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Primikiris P, Hadjigeorgiou G, Tsamopoulou M, Biondi A, Iosif C. Review on the current treatment status of vein of Galen malformations and future directions in research and treatment. Expert Rev Med Devices 2021; 18:933-954. [PMID: 34424109 DOI: 10.1080/17434440.2021.1970527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Vein of Galen malformations (VOGMs) represent a rare pathologic entity with often catastrophic natural history. The advances in endovascular treatment in recent years have allowed for a paradigm shift in the treatment and outcome of these high-flow shunts, even though their pathogenetic mechanisms and evolution remain in part obscure. AREAS COVERED The overall management of VOGMs requires a tailored case-to-case approach, starting with in utero detection and reserving endovascular treatment for indicated cases. Lately, the advances in translational research with whole-genome sequencing and the coupling with cellular-level hemodynamics attempt to shed more light in the pathogenesis and evolution of these lesions. At the same time the advances in endovascular techniques allow for more safety and tailored technical strategy planning. Furthermore, the advances in MRI techniques allow a better understanding of their vascular anatomy. In view of these recent advances and by performing a PUBMED literature review of the last 15 years, we attempt a review of the evolutions in the imaging, management, endovascular treatment and understanding of underlying mechanisms for VOGMs. EXPERT OPINION The progress in the fields detailed in this review appears very promising in better understanding VOGMs and expanding the available therapeutic arsenal.
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Affiliation(s)
- Panagiotis Primikiris
- Department of Interventional Neuroradiology, Jean Minjoz University Hospital, Besancon, France
| | | | - Maria Tsamopoulou
- School of Medicine, National Kapodistrian University of Athens, Greece
| | - Alessandra Biondi
- Department of Interventional Neuroradiology, Jean Minjoz University Hospital, Besancon, France
| | - Christina Iosif
- School of Medicine, European University of Cyprus, Nicosia, Cyprus.,Department of Interventional Neuroradiology, Henry Dunant Hospital, Athens, Greece
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Kortman H, Navaei E, Raybaud CA, Bhatia KD, Shroff M, terBrugge K, Armstrong D, Pereira VM, Dirks PB, Krings T, Muthusami P. Deep venous communication in vein of Galen malformations: incidence, Imaging, and Implications for treatment. J Neurointerv Surg 2020; 13:290-293. [PMID: 32546638 DOI: 10.1136/neurintsurg-2020-016224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Failure to appreciate deep venous drainage pathways is a major cause of severe complications in the endovascular treatment of vein of Galen aneurysmal malformations (VOGMs). OBJECTIVE To report deep venous drainage patterns in patients with VOGM, emphasizing the internal cerebral veins, and to describe the challenges in evaluating these. METHODS Patients with VOGM presenting to our institute between 2000 and 2018 were retrospectively analyzed. Patients with complete and good quality imaging datasets were included in the study. Three neuroradiologists with expertise in the subject independently analyzed the deep venous drainage patterns on multi-sequence MRI and digital subtraction angiography. Follow-up imaging studies were analyzed for alterations in deep venous drainage patterns that occurred following endovascular treatment. Descriptive statistics were used to report findings. RESULTS Twenty-three patients had optimal quality MRI imaging and 25 had optimal quality DSA imaging available. In 14/23 (61%) patients, internal cerebral vein (ICV) communication could be reliably identified on MRI and in 8/25 (32%) patients on DSA. Deep venous communication with the VOGM was demonstrated in 8/26 (30.8%) patients. One (3.8%) patient demonstrated ICV communication with the VOGM only on postoperative imaging, while in 2 (8%) patients the ICV drainage route changed from VOGM to alternative pathways after the procedure. Other variant pathways included lateral mesencephalic vein, superior or inferior sagittal sinus, anterior mesencephalic vein, tentorial sinus, deep Sylvian vein, and superior vermian vein. CONCLUSION ICV communication with the VOGM is not uncommon and requires dedicated preprocedural imaging to identify it. However, there are significant challenges in assessing this communication in the presence of high-flow fistulae, vessel tortuosity and size, and contrast limitations in this population.
