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Ma L, Hoz SS, Grossberg JA, Lang MJ, Gross BA. Developmental Venous Anomalies. Neurosurg Clin N Am 2024; 35:355-361. [PMID: 38782528 DOI: 10.1016/j.nec.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Developmental venous anomalies (DVAs) are the most common vascular malformation detected on intracranial cross-sectional imaging. They are generally benign lesions thought to drain normal parenchyma. Spontaneous hemorrhages attributed to DVAs are rare and should be ascribed to associated cerebral cavernous malformations, flow-related shunts, or venous outflow obstruction. Contrast-enhanced MRI, susceptibility-weighted imaging, and high-field MRI are ideal tools for visualizing vessel connectivity and associated lesions. DVAs are not generally considered targets for treatment. Preservation of DVAs is an established practice in the microsurgical or radiosurgical treatment of associated lesions.
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Affiliation(s)
- Li Ma
- Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Samer S Hoz
- Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | | | - Michael J Lang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Bradley A Gross
- Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Piccardo A, Albert NL, Borgwardt L, Fahey FH, Hargrave D, Galldiks N, Jehanno N, Kurch L, Law I, Lim R, Lopci E, Marner L, Morana G, Young Poussaint T, Seghers VJ, Shulkin BL, Warren KE, Traub-Weidinger T, Zucchetta P. Joint EANM/SIOPE/RAPNO practice guidelines/SNMMI procedure standards for imaging of paediatric gliomas using PET with radiolabelled amino acids and [ 18F]FDG: version 1.0. Eur J Nucl Med Mol Imaging 2022; 49:3852-3869. [PMID: 35536420 PMCID: PMC9399211 DOI: 10.1007/s00259-022-05817-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/23/2022] [Indexed: 01/18/2023]
Abstract
Positron emission tomography (PET) has been widely used in paediatric oncology. 2-Deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) is the most commonly used radiopharmaceutical for PET imaging. For oncological brain imaging, different amino acid PET radiopharmaceuticals have been introduced in the last years. The purpose of this document is to provide imaging specialists and clinicians guidelines for indication, acquisition, and interpretation of [18F]FDG and radiolabelled amino acid PET in paediatric patients affected by brain gliomas. There is no high level of evidence for all recommendations suggested in this paper. These recommendations represent instead the consensus opinion of experienced leaders in the field. Further studies are needed to reach evidence-based recommendations for the applications of [18F]FDG and radiolabelled amino acid PET in paediatric neuro-oncology. These recommendations are not intended to be a substitute for national and international legal or regulatory provisions and should be considered in the context of good practice in nuclear medicine. The present guidelines/standards were developed collaboratively by the EANM and SNMMI with the European Society for Paediatric Oncology (SIOPE) Brain Tumour Group and the Response Assessment in Paediatric Neuro-Oncology (RAPNO) working group. They summarize also the views of the Neuroimaging and Oncology and Theranostics Committees of the EANM and reflect recommendations for which the EANM and other societies cannot be held responsible.
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Affiliation(s)
- Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, Italy
| | - Nathalie L Albert
- Department of Nuclear Medicine, University Hospital of LMU Munich, Munich, Germany
| | - Lise Borgwardt
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frederic H Fahey
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Darren Hargrave
- Department of Paediatric Oncology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany
| | - Nina Jehanno
- Department of Nuclear Medicine, Institut Curie Paris, Paris, France
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany.
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Lim
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS-Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Lisbeth Marner
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Giovanni Morana
- Department of Neurosciences, University of Turin, Turin, Italy
| | - Tina Young Poussaint
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Victor J Seghers
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Barry L Shulkin
- Nuclear Medicine Department of Diagnostic Imaging St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Katherine E Warren
- Department of Pediatric Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine - DIMED, University Hospital of Padova, Padua, Italy
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Djekidel M, Alsadi R, Bouhali O, Maaz AUR. Amino Acid PET Imaging with 18F-DOPA in the evaluation of Pediatric Brain Tumors. J Nucl Med Technol 2022; 50:jnmt.121.263050. [PMID: 35440479 DOI: 10.2967/jnmt.121.263050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
Although MRI is the workhorse of brain tumor initial evaluation and follow-up, there is a growing amount of data recommending the incorporation of amino-acid PET imaging at different stages of the management of these patients. Recent nuclear medicine and neuro-oncology clinical practice recommendations support the use of amino-acid imaging in brain tumor imaging. Considering 18F-DOPA is FDA approved for the evaluation of parkinsonian syndromes, it could be used clinically for other valuable clinical indications such as brain tumor evaluations. This value seems to be well established in adults and has growing evidence for its use in pediatrics as well. We offer to present four pediatric brain tumor cases imaged with 18F-DOPA and review the literature.
