Left frontobasal developmental venous anomaly (DVA), case 1

This 21 year old female presented with recurrent headache.
The initial CT examination disclosed a vascular lesion in the left frontal region. For further evaluation a combined MRI-MRA examination was required. It confirmed the vascular character of the lesion but ruled out the possibility of an arteriovenous malformation and provided evidence for the diagnosis of a DVA. No conventional catheter based angiography was performed.

(Supratentorial DVA, 1.5T)
Fig.1 Transverse contrast-enhanced CT images. These images were felt to be suggestive of a vascular malformation in the referring hospital.
Fig.2 Sagittal non-enhanced T1-weighted spin-echo images. A faintly hyperintense area (caput medusae) is seen inferior to the left lateral ventricle (arrows) in conjunction with a signal void from an unusual vascular structure (transcerebral collector) behind (blue arrows).
Fig.3 Transverse proton density fast spin-echo images. The transcerebral collector (prominent uncinate vein?) is now clearly seen anterior to the M-1 segment of the left middle cerebral artery (blue arrow), whereas the caput medusae is seen as a hyperintense area (yellow arrow).
Fig.4 Transverse T2-weighted fast spin-echo and FLAIR images. The same hyperintense area, corresponding to the caput medusae is better appreciated.
Fig.5 Transverse source images from a non-enhanced 2D TOF acquisition (arteries are invisible due to a caudally positioned saturation band). This provides objective evidence for the venous origin of the previously seen vascular structures.
Fig.6 Transverse targeted MIP reconstruction from the non-enhanced 2D TOF data set. Same information as Fig.5.
Fig.7 Sagittal and coronal targeted MIP reconstructions from the non-enhanced 2D TOF data set. Same information as Fig.5 and 6, however, here the characteristic components of the DVA are more easily recognized. The DVA drains into the cavernous sinus through the uncinate vein.
Fig.8 Transverse source images from a Gadolinium-enhanced multi-slab 3D TOF acquisition. Excellent visualization of both the caput medusae and the transcerebral collector due the superior spatial resolution of this technique.
Fig.9 Transverse collapsed and targeted MIP reconstructions from the Gadolinium-enhanced multi-slab 3D TOF data set. This example demonstrates the importance of skilled post-processing. The DVA is practically invisible on the collapsed MIP image (above) due to superimposition of other vascular structures.
Fig.10 Coronal collapsed and targeted MIP reconstructions from the Gadolinium-enhanced multi-slab 3D TOF data set. Same observations as Fig.9.
Fig.11 Sagittal collapsed and targeted MIP reconstructions from the Gadolinium-enhanced multi-slab 3D TOF data set. Same observations as Fig. 9 and 10.
Fig.12 Coronal and sagittal 2D PC images (Venc: 5 cm/s, slice thickness: 25 mm). These are very rapid MRA sequences (less than 1 minute) however, image quality is significantly inferior to that obtained by either previously used TOF technique.

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