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Affiliation(s)
- Hans Kortman
- Department of Radiology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Ershad Navaei
- Department of Image Guided Therapy, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Charles A Raybaud
- Department of Image Guided Therapy, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kartik Dev Bhatia
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Manohar Shroff
- Department of Image Guided Therapy, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karel terBrugge
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Derek Armstrong
- Department of Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Peter B Dirks
- Department of Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Prakash Muthusami
- Department of Image Guided Therapy, Hospital for Sick Children, Toronto, Ontario, Canada
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El Mekabaty A, Pearl MS, Mershon B, Berkowitz I, Gailloud P, Huisman TAGM. Susceptibility weighted imaging in infants with staged embolization of vein of Galen aneurysmal malformations. J Neuroradiol 2018; 46:214-221. [PMID: 30423378 DOI: 10.1016/j.neurad.2018.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 05/07/2018] [Accepted: 09/24/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE The vein of Galen aneurysmal malformation (VGAM) is a rare congenital vascular malformation with a higher morbidity and mortality, especially in neonates. Ultrasound, CT and MR are usually used in diagnosis and treatment monitoring of these disorders. In this current study, we aim to examine utility of SWI in evaluation of treatment response in infants with VGAM. MATERIALS AND METHODS We performed a retrospective chart analysis of children with VGAM in our institution between January 2008 and December 2016. Inclusion criteria included; confirmed VGAM on DSA; available SWI sequence at baseline and at follow up after at least a single embolization session; age at initial MR of 18 years or younger. Signal intensity and Angioarchitecture of VGAM and cerebral veins on SWI, as well as hydrocephalus and clinical outcome were evaluated. RESULTS Of 11 patients identified with VGAM in our institution, 5 children (3 males and 2 females) satisfied the inclusion criteria. The average age at initial MR was 29 days (range 1-120). Fourteen MRI were available for review. All children had VGAM of mural type. Intramedullary veins were dilated and SWI-hypointense in all children, while subependymal and sulcal veins were dilated and SWI-hypointense in 4 patients on initial MRI. On the first available follow up MRI, cerebral veins have mostly normalized in 4 children and remained mostly dilated and SWI-hypointense in 1 child; even after complete treatment of the VGAM. CONCLUSION Our preliminary findings show that SWI seems to offer a beneficial non-invasive tool in evaluating passive venous congestion patterns in pediatric patients with VGAM. It remains to be determined in larger studies, the clinical significance of these SWI changes.
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Affiliation(s)
- Amgad El Mekabaty
- Division of Interventional Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns-Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Monica S Pearl
- Division of Interventional Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns-Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bommy Mershon
- Department of Anesthesiology and Critical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ivor Berkowitz
- Department of Anesthesiology and Critical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Philippe Gailloud
- Division of Interventional Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns-Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thierry A G M Huisman
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns-Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Dürr NR, Brinjikji W, Pohrt A, Lanfermann H, Brassel F, Meila D. Non-enhanced MR imaging for preinterventional assessment of the angioarchitecture in vein of Galen malformations. J Neurointerv Surg 2018; 10:999-1004. [PMID: 29436506 DOI: 10.1136/neurintsurg-2017-013611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular treatment of vein of Galen malformations (VGMs) requires sufficient preceding MR imaging. Standardized, preinterventional, non-invasive imaging has not been established. Our study is the first to examine the role of a dedicated, standardized, non-invasive imaging protocol in the evaluation of VGM angioarchitecture by non-contrast MRI/MR angiography. MATERIALS AND METHODS We retrospectively evaluated a consecutive series of VGM patients who underwent a 1.5 T MRI protocol, including standard T2 weighted images (T2WI), arterial time of flight (TOF), and thin T2WI without flow compensation (T2OffPh). The primary outcome was the proportion of patients in whom VGM subtypes and all arterial feeders (anterior (AChA) and posterior (PChA) choroidal arteries, pericallosal arteries, basilar tip, and leptomeningeal supply) could be accurately identified compared with a DSA gold standard. RESULTS A total of 26 VGM patients who underwent 108 studies were used in the statistical analysis. VGM subtype was best seen in axial T2OffPh (92.1%) and TOF (89.8%). AChA feeders were best seen in TOF (86.5%) and axial T2OffPh (72.2%). PChA feeders were best seen in TOF (95.1%) and axial T2OffPh (88.1%). Pericallosal feeders were best seen in axial T2OffPh (95.4%) and TOF (95.1%). Basilar tip feeders were best seen in TOF (90.6%) and axial T2OffPh (88.4%). CONCLUSION VGM angioarchitecture is best seen in TOF and axial T2OffPh. It can be used as an alternative to global angiographic series.