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Affiliation(s)
- Mehdi Djekidel
- Department of Diagnostic Imaging, Division of Nuclear Medicine and Molecular Imaging, Sidra Medicine, Qatar
| | - Rahaf Alsadi
- Department of Science, Texas A&M University at Qatar
| | | | - Ata Ur Rehman Maaz
- Department of Pediatrics, Division of Hematology Oncology, Sidra Medicine, Qatar
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Lv X, Z. Ghali M, Yu J, Zhao X. Developmental Venous Anomalies and Arteriovenous Malformations Coordinately Drained by the Internal Cerebral Vein: Clues to Pathogenesis. Neurol India 2022; 70:1874-1878. [DOI: 10.4103/0028-3886.359225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Taydas O, Ogul H, Kantarci M. An analysis of lesions associated with developmental venous anomalies. Ann R Coll Surg Engl 2021; 103:768-774. [PMID: 34448641 DOI: 10.1308/rcsann.2021.0121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The aim of this study was to describe different lesions and features associated with developmental venous anomalies (DVAs). METHODS The records and magnetic resonance imaging (MRI) images of 1,722 patients who underwent cranial MRI between 2010 and 2017 were retrospectively reviewed. It was found that 124 (7.2%) patients had DVAs, and 48 of these patients (38.7%) had additional anomalies accompanying DVAs. Of the patients with DVAs, 25 were female and 23 were male, with a mean age of 39.3 years (range, 3-77 years). MRI was performed in all the patients. RESULTS In addition to DVAs, cavernomas were present in 30 patients (62.5%), haematomas in 7 (14.5%), gliosis in 6 (12.5%), demyelinating plaques in 4 (8.3%) and a glioblastoma in 1 (2.2%). The mean diameter of the DVAs was 1.1mm and the mean diameter of the lesions was 17.4mm. The susceptibility weighted imaging (SWI) sequence was also applied to 12 patients with cavernomas. The relevant sequence in all of these patients contributed to the diagnosis. CONCLUSION Our study shows that DVAs can accompany a wide spectrum of lesions, especially cavernomas. Although their pathophysiology has not yet been clearly established, these lesions may have a common aetiology.
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Affiliation(s)
| | - H Ogul
- Duzce University, Duzce, Turkey
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Zhou X, Niu X, Mao Q, Liu Y. High prevalence of developmental venous anomaly in adult patients with midline thalamic diffuse gliomas. J Clin Neurosci 2021; 87:59-65. [PMID: 33863535 DOI: 10.1016/j.jocn.2021.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/15/2021] [Accepted: 02/15/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to assess the prevalence of developmental venous anomaly (DVA) in patients with thalamic glioma. Furthermore, we explored the association between DVA and some important biomarkers, such as IDH1 mutation, and H3K27M mutation. PATIENTS AND METHODS Patients who received tumor resection in West China Hospital between August 2009 and October 2017 were enrolled. Propensity score matching was conducted based on a logistic regression model and 1:1 matching for case and control was used to generate a new cohort from patients with meningioma. Chi-square test, t-test, univariate and multivariate analyses were employed to assess the prevalence of DVA in thalamic glioma and meningioma and to identify risk factors associated with DVA. RESULTS Ninety-nine patients with thalamic glioma were enrolled in the current study (male, n = 54; female, n = 45). The mean age was 42.9 ± 15.3 years old. We identified a higher prevalence of DVA in 99 patients with thalamic glioma when compared with 99 patients with meningioma (18.18% vs. 7.07%), which was slightly lower than the prevalence of DVA in glioma reported in previous studies. Furthermore, the distribution of gender, age, and tumor grade in DVA did not reach statistical significance. Chi-square test, univariate and multivariate analyses showed that IDH1 mutation, ATRX mutation, MGMT promoter methylation, p53 mutation, MMP9, EGFR, and Top II positive expression, TERT mutation, and H3K27M mutation were not associated with the development of DVA in thalamic glioma. CONCLUSION A higher prevalence of DVA was found in thalamic glioma compared with meningioma.
