Topgraphically associated cavernous angioma and developmental venous anomaly (DVA), case 2

This 16 year old male patient presented with generalized epileptic seizures.
The initial CT examination demonstrated a left frontal intracerebral lesion. At the subsequent MRI examination the lesion was found to be a cavernous angioma. Before surgical excision a complementary MRA examination was also performed, in order to rule out a topographically associated DVA.

Cavernous angioma and DVA, 0.5 T
Fig.1 Coronal T1-weighted gradient-echo image of a frontal cavernous angioma. The typical target-like (high signal intensity center surrounded by a low signal intensity rim) appearance of the cavernous angioma in the left frontal subcortical white matter is well appreciated.
Fig.2 Transverse T2-weighted fast spin-echo image. Same observation as on Fig.1.
Fig.3 Corresponding enlarged transverse T2-weighted fast spin-echo and targeted MIP images, the latter from a Gadolinium-enhanced single-volume 3D TOF acquisition data set. The cavernous angioma remains visible on the MIP image because of the T1 contamination artifact from the short T1 relaxation time methemoglobin content of the center of the lesion. A small topographically associated DVA is also detected, the transcerebral collector leading towards the frontal cortex.
N.B. In the case of this cavernous angioma, surgical removal was considered. The combined pre-operative MRI-MRA evaluation was useful, because it revealed an associated DVA, situated exactly in the same cortical sulcus, which had been elected for the surgical approach. This information is important in avoiding inadvertent coagulation of the transcerebral collector at intervention, potentially leading to venous infarct.

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