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Susceptibility-weighted angiography for the detection of high-flow intracranial vascular lesions: preliminary study

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Abstract

Objectives

Susceptibility-weighted magnetic resonance imaging (MRI) sequences may demonstrate various signal intensities of draining veins in cases of high-flow vascular malformation (HFVM), including arteriovenous malformation (AVM) and dural arteriovenous fistula (dAVF). Our objective was to evaluate susceptibility-weighted angiography (SWAN) for the detection of HFVM.

Methods

Fifty-eight consecutive patients with a suspected intracranial vascular malformation were explored with SWAN and post-contrast MRI sequences at 3 T. The diagnosis of slow-flow vascular malformation (SFVM), including developmental venous anomaly (DVA) or brain capillary telangiectasia (BCT), was based on MRI. Patients with suspected HFVM underwent digital subtraction angiography (DSA). SWAN images were analysed by three blinded readers according to a three-point scale of the venous signal.

Results

Thirty-one patients presented 35 SFVM (26 DVA and 9 BCT) that systematically appeared hypointense on SWAN images. In patients with atypical MRI findings, DSA revealed one patient with an atypical DVA and 26 patients with HFVM (22 AVM and 4 dAVF). SWAN revealed at least one venous hyperintensity in all patients with HFVM. Agreement between readers was excellent.

Conclusions

SWAN appears reliable for characterising blood flow dynamics in brain veins. In clinical practice, SWAN can routinely rule out HFVM in patients with atypical brain veins.

Key Points

• Susceptibility-weighted angiography (SWAN) offers new perspectives for detecting intracranial vascular malformations.

• SWAN sequence provides non-invasive characterisation of blood flow dynamics.

• SWAN can differentiate between high and slow flowing venous blood.

• SWAN can routinely rule out high-flow vascular malformations.

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Abbreviations

SFVM:

Slow-flow vascular malformation

HFVM:

High-flow vascular malformation

AVM:

Arteriovenous malformation

dAVF:

Dural arteriovenous fistula

DVA:

Developmental venous anomaly

BCT:

Brain capillary telangiectasia

DSA:

Digital subtraction angiography

SWI:

Susceptibility-weighted imaging

SWAN:

Susceptibility-weighted angiography

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Acknowledgements

Cécile Rabrait is an employee of General Electric.

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Authors and Affiliations

  1. Department of Radiology, Hôpital Saint Joseph, Paris, France

    Jérôme Hodel, Antoine Guillonnet, Sophie Gerber & Marc Zins

  2. Department of Neuroradiology, CHRU Roger Salengro, Lille, France

    Jérôme Hodel, Jean-Pierre Pruvo & Xavier Leclerc

  3. Department of Interventional Neuroradiology, Fondation Ophtalmologique Rothschild, Paris, France

    Raphaël Blanc & Silvia Pistocchi

  4. Department of Radiology, Centre Cardiologique du Nord, Saint Denis, France

    Mathieu Rodallec

  5. INSERM, Unité 1018, Villejuif, France

    Rémi Sitta

  6. GE Healthcare, Clinical Science Development Group, Buc, France

    Cécile Rabrait

  7. Department of Neurology, Hôpital Saint Joseph, Paris, France

    Mathieu Zuber

  8. Service de Radiologie, Hôpital Saint Joseph, 186, rue Raymond Losserand, Paris, France

    Jérôme Hodel

Authors
  1. Jérôme Hodel
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  2. Raphaël Blanc
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  4. Antoine Guillonnet
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  5. Sophie Gerber
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  8. Cécile Rabrait
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  10. Jean-Pierre Pruvo
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  12. Xavier Leclerc
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Corresponding author

Correspondence to Jérôme Hodel.

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Hodel, J., Blanc, R., Rodallec, M. et al. Susceptibility-weighted angiography for the detection of high-flow intracranial vascular lesions: preliminary study. Eur Radiol 23, 1122–1130 (2013). https://doi.org/10.1007/s00330-012-2690-0

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  • DOI: https://doi.org/10.1007/s00330-012-2690-0

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