Susceptibility-Weighted Imaging: A New Tool in the Diagnosis and Evaluation of Abnormalities of the Vein of Galen in Children

B.D. Jagadeesan; D.T. Cross; J.E. Delgado Almandoz; C.P. Derdeyn; D.N. Loy; R.C. McKinstry; T.L.S. Benzinger; C.J. Moran

doi:10.3174/ajnr.A3058

Article Figures & Data

Figures

Fig 1.
Images from a 3-year-old child with intracranial hemorrhage in utero and new onset aphasia. A, Sagittal time-of-flight MRA image shows an enlarged vein of Galen with mild prominence of the straight sinus. B, Sagittal reconstruction of an SWI image shows that the vein of Galen is entirely hypointense, suggesting that there is no arteriovenous shunt surgery. C, Lateral projection from the venous phase of a left common carotid artery injection during conventional catheter digital subtraction angiography shows an atypical frontal developmental venous anomaly draining into the vein of Galen.
Fig 2.
Images from a 4-week-old child with seizures. A, Postero anterior projection after left internal carotid artery injection during a DSA study shows an extensive arteriovenous malformation involving the entire left cerebral convexity, draining into the vein of Galen via a unique deep vein that drains the entire hemisphere. B, Postero anterior projection after microcatheter injection of a choroidal branch of the left posterior cerebral artery, showing that, in addition to the large draining vein from the cortical AVM, this malformation also has a fistulous communication with vein of Galen. C, Axial SWI image from the same patient shows hyperintense arterialized blood streaming into the vein of Galen from an enlarged draining vein. The extensive network of hyperintense vessels overlying the cerebral hemisphere corresponds to the large AVM seen on the DSA study. In addition, note the hypointense hemorrhagic blood products in the left parieto-occipital lobe. D, Axial SWI image at a different level also shows the fistulous component of this malformation with high signal intensity arterial blood streaming into the venous sac.
Fig 3.
Images from a 3-month-old child with congestive cardiac failure. A, Sagittal image from a time-of-flight MRA study showing a choroidal-type VGAM with arterial supply from the branches of the anterior cerebral artery and posterior choroidal arteries. There is, however, not much information about the venous drainage pattern from the VGAM. B, Sagittal image from a contrast-enhanced MR angiogram showing multiple venous varices draining the vein of Galen and surrounding the brain stem. C and D, Sagittal reconstructions from SWI studies in the same child clearly show both the arterial feeders and the venous aneurysms associated with this VGAM. Axial maximal intensity projection image (E) and minimum intensity projection image (F) obtained from a postcontrast SWI dataset in the same patient show the hyperintense blood flow in the venous aneurysms around the brain stem (E) and the hypointense passive venous congestion in the deep and cortical veins (F). Note the associated ventriculomegaly in this child.