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Affiliation(s)
- Nikola Reinhard Dürr
- Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Zu den Rehwiesen, Duisburg, Germany
| | - Waleed Brinjikji
- Department of Radiology and Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anne Pohrt
- Federal Institute for Occupational Safety and Health, Berlin, Germany
| | - Henrich Lanfermann
- Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany
| | - Friedhelm Brassel
- Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Zu den Rehwiesen, Duisburg, Germany
| | - Dan Meila
- Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany.,Department of Interventional Neuroradiology, Johanna-Etienne-Krankenhaus Neuss, Neuss, Germany
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Wu CX, Ma L, Chen XZ, Chen XL, Chen Y, Zhao YL, Hess C, Kim H, Jin HW, Ma J. Evaluation of Angioarchitectural Features of Unruptured Brain Arteriovenous Malformation by Susceptibility Weighted Imaging. World Neurosurg 2018; 116:e1015-e1022. [PMID: 29859363 DOI: 10.1016/j.wneu.2018.05.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES A precise assessment of angioarchitectural characteristics using noninvasive imaging is helpful for serial follow-up and weighting risk of natural history in unruptured brain arteriovenous malformation (bAVM). This study aimed to test the hypothesis that susceptibility weighted imaging (SWI) would provide an accurate evaluation of angioarchitectural features of unruptured bAVM. METHODS A total of 81 consecutive patients with unruptured bAVM were examined. Image quality of SWI for the assessment of bAVM angioarchitectural features was determined by a 5-point scale. The accuracy of SWI for detection of angioarchitectural features was evaluated using digital subtraction angiography as a standard reference and further compared among unruptured bAVMs with or without silent intralesional microhemorrhage on SWI to examine the potential confounding effect of microhemorrhage on image analysis. RESULTS All lesions were identified on SWI. Image quality of SWI was judged to be at least adequate for diagnosis (range, 3-5) in all patients by both readers. Using digital subtraction angiography as a reference standard, the area under the receiver operating curve of detection of deep or posterior fossa location, exclusively deep venous drainage, venous ectasia, venous varices, and the presence of associated aneurysm on SWI was 1, 0.93, 0.94, 0.95, and 0.83, respectively. Silent intralesional microhemorrhage were detected in 39 patients (48.15%) on SWI and no significant difference (P > 0.05) was found in angioarchitectural features between patients with and without silent microhemorrhage. CONCLUSIONS SWI might be a noninvasive alternative technique for angiography in the angioarchitectural assessment of unruptured bAVM.
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Affiliation(s)
- Chun-Xue Wu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, People's Republic of China
| | - Li Ma
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Xu-Zhu Chen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, People's Republic of China
| | - Xiao-Lin Chen
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Yu Chen
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Yuan-Li Zhao
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China; Stroke Center, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China
| | - Christopher Hess
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
| | - Helen Kim
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
| | - Heng-Wei Jin
- Interventional Neuroradiology Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, People's Republic of China
| | - Jun Ma
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, People's Republic of China.
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Winkler O, Brinjikji W, Lanfermann H, Brassel F, Meila D. Anatomy of the deep venous system in vein of Galen malformation and its changes after endovascular treatment depicted by magnetic resonance venography. J Neurointerv Surg 2018; 11:84-89. [PMID: 29794159 DOI: 10.1136/neurintsurg-2018-013789] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/20/2018] [Accepted: 05/01/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE It is classically thought that the internal cerebral veins (ICV) do not communicate with the venous pouch of vein of Galen malformations (VGM). We report on the anatomy of the deep venous system in VGM with special emphasis on the drainage of the ICV and possible changes after endovascular treatment. MATERIALS AND METHODS We retrospectively analyzed DSA and 2D time-of-flight MR venograms of 55 children with VGM. We evaluated all pre- and post-operative images for the presence of the ICVs and determined their route of venous drainage. RESULTS Of 55 children, pre-operative 2D MRV detected the ICVs in 19 cases (35%) compared with one case (2%) for pre-embolization DSA (2%) (P<0.0001). Of the cases in which the ICVs were seen preoperatively, in 15 cases (78.9%) the ICV drained directly into the VGM while in the other four cases, the ICV used alternative venous drainage routes. On post-operative MRV, the ICVs were seen in 17 cases (31%) on MRV and 10 cases (18.2%) on DSA with drainage into an adult-like vein of Galen in 13 cases (76%), respectively (P=0.08). In four cases normal ICV drainage into the vein of Galen was seen even when the venous sac was closed. In two cases there was a change in ICV drainage from the vein of Galen to the lateral mesencephalic vein. CONCLUSION The communication of the ICV with the VGM is a common phenomenon. Different changes of venous drainage routes do occur after treatment and are best seen on MRV.
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Affiliation(s)
- Olivia Winkler
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Waleed Brinjikji
- Department of Radiology and Neurosurgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Heinrich Lanfermann
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Friedhelm Brassel
- Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany
| | - Dan Meila
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
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Abstract
Susceptibility-weighted imaging (SWI) has become an important imaging sequence in the evaluation of patients with neurovascular disease. In this review, we provide a general overview of the physics of SWI and describe how image contrast is produced with this technique. We provide a general approach and differential diagnosis for 2 commonly encountered radiographic patterns seen with SWI in neurovascular disease. Finally, we discuss specific neurovascular applications of SWI, including its application in acute stroke, vascular malformations, venous thrombosis, and evaluation of cerebral microbleeds.
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Hodel J, Leclerc X, Kalsoum E, Zuber M, Tamazyan R, Benadjaoud MA, Pruvo JP, Piotin M, Baharvahdat H, Zins M, Blanc R. Intracranial Arteriovenous Shunting: Detection with Arterial Spin-Labeling and Susceptibility-Weighted Imaging Combined. AJNR Am J Neuroradiol 2016; 38:71-76. [PMID: 27789452 DOI: 10.3174/ajnr.a4961] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/16/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Arterial spin-labeling and susceptibility-weighted imaging are 2 MR imaging techniques that do not require gadolinium. The study aimed to assess the accuracy of arterial spin-labeling and SWI combined for detecting intracranial arteriovenous shunting in comparison with conventional MR imaging. MATERIALS AND METHODS Ninety-two consecutive patients with a known (n = 24) or suspected arteriovenous shunting (n = 68) underwent digital subtraction angiography and brain MR imaging, including arterial spin-labeling/SWI and conventional angiographic MR imaging (3D TOF, 4D time-resolved, and 3D contrast-enhanced MRA). Arterial spin-labeling/SWI and conventional MR imaging were reviewed separately in a randomized order by 2 blinded radiologists who judged the presence or absence of arteriovenous shunting. The accuracy of arterial spin-labeling/SWI for the detection of arteriovenous shunting was calculated by using the area under receiver operating curve with DSA as reference standard. κ coefficients were computed to determine interobserver and intermodality agreement. RESULTS Of the 92 patients, DSA showed arteriovenous shunting in 63 (arteriovenous malformation in 53 and dural arteriovenous fistula in 10). Interobserver agreement was excellent (κ =0.83-0.95). In 5 patients, arterial spin-labeling/SWI correctly detected arteriovenous shunting, while the conventional angiographic MR imaging did not. Compared with conventional MR imaging, arterial spin-labeling/SWI was significantly more sensitive (0.98 versus 0.90, P = .04) and equally specific (0.97) and showed significantly higher agreement with DSA (κ = 0.95 versus 0.84, P = .01) and higher area under the receiver operating curve (0.97 versus 0.93, P = .02). CONCLUSIONS Our study showed that the combined use of arterial spin-labeling and SWI may be an alternative to contrast-enhanced MRA for the detection of intracranial arteriovenous shunting.
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Affiliation(s)
- J Hodel
- From the Departments of Radiology (J.H., M.Z.) .,Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - X Leclerc
- Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France
| | - E Kalsoum
- Department of Neuroradiology (J.H., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
| | - M Zuber
- From the Departments of Radiology (J.H., M.Z.).,Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France
| | - R Tamazyan
- Neurology (M.Z., R.T.), Saint Joseph Hospital, Paris, France
| | - M A Benadjaoud
- Department of Radiobiology and Epidemiology (M.A.B.), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France
| | - J-P Pruvo
- Department of Neuroradiology (X.L., J.-P. P.), Roger Salengro Hospital, Lille, France
| | - M Piotin
- Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France
| | - H Baharvahdat
- Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France
| | - M Zins
- From the Departments of Radiology (J.H., M.Z.)
| | - R Blanc
- Department of Interventional Neuroradiology (M.P., H.B., R.B.), Rothschild Foundation Hospital, Paris, France
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Di Ieva A, Lam T, Alcaide-Leon P, Bharatha A, Montanera W, Cusimano MD. Magnetic resonance susceptibility weighted imaging in neurosurgery: current applications and future perspectives. J Neurosurg 2015. [PMID: 26207600 DOI: 10.3171/2015.1.jns142349] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Susceptibility weighted imaging (SWI) is a relatively new imaging technique. Its high sensitivity to hemorrhagic components and ability to depict microvasculature by means of susceptibility effects within the veins allow for the accurate detection, grading, and monitoring of brain tumors. This imaging modality can also detect changes in blood flow to monitor stroke recovery and reveal specific subtypes of vascular malformations. In addition, small punctate lesions can be demonstrated with SWI, suggesting diffuse axonal injury, and the location of these lesions can help predict neurological outcome in patients. This imaging technique is also beneficial for applications in functional neurosurgery given its ability to clearly depict and differentiate deep midbrain nuclei and close submillimeter veins, both of which are necessary for presurgical planning of deep brain stimulation. By exploiting the magnetic susceptibilities of substances within the body, such as deoxyhemoglobin, calcium, and iron, SWI can clearly visualize the vasculature and hemorrhagic components even without the use of contrast agents. The high sensitivity of SWI relative to other imaging techniques in showing tumor vasculature and microhemorrhages suggests that it is an effective imaging modality that provides additional information not shown using conventional MRI. Despite SWI's clinical advantages, its implementation in MRI protocols is still far from consistent in clinical usage. To develop a deeper appreciation for SWI, the authors here review the clinical applications in 4 major fields of neurosurgery: neurooncology, vascular neurosurgery, neurotraumatology, and functional neurosurgery. Finally, they address the limitations of and future perspectives on SWI in neurosurgery.
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Affiliation(s)
| | - Timothy Lam
- Division of Neurosurgery, Department of Surgery; and
| | - Paula Alcaide-Leon
- Division of Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Aditya Bharatha
- Division of Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Walter Montanera
- Division of Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
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Nabavizadeh SA, Edgar JC, Vossough A. Utility of susceptibility-weighted imaging and arterial spin perfusion imaging in pediatric brain arteriovenous shunting. Neuroradiology 2014; 56:877-84. [DOI: 10.1007/s00234-014-1408-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/16/2014] [Indexed: 10/25/2022]
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11
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Bosemani T, Poretti A, Huisman TA. Susceptibility-weighted imaging in pediatric neuroimaging. J Magn Reson Imaging 2013; 40:530-44. [DOI: 10.1002/jmri.24410] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 08/22/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- Thangamadhan Bosemani
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Thierry A.G.M. Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins University School of Medicine; Baltimore MD USA
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