30, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000544
Olivier Heck
From the Departments of Neuroradiology and MRI (O.H., A.K., K.B., F.T., A.A., J.F.L.B., S.G.), University Hospital of Grenoble; the Department of Diagnostic and Interventional Neuroradiology (O.H.), University Hospital of Nancy; and the Department of Pathology (J.B.), University Hospital of Grenoble, France.
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Alexandre Krainik
From the Departments of Neuroradiology and MRI (O.H., A.K., K.B., F.T., A.A., J.F.L.B., S.G.), University Hospital of Grenoble; the Department of Diagnostic and Interventional Neuroradiology (O.H.), University Hospital of Nancy; and the Department of Pathology (J.B.), University Hospital of Grenoble, France.
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Kamel Boubagra
From the Departments of Neuroradiology and MRI (O.H., A.K., K.B., F.T., A.A., J.F.L.B., S.G.), University Hospital of Grenoble; the Department of Diagnostic and Interventional Neuroradiology (O.H.), University Hospital of Nancy; and the Department of Pathology (J.B.), University Hospital of Grenoble, France.
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Florence Tahon
From the Departments of Neuroradiology and MRI (O.H., A.K., K.B., F.T., A.A., J.F.L.B., S.G.), University Hospital of Grenoble; the Department of Diagnostic and Interventional Neuroradiology (O.H.), University Hospital of Nancy; and the Department of Pathology (J.B.), University Hospital of Grenoble, France.
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Arnaud Attye
From the Departments of Neuroradiology and MRI (O.H., A.K., K.B., F.T., A.A., J.F.L.B., S.G.), University Hospital of Grenoble; the Department of Diagnostic and Interventional Neuroradiology (O.H.), University Hospital of Nancy; and the Department of Pathology (J.B.), University Hospital of Grenoble, France.
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Jean François Le Bas
From the Departments of Neuroradiology and MRI (O.H., A.K., K.B., F.T., A.A., J.F.L.B., S.G.), University Hospital of Grenoble; the Department of Diagnostic and Interventional Neuroradiology (O.H.), University Hospital of Nancy; and the Department of Pathology (J.B.), University Hospital of Grenoble, France.
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Jean Boutonnat
From the Departments of Neuroradiology and MRI (O.H., A.K., K.B., F.T., A.A., J.F.L.B., S.G.), University Hospital of Grenoble; the Department of Diagnostic and Interventional Neuroradiology (O.H.), University Hospital of Nancy; and the Department of Pathology (J.B.), University Hospital of Grenoble, France.
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Sylvie Grand
From the Departments of Neuroradiology and MRI (O.H., A.K., K.B., F.T., A.A., J.F.L.B., S.G.), University Hospital of Grenoble; the Department of Diagnostic and Interventional Neuroradiology (O.H.), University Hospital of Nancy; and the Department of Pathology (J.B.), University Hospital of Grenoble, France.
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Citation
Low-flow vascular malformation
Contribution of sequential postcontrast MRI acquisitions
Olivier Heck, Alexandre Krainik, Kamel Boubagra, Florence Tahon, Arnaud Attye, Jean François Le Bas, Jean Boutonnat, Sylvie Grand
Neurology Jul 2014, 83 (1) 100-101; DOI: 10.1212/WNL.0000000000000544

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A 50-year-old man was referred for subacute intracranial hypertension. MRI revealed a well-circumscribed lesion in the posterior fossa that was hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging (figure 1, A and E). Cerebral blood volume map and sequential postcontrast T1-weighted images showed progressive increase in the homogeneity of the contrast enhancement, indicating that the lesion had low but substantial flow (figure 1, B–D). Digital subtraction angiography showed a vascular lesion with a central to peripheral pattern of vascularity and absence of early venous return (figure 1, F–H). The lesion was resected. Pathologic examination revealed a capillary-venous malformation (figure 2).1,2 This case highlights that MRI can identify low flow in vascular malformations.

Figure 1
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Figure 1 MRI and digital subtraction angiography

T1-weighted imaging (A) and T2-weighted imaging (E). Central high perfusion on the cerebral blood volume map (dynamic susceptibility contrast perfusion) (B), progressive enhancement on T1-weighted imaging immediately after injection (C), and 5 minutes later (D). Progressive vascular filling on digital subtraction angiography: arterial phase (F), intermediate phase (G), and late phase (H).

Figure 2
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Figure 2 Pathologic examination (magnification ×40)

Paraffin-embedded section stained with hematoxylin & eosin–Safran shows large blood vessels with thin walls. Absence of proliferating cells; no expression of GLUT1. This can be defined as capillary-venous malformation according to the International Society for the Study of Vascular Anomalies classification system.

Footnotes

  • Author contributions: Dr. Heck: design and conceptualization of the study, analysis and interpretation of the data, drafting and revising the manuscript for intellectual content. Dr. Krainik: revising the manuscript for intellectual content. Dr. Boubagra: analysis and interpretation of the data. Dr. Tahon: analysis and interpretation of the data. Dr. Attye: revising the manuscript for intellectual content. Dr. Le Bas: revising the manuscript for intellectual content. Dr. Boutonnat: analysis and interpretation of the data. Sylvie Grand: design and conceptualization of the study, analysis and interpretation of the data, drafting and revising the manuscript for intellectual content.

  • Study funding: No targeted funding reported.

  • Disclosure: The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

  • © 2014 American Academy of Neurology

References

  1. 1.↵
    1. Lowe LH,
    2. Marchant TC,
    3. Rivard DC,
    4. et al
    . Vascular malformations: classification and terminology the radiologist needs to know. Semin Roentgenol 2012;47:106–117.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Flors L,
    2. Leiva-Salinas C,
    3. Maged IM,
    4. et al
    . MR imaging of soft-tissue vascular malformations: diagnosis, classification, and therapy follow-up. Radiographics 2011;31:1321–1340.
    OpenUrlCrossRefPubMed
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