Presence of Vessel Wall Hyperintensity in Unruptured Arteriovenous Malformations on Vessel Wall Magnetic Resonance Imaging: Pilot Study of AVM Vessel Wall "Enhancement".

Laura B Eisenmenger,Christopher Hess,Kevin M Johnson,Steven Hetts,Daniel Cooke,Jesse M Manunga,Jacqueline C Junn,Helen Kim,David Saloner,Chengcheng Zhu

doi:10.3389/fnins.2021.697432

Abstract

Purpose: High-resolution vessel wall magnetic resonance imaging (VW-MRI) could provide a way to identify high risk arteriovenous malformation (AVM) features. We present the first pilot study of clinically unruptured AVMs evaluated by high-resolution VW-MRI.Methods: A retrospective review of clinically unruptured AVMs with VW-MRI between January 1, 2016 and December 31, 2018 was performed documenting the presence or absence of vessel wall “hyperintensity,” or enhancement, within the nidus as well as perivascular enhancement and evidence of old hemorrhage (EOOH). The extent of nidal vessel wall “hyperintensity” was approximated into five groups: 0, 1–25, 26–50, 51–75, and 76–100%.Results: Of the nine cases, eight demonstrated at least some degree of vessel wall nidus “hyperintensity.” Of those eight cases, four demonstrated greater than 50% of the nidus with hyperintensity at the vessel wall, and three cases had perivascular enhancement adjacent to nidal vessels. Although none of the subjects had prior clinical hemorrhage/AVM rupture, of the six patients with available susceptibility weighted imaging to assess for remote hemorrhage, only two had subtle siderosis to suggest prior sub-clinical bleeds.Conclusion: Vessel wall “enhancement” occurs in AVMs with no prior clinical rupture. Additional studies are needed to further investigate the implication of these findings.

Highlights

Traditional vascular imaging has been primarily “lumenography,” or imaging techniques that delineate the vascular lumen to study vascular pathology
We present the first pilot study of clinically unruptured arteriovenous malformations (AVMs) evaluated by high-resolution vessel wall magnetic resonance imaging (VW-MRI)
These conventional techniques include digital subtraction angiography (DSA), computed tomography angiography (CTA), and magnetic resonance angiography (MRA) (Mandell and Shroff, 2011; Dieleman et al, 2014; Matouk et al, 2016), focusing attention to the inside of blood vessels; it has long been appreciated that cerebrovascular disease pathogenesis resides, in large part, within the vessel wall

Summary

Introduction

Traditional vascular imaging has been primarily “lumenography,” or imaging techniques that delineate the vascular lumen to study vascular pathology. These conventional techniques include digital subtraction angiography (DSA), computed tomography angiography (CTA), and magnetic resonance angiography (MRA) (Mandell and Shroff, 2011; Dieleman et al, 2014; Matouk et al, 2016), focusing attention to the inside of blood vessels; it has long been appreciated that cerebrovascular disease pathogenesis resides, in large part, within the vessel wall. We present the first pilot study of VW-MRI in clinically unruptured brain AVMs and discuss this method’s promise and limitations when applied to this type of complex vascular malformation

Results

Discussion

Conclusion