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Research ArticleBrain

Hemodynamic Effects of Developmental Venous Anomalies with and without Cavernous Malformations

A. Sharma, G.J. Zipfel, C. Hildebolt and C.P. Derdeyn
American Journal of Neuroradiology September 2013, 34 (9) 1746-1751; DOI: https://doi.org/10.3174/ajnr.A3516
A. Sharma
aFrom the Mallinckrodt Institute of Radiology (A.S., G.J.Z., C.H., C.P.D.)
cDepartment of Radiology (A.S., G.J.Z., C.P.D.), Barnes-Jewish Hospital South, St. Louis, Missouri
dDepartment of Radiology (A.S., G.J.Z., C.P.D.), Saint Louis Children's Hospital, St. Louis, Missouri.
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G.J. Zipfel
aFrom the Mallinckrodt Institute of Radiology (A.S., G.J.Z., C.H., C.P.D.)
bDepartments of Neurology and Neurologic Surgery (G.J.Z., C.P.D.), Washington University School of Medicine, St. Louis, Missouri
cDepartment of Radiology (A.S., G.J.Z., C.P.D.), Barnes-Jewish Hospital South, St. Louis, Missouri
dDepartment of Radiology (A.S., G.J.Z., C.P.D.), Saint Louis Children's Hospital, St. Louis, Missouri.
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C. Hildebolt
aFrom the Mallinckrodt Institute of Radiology (A.S., G.J.Z., C.H., C.P.D.)
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C.P. Derdeyn
aFrom the Mallinckrodt Institute of Radiology (A.S., G.J.Z., C.H., C.P.D.)
bDepartments of Neurology and Neurologic Surgery (G.J.Z., C.P.D.), Washington University School of Medicine, St. Louis, Missouri
cDepartment of Radiology (A.S., G.J.Z., C.P.D.), Barnes-Jewish Hospital South, St. Louis, Missouri
dDepartment of Radiology (A.S., G.J.Z., C.P.D.), Saint Louis Children's Hospital, St. Louis, Missouri.
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    Fig 1.

    Axial contrast-enhanced T1-weighted (A) and susceptibility-weighted (B) images demonstrate a small developmental venous anomaly (arrows) in the right basal ganglia with a cavernous malformation in the right caudate head (B). Corresponding cerebral blood volume map shows a wide zone of higher cerebral blood volume (indicated by green on this color map) in the brain around the DVA. Note that the elevation of CBV is not restricted to the location of the individual venous channels of the DVA (arrows) but involves a wider confluent zone of brain around the draining vein. Note placement of regions of interest to get the objective parameters for quantification of perfusion around DVAs (C) and for brain with normal venous drainage (D).

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    Fig 2.

    Ninety-five percent mean diamond plots for rCBV (A), rCBF (B), and rMTT (C) for patients with and without cavernous malformations. The horizontal line is the grand mean. The heights of the diamonds represent the 95% confidence intervals, and the widths of the diamonds are proportional to the sample sizes. If the overlap line of one diamond is closer to the mean of another diamond than is the overlap line of that diamond, there is no difference between the groups.

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    Fig 3.

    Axial contrast-enhanced T1-weighted image (A) demonstrates tributaries of the DVA in the right lentiform nucleus, seen as punctate enhancing foci. Corresponding rCBV (B), rCBF (C), and rMTT (D) maps demonstrate a zone of perfusion alteration around these tributaries incorporating otherwise normal-appearing brain tissue. Note that in this case, the alteration in rCBV and rMTT maps was more pronounced relative to the rCBF.

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    Table 1:

    Descriptive statistics for relative perfusion parameters for brain parenchyma drained by DVAs and for control regions with normal venous drainage

    Perfusion ParameteraMean95% CIMedianMinimumMaximumP Valueb
    rCBV3.262.61–3.912.981.396.61.04
    rCBF2.091.75–2.432.000.794.43.19
    rMTT1.461.32–1.591.441.002.14.15
    cCBV1.000.98–1.020.990.891.06.15
    cCBF1.010.98–1.041.000.941.27<.01
    cMTT1.000.98–1.021.000.911.15.11
    • ↵a rCBV, rCBF, and rMTT represent relative cerebral blood volume, relative cerebral blood flow, and relative mean transit time respectively, for brain tissue around the DVA. cCBV, cCBF, and cMTT represent corresponding control values as measured in brain tissue with normal venous drainage (ipsilateral to the DVA).

    • ↵b P value for Shapiro-Wilk W-test for data distribution normality. A value < .05 indicates a non-normal distribution.

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    Table 2:

    Descriptive statistics for perfusion parameters in DVAs without and with CMs

    Perfusion ParameteraCMMean95% CIMedianMinimumMaximumP Valueb
    rCBV−3.322.45–4.202.981.396.61.16
    +3.172.01–4.342.831.415.92.24
    rCBF−2.281.85–2.702.211.094.43.07
    +1.821.20–2.431.810.793.47.60
    rMTT−1.291.19–1.401.321.001.62.67
    +1.701.46–1.931.751.172.14.62
    cCBV−1.010.99–1.031.010.941.06.22
    +0.980.95–1.020.980.891.05.85
    cCBF−1.020.98–1.061.010.951.27<.01
    +0.990.96–1.030.980.941.08.33
    cMTT−1.000.97–1.031.000.911.15.35
    +0.990.97–1.020.990.941.05.99
    • Note:— +, present; −, absent.

    • ↵a rCBV, rCBF, and rMTT represent relative cerebral blood volume, relative cerebral blood flow, and relative mean transit time respectively, as measured in brain tissue around the DVA. cCBV, cCBF, and cMTT represent corresponding control values as measured in brain tissue with normal venous drainage (ipsilateral to the DVA).

    • ↵b P value for Shapiro-Wilk W-test for data distribution normality. A value < .05 indicates a non-normal distribution.

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American Journal of Neuroradiology: 34 (9)
American Journal of Neuroradiology
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1 Sep 2013
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Cite this article
A. Sharma, G.J. Zipfel, C. Hildebolt, C.P. Derdeyn
Hemodynamic Effects of Developmental Venous Anomalies with and without Cavernous Malformations
American Journal of Neuroradiology Sep 2013, 34 (9) 1746-1751; DOI: 10.3174/ajnr.A3516

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Hemodynamic Effects of Developmental Venous Anomalies with and without Cavernous Malformations
A. Sharma, G.J. Zipfel, C. Hildebolt, C.P. Derdeyn
American Journal of Neuroradiology Sep 2013, 34 (9) 1746-1751; DOI: 10.3174/ajnr.A3516
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