Sample MR imaging–based protocol for brain VM screening in children with HHT (see also Vella et al17)
MR imaging brain with and without contrast |
DWI and ADC: assess for acute ischemia |
ASL: evaluate for asymmetric perfusion that can identify arteriovenous shunting |
FLAIR: sensitive for edema or gliosis related to VMs |
SWI: most sensitive for evidence of hemorrhage or microhemorrhage |
T1-weighted pre and postcontrast: differentiate intrinsic T1 shortening from enhancement |
High-resolution 3D postcontrast: most sensitive sequence for small HHT-related shunting AVMs and nonshunting capillary malformations |
High-resolution 3D T2-weighted: sensitive for edema or gliosis related to VMs |
MRA head |
Obtain TOF images from skull base to vertex (“whole head” MRA) because VMs can occur anywhere in brain parenchyma, not just near the circle of Willis |