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Affiliation(s)
- Xingwang Zhou
- Department of Neurosurgery, West China Hospital, Chengdu, Sichuan Province, PR China
| | - Xiaodong Niu
- Department of Neurosurgery, West China Hospital, Chengdu, Sichuan Province, PR China
| | - Qing Mao
- Department of Neurosurgery, West China Hospital, Chengdu, Sichuan Province, PR China.
| | - Yanhui Liu
- Department of Neurosurgery, West China Hospital, Chengdu, Sichuan Province, PR China.
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Geraldo AF, Messina SS, Tortora D, Parodi A, Malova M, Morana G, Gandolfo C, D'Amico A, Herkert E, Govaert P, Ramenghi LA, Rossi A, Severino M. Neonatal Developmental Venous Anomalies: Clinicoradiologic Characterization and Follow-Up. AJNR Am J Neuroradiol 2020; 41:2370-2376. [PMID: 33093132 DOI: 10.3174/ajnr.a6829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/06/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although developmental venous anomalies have been frequently studied in adults and occasionally in children, data regarding these entities are scarce in neonates. We aimed to characterize clinical and neuroimaging features of neonatal developmental venous anomalies and to evaluate any association between MR imaging abnormalities in their drainage territory and corresponding angioarchitectural features. MATERIALS AND METHODS We reviewed parenchymal abnormalities and angioarchitectural features of 41 neonates with developmental venous anomalies (20 males; mean corrected age, 39.9 weeks) selected through a radiology report text search from 2135 neonates who underwent brain MR imaging between 2008 and 2019. Fetal and longitudinal MR images were also reviewed. Neurologic outcomes were collected. Statistics were performed using χ2, Fisher exact, Mann-Whitney U, or t tests corrected for multiple comparisons. RESULTS Developmental venous anomalies were detected in 1.9% of neonatal scans. These were complicated by parenchymal/ventricular abnormalities in 15/41 cases (36.6%), improving at last follow-up in 8/10 (80%), with normal neurologic outcome in 9/14 (64.2%). Multiple collectors (P = .008) and larger collector caliber (P < .001) were significantly more frequent in complicated developmental venous anomalies. At a patient level, multiplicity (P = .002) was significantly associated with the presence of ≥1 complicated developmental venous anomaly. Retrospective fetal detection was possible in 3/11 subjects (27.2%). CONCLUSIONS One-third of neonatal developmental venous anomalies may be complicated by parenchymal abnormalities, especially with multiple and larger collectors. Neuroimaging and neurologic outcomes were favorable in most cases, suggesting a benign, self-limited nature of these vascular anomalies. A congenital origin could be confirmed in one-quarter of cases with available fetal MR imaging.
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Affiliation(s)
- A F Geraldo
- From the Neuroradiology Unit (A.F.G.), Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.,Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| | - S S Messina
- Radiology Unit (S.S.M.), Casa di Cura Regina Pacis, Palermo, Italy
| | - D Tortora
- Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| | - A Parodi
- Neonatal Intensive Care Unit (A.P., M.M., L.A.R.)
| | - M Malova
- Neonatal Intensive Care Unit (A.P., M.M., L.A.R.)
| | - G Morana
- Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| | - C Gandolfo
- Interventional Unit (C.G.), IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - A D'Amico
- Dipartimento di Scienze Biomediche Avanzate (A.D.), Universita' Federico II, Napoli, Italy
| | - E Herkert
- Division of Neonatology (E.H., P.G.), Department of Paediatrics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - P Govaert
- Division of Neonatology (E.H., P.G.), Department of Paediatrics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - L A Ramenghi
- Neonatal Intensive Care Unit (A.P., M.M., L.A.R.)
| | - A Rossi
- Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| | - M Severino
- Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
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8
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Roux A, Boddaert N, Grill J, Castel D, Zanello M, Zah-Bi G, Chrétien F, Lefevre E, Ros VD, Zerah M, Puget S, Pallud J, Varlet P. High Prevalence of Developmental Venous Anomaly in Diffuse Intrinsic Pontine Gliomas: A Pediatric Control Study. Neurosurgery 2020; 86:517-523. [PMID: 31342064 DOI: 10.1093/neuros/nyz298] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 03/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND No link has been demonstrated between diffuse intrinsic pontine glioma and developmental venous anomaly in pediatric patients. OBJECTIVE To determine the prevalence of developmental venous anomaly in a pediatric cohort of diffuse intrinsic pontine glioma. METHODS We performed a retrospective cohort study (1998-2017) of consecutive pediatric patients harboring a diffuse intrinsic pontine glioma (experimental set, n = 162) or a craniopharyngioma (control set, n = 142) in a tertiary pediatric neurosurgical center. The inclusion criteria were the following: age <18 yr at diagnosis; histopathological diagnosis of diffuse intrinsic pontine glioma or craniopharyngioma according to the 2016 World Health Organization classification of tumors of the central nervous system; no previous oncological treatment; and available preoperative magnetic resonance imaging performed with similar acquisition protocol. RESULTS We found a significantly higher prevalence of developmental venous anomaly in the experimental set of 162 diffuse intrinsic pontine gliomas (24.1%) than in the control set of 142 craniopharyngiomas (10.6%; P = .001). The prevalence of developmental venous anomalies was not significantly impacted by demographic data (sex, age at diagnosis, and underlying pathological condition), biomolecular analysis (H3-K27M-mutant subgroup, H3.1-K27M-mutant subgroup, and H3.3-K27M-mutant subgroup), or imaging findings (anatomic location, anatomic extension, side, and obstructive hydrocephalus) of the studied diffuse intrinsic pontine gliomas. CONCLUSION We report a higher prevalence of developmental venous anomaly in pediatric diffuse intrinsic pontine glioma patients than in control patients, which suggests a potential underlying common predisposition or a causal relationship that will require deeper investigations.
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Affiliation(s)
- Alexandre Roux
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Inserm UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Nathalie Boddaert
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Paediatric Radiology, Necker Enfants-Malades Hospital, Paris, France.,Inserm UMR 1163, Institut Imagine, Inserm U1000, Paris, France
| | - Jacques Grill
- Department of Pediatric Oncology, Gustave-Roussy, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.,UMR8203 "Vectorologie et Thérapeutiques Anticancéreuses," CNRS, Gustave Roussy, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - David Castel
- Department of Pediatric Oncology, Gustave-Roussy, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.,UMR8203 "Vectorologie et Thérapeutiques Anticancéreuses," CNRS, Gustave Roussy, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Marc Zanello
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Inserm UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Gilles Zah-Bi
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France
| | - Fabrice Chrétien
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Neuropathology, Sainte-Anne Hospital, Paris, France
| | - Etienne Lefevre
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Volodia Dangouloff Ros
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Paediatric Radiology, Necker Enfants-Malades Hospital, Paris, France.,Inserm UMR 1163, Institut Imagine, Inserm U1000, Paris, France
| | - Michel Zerah
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Pediatric Neurosurgery, Necker Enfants-Malades Hospital, Paris, France
| | - Stéphanie Puget
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Pediatric Neurosurgery, Necker Enfants-Malades Hospital, Paris, France
| | - Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Inserm UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Pascale Varlet
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Inserm UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Department of Neuropathology, Sainte-Anne Hospital, Paris, France
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Silva AHD, Wijesinghe H, Lo WB, Walsh AR, Rodrigues D, Solanki GA. Paediatric developmental venous anomalies (DVAs): how often do they bleed and where? Childs Nerv Syst 2020; 36:1435-1443. [PMID: 31900628 DOI: 10.1007/s00381-019-04460-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/28/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Developmental venous anomalies (DVAs) are anomalies of venous drainage and considered a low-flow malformation. Studies evaluating natural history and risk factors for intracranial haemorrhage in the paediatric population are rare. We evaluate clinical and radiological features, risk factors and outcomes of paediatric DVAs. METHODS A retrospective study was conducted over a 10-year period between 2004 and 2014. Medical records, imaging and prospective databases were reviewed. Three-hundred-and-three radiological studies in total were evaluated. RESULTS Fifty-two children (20 boys and 32 girls [median age: 6 years] were identified with DVAs. Their age distribution was as follows: 1.9% neonates (< 1 month), 11.5% infants (1 month to 1 year), 30.8% 1-5 years, 30.8% 5-12 years and 25% 12-16 years. The majority (92.3%) presented with asymptomatic DVAs identified incidentally. Overall, anatomical distribution revealed predilection for frontal region (42.3%) with other common sites being posterior fossa (17.3%) and basal ganglia (13.5%). Temporal (11.5%), parietal (9.6%) and occipital (5.8%) were the remainder. Associated cavernous malformations (CMs) were present in 3/52 (5.8%), and no DVAs were associated with aneurysms or arteriovenous malformations (AVMs). Three patients had more than one DVA. There were three deaths unrelated to DVAs over median follow-up of 3.8 years. Four patients (7.7%) suffered DVA-related intracranial haemorrhage presenting with neurological deficits. The ages of the children with DVA-related haemorrhages were 21 days, 2 years and 6 months, 7 years and 1 month and 11 years and 7 months. Left-sided DVA haemorrhages predominated (3/4, 75%). The relative risk of a cerebellar DVA haemorrhage compared to its supratentorial counterpart was 5.35 (OR 6.8, 95% CI 0.8-58). DISCUSSION DVA-related haemorrhage is sevenfold greater in our paediatric cohort compared to adults and is significantly associated with cerebellar location and cavernous malformations. There were no haemorrhages over a median period of 3.8 years of prospective follow-up.
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Affiliation(s)
- Adikarige H D Silva
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Haren Wijesinghe
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - William B Lo
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - A Richard Walsh
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Desiderio Rodrigues
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Guirish A Solanki
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
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10
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Low-grade astrocytoma in the setting of a developmental venous anomaly. Childs Nerv Syst 2020; 36:1315-1318. [PMID: 31776715 DOI: 10.1007/s00381-019-04426-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
Abstract
Developmental venous anomalies (DVAs) are the most common type of cerebrovascular malformation and are considered benign. There are a few literature studies associating DVA with brain tumors, suggesting a possible underlying predisposition in these patients for tumor neogenesis. We report a 7-year-old female with a complex DVA who developed a low-grade astrocytoma in the opposite hemisphere. With analysis of a comprehensive solid tumor panel and imaging, we describe the possible association of an underlying susceptibility to neoplastic growth in the presence of a vascular malformation.
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11
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Symptomatic developmental venous anomalies. Acta Neurochir (Wien) 2020; 162:1115-1125. [PMID: 31925540 DOI: 10.1007/s00701-020-04213-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
Cerebral developmental venous anomalies (DVAs) are variations of venous vascular anatomy related to an underdevelopment of either the superficial or deep venous emissary system, resulting in a dilated transmedullary vein fed by multiple smaller venous radicles responsible for drainage of normal brain parenchyma. While typically benign and found incidentally on imaging studies, DVAs can rarely be symptomatic. The radiographic appearance of DVAs, as well as their symptomatic manifestations, is diverse. Herein, we will discuss the pathophysiology of symptomatic DVAs while providing illustrative case examples depicting each of their pathogenic mechanisms.
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12
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Kerpel A, Yalon M, Soudack M, Chiang J, Gajjar A, Nichols KE, Patay Z, Shrot S, Hoffmann C. Neuroimaging Findings in Children with Constitutional Mismatch Repair Deficiency Syndrome. AJNR Am J Neuroradiol 2020; 41:904-910. [PMID: 32354708 DOI: 10.3174/ajnr.a6512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/26/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Constitutional mismatch repair deficiency is a hereditary childhood cancer predisposition syndrome characterized by brain tumors and colorectal and hematologic malignancies. Our objective was to describe the neuroimaging findings in patients with constitutional mismatch repair deficiency. MATERIALS AND METHODS This retrospective study included 14 children with genetically confirmed constitutional mismatch repair deficiency who were referred to 2 tertiary pediatric oncology centers. RESULTS Fourteen patients from 11 different families had diagnosed constitutional mismatch repair deficiency. The mean age at presentation was 9.3 years (range, 5-14 years). The most common clinical presentation was brain malignancy, diagnosed in 13 of the 14 patients. The most common brain tumors were glioblastoma (n = 7 patients), anaplastic astrocytoma (n = 3 patients), and diffuse astrocytoma (n = 3 patients). Nonspecific subcortical white matter T2 hyperintensities were noted in 10 patients (71%). Subcortical hyperintensities transformed into overt brain tumors on follow-up imaging in 3 patients. Additional non-neoplastic brain MR imaging findings included developmental venous anomalies in 12 patients (85%) and nontherapy-induced cavernous hemangiomas in 3 patients (21%). CONCLUSIONS On brain MR imaging, these patients have both highly characteristic intra-axial tumors (typically multifocal high-grade gliomas) and nonspecific findings, some of which might represent early stages of neoplastic transformation. The incidence of developmental venous anomalies is high in these patients for unclear reasons. Awareness of these imaging findings, especially in combination, is important to raise the suspicion of constitutional mismatch repair deficiency in routine diagnostic imaging evaluation or surveillance imaging studies of asymptomatic carriers because early identification of the phenotypic "gestalt" might improve outcomes.
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Affiliation(s)
- A Kerpel
- From the Department of Radiology (A.K., M.S., S.S., C.H.), Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel .,Sackler School of Medicine (A.K., M.Y., M.S., S.S., C.H.), Tel Aviv University, Tel Aviv, Israel
| | - M Yalon
- Pediatric Hemato-Oncology (M.Y.), Edmond and Lilly Safra Children's Hospital and Cancer Research Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine (A.K., M.Y., M.S., S.S., C.H.), Tel Aviv University, Tel Aviv, Israel
| | - M Soudack
- From the Department of Radiology (A.K., M.S., S.S., C.H.), Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine (A.K., M.Y., M.S., S.S., C.H.), Tel Aviv University, Tel Aviv, Israel
| | | | - A Gajjar
- Divisions of Neuro-Oncology (A.G.)
| | | | - Z Patay
- Department of Oncology and Section of Neuroimaging, Department of Diagnostic Imaging (Z.P.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - S Shrot
- From the Department of Radiology (A.K., M.S., S.S., C.H.), Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine (A.K., M.Y., M.S., S.S., C.H.), Tel Aviv University, Tel Aviv, Israel
| | - C Hoffmann
- From the Department of Radiology (A.K., M.S., S.S., C.H.), Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine (A.K., M.Y., M.S., S.S., C.H.), Tel Aviv University, Tel Aviv, Israel
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13
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Diestro JDB, Spears J, Marotta TR. Developmental Venous Anomaly Inside a Glioblastoma. JAMA Neurol 2020; 77:127-128. [PMID: 31710346 DOI: 10.1001/jamaneurol.2019.3840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jose Danilo Bengzon Diestro
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Julian Spears
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Thomas R Marotta
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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14
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Reply: "Developmental venous anomaly depicted incidentally in fetal MRI and confirmed in post-natal MRI". Neuroradiology 2018; 61:11-12. [PMID: 30426145 DOI: 10.1007/s00234-018-2132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
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15
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Brinjikji W, Lanzino G. Letter regarding "Developmental venous anomaly depicted incidentally in fetal MRI and confirmed in post-natal MRI". Neuroradiology 2018; 61:9. [PMID: 30382293 DOI: 10.1007/s00234-018-2123-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/26/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Waleed Brinjikji
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
- Neurosurgery, Mayo Clinic, Rochester, MN, USA.
| | - Giuseppe Lanzino
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
- Neurosurgery, Mayo Clinic, Rochester, MN, USA
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16
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Shiran SI, Ben-Sira L, Elhasid R, Roth J, Tabori U, Yalon M, Constantini S, Dvir R. Multiple Brain Developmental Venous Anomalies as a Marker for Constitutional Mismatch Repair Deficiency Syndrome. AJNR Am J Neuroradiol 2018; 39:1943-1946. [PMID: 30166433 DOI: 10.3174/ajnr.a5766] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 06/25/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Biallelic constitutional mutations in DNA mismatch repair genes cause a distinct syndrome, constitutional mismatch repair deficiency syndrome (CMMRD), characterized by cancers from multiple organs, most commonly brain tumors, during childhood. Surveillance protocols include total and brain MR imaging among other modalities to enable early detection of tumors. Brain surveillance scans revealed prominent brain developmental venous anomalies (DVAs) in some patients. DVAs are benign vascular anomalies, and their incidence in the general population is 2.6%-6.4%. Most developmental venous anomalies are asymptomatic and are found incidentally. Our purpose was to assess the prevalence of DVAs in CMMRD patients and describe their phenotype. MATERIALS AND METHODS A retrospective descriptive analysis of brain MR imaging studies from 10 patients from 3 families with CMMRD was performed. Analysis included the number of developmental venous anomalies, location, draining vessels, and associated vascular anomalies (ie, cavernomas), with clinical correlation of symptoms and tumors. RESULTS All 10 patients had ≥2 developmental venous anomalies, and 2 had, in addition, non-therapy-induced cavernomas. There was no clinically symptomatic intracranial bleeding from developmental venous anomalies. Six patients had malignant brain tumors. The location of brain tumors was not adjacent to the developmental venous anomalies. No new developmental venous anomalies developed during follow-up. CONCLUSIONS The occurrence of multiple developmental venous anomalies in all our patients with CMMRD suggests that developmental venous anomalies may be a characteristic of this syndrome that has not been previously described. If confirmed, this quantifiable feature can be added to the current scoring system and could result in early implementation of genetic testing and surveillance protocols, which can be life-saving for these patients.
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Affiliation(s)
- S I Shiran
- From the Departments of Radiology (S.I.S., L.B.-S.)
| | - L Ben-Sira
- From the Departments of Radiology (S.I.S., L.B.-S.)
| | - R Elhasid
- Pediatric Hematology/Oncology (R.E., R.D.)
| | - J Roth
- Pediatric Neurosurgery (J.R., S.C.), Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - U Tabori
- Division of Hematology/Oncology (U.T.), Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - M Yalon
- Department of Pediatric Hematology/Oncology (M.Y.), Sheba Medical Center, Tel-Hashomer, Israel
| | - S Constantini
- Pediatric Neurosurgery (J.R., S.C.), Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Dvir
- Pediatric Hematology/Oncology (R.E., R.D.)
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17
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Brinjikji W, El-Rida El-Masri A, Wald JT, Lanzino G. Prevalence of Developmental Venous Anomalies Increases With Age. Stroke 2017; 48:1997-1999. [PMID: 28536179 DOI: 10.1161/strokeaha.116.016145] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 04/08/2017] [Accepted: 04/11/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To test the hypothesis that developmental venous anomalies (DVAs) may develop in the postnatal period, we studied the age-related prevalence of DVAs on contrast-enhanced magnetic resonance imaging. METHODS Reports from a consecutive series of head magnetic resonance images with intravenous contrast performed over a 2-year period at our institution were reviewed. Studies reporting the presence of a DVA were retrieved and reviewed by a neuroradiologist. Patients were divided into 4 age groups: (1) <1 year old (neonates/infants), (2) 1 to 5 years old (toddlers and preschoolers), (3) 6 to 17 years old (grade schoolers), and (4) ≥18 years old (adults), and DVA prevalence by age group was studied. RESULTS A total of 18 073 individuals were included. DVA prevalence in the neonate/infant age group was 1.5% (5/335) compared with 7.1% (51/714) in the toddler/preschool age group. In both the grade-school age group and adult age group, DVA prevalence was 9.6% (150/1557 and 1483/15 467, respectively). Neonates/infants were significantly less likely to have DVAs than other age groups (P<0.001). CONCLUSIONS We found a very low prevalence of DVAs on contrast-enhanced magnetic resonance imaging in patients <1 year old which was significantly lower than other age groups. These findings suggest that postnatal changes in venous architecture and drainage patterns may contribute to the development of DVAs.
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Affiliation(s)
- Waleed Brinjikji
- From the Department of Radiology (W.B., A.E.-R.E.-M., J.T.W., G.L.) and Department of Neurosurgery (W.B., G.L.), Mayo Clinic, Rochester, MN.
| | - Ali El-Rida El-Masri
- From the Department of Radiology (W.B., A.E.-R.E.-M., J.T.W., G.L.) and Department of Neurosurgery (W.B., G.L.), Mayo Clinic, Rochester, MN
| | - John T Wald
- From the Department of Radiology (W.B., A.E.-R.E.-M., J.T.W., G.L.) and Department of Neurosurgery (W.B., G.L.), Mayo Clinic, Rochester, MN
| | - Giuseppe Lanzino
- From the Department of Radiology (W.B., A.E.-R.E.-M., J.T.W., G.L.) and Department of Neurosurgery (W.B., G.L.), Mayo Clinic, Rochester, MN
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18
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Developmental Venous Anomalies Mimicking Neoplasm on 11C-Methionine PET and DSC Perfusion MRI. Clin Nucl Med 2017; 42:e275-e276. [PMID: 28319499 DOI: 10.1097/rlu.0000000000001637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Elevated relative cerebral blood volume on perfusion MRI and increased uptake on C-methionine PET can be used to diagnose and guide biopsy of brain tumors but are not specific. We report increased uptake on C-methionine PET associated with 4 developmental venous anomalies (DVAs) in 3 children with brain tumors, which could potentially mimic tumor and misdirect biopsy. Because DVAs are not readily visible on CT, prevention of misdirected biopsy in patients with focally elevated C-methionine uptake and relative cerebral blood volume relies on close correlation with contrast-enhanced anatomic MRI to exclude DVA or other nonneoplastic etiology.
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Abstract
We report the finding of increased F-3,4-dihydroxyphenylalanine uptake of the brain parenchyma adjacent to developmental venous anomalies, incidentally discovered in 3 pediatric patients with diffusely infiltrating gliomas. One patient presented 3 developmental venous anomalies located distant from the tumor, whereas in the remaining 2 patients, the vascular anomalies were inside the tumoral area mimicking a focal area of increased tumor metabolism. In the setting of brain tumor imaging, focal increased F-3,4-dihydroxyphenylalanine uptake should be carefully interpreted in light of MRI findings, and nuclear medicine physicians should be aware of any incidental minor vascular abnormality for proper interpretation of PET data.
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20
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Agarwal N, Zuccoli G, Murdoch G, Jankowitz BT, Greene S. Developmental venous anomaly presenting as a spontaneous intraparenchymal hematoma without thrombosis. Neuroradiol J 2016; 29:465-469. [PMID: 27613246 DOI: 10.1177/1971400916665387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Developmental venous anomalies (DVAs) are cited as the most common cerebral vascular malformations. Still, intracerebral hematomas are rarely thought to be caused by DVAs. In this report, the authors present a unique case of a DVA that hemorrhaged spontaneously, rather than hemorrhaging into a venous infarction following DVA thrombosis as has been more commonly reported. CLINICAL PRESENTATION A 22-year-old previously healthy male presented to the emergency department with a severe headache, confusion, and progressive hemiparesis. A computed tomography (CT) scan demonstrated a spontaneous left parietal intraparenchymal hemorrhage (IPH), with intraventricular extension and acute hydrocephalus. CT angiography did not demonstrate an underlying vascular malformation. The patient was taken emergently to the operating room for a left parietal craniotomy for evacuation of the hematoma. Intraoperative pathology was consistent with a DVA Postoperative magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and magnetic resonance venography (MRV) did not demonstrate a mass lesion, ischemic stroke, or underlying vascular malformation. An MRI obtained three years previously for headaches was normal. A postoperative diagnostic cerebral angiogram was normal. An MRI/MRA performed six months postoperatively demonstrated two foci of abnormal vessels on susceptibility-weighted imaging (SWI), suggesting the presence of a venous vascular malformation. A diagnostic cerebral angiogram obtained six months postoperatively was again normal, including delayed imaging. CONCLUSION Few reports have cited DVA as the sole cause of intracerebral hemorrhage. While very rare, these reports suggest hemorrhagic conversion of a venous infarction secondary to a thrombosed DVA as a possible etiology, and several provide imaging consistent with this diagnosis. This case study demonstrates a unique presentation of a hemorrhagic DVA in the absence of thrombosis or stroke.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, USA
| | - Giulio Zuccoli
- Department of Radiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, USA
| | - Geoffrey Murdoch
- Department of Pathology, University of Pittsburgh Medical Center, USA
| | - Brian T Jankowitz
- Department of Neurological Surgery, University of Pittsburgh Medical Center, USA
| | - Stephanie Greene
- Department of Neurological Surgery, University of Pittsburgh Medical Center, USA
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21
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Nabavizadeh SA, Mamourian AC, Vossough A, Loevner LA, Hurst R. The Many Faces of Cerebral Developmental Venous Anomaly and Its Mimicks: Spectrum of Imaging Findings. J Neuroimaging 2016; 26:463-72. [DOI: 10.1111/jon.12373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 12/01/2022] Open
Affiliation(s)
- Seyed Ali Nabavizadeh
- Department of Radiology, Hospital of University of Pennsylvania; Perelman School of Medicine of the University of Pennsylvania; Philadelphia PA
| | - Alexander C. Mamourian
- Department of Radiology, Hospital of University of Pennsylvania; Perelman School of Medicine of the University of Pennsylvania; Philadelphia PA
| | - Arastoo Vossough
- Division of Neuroradiology, Children's Hospital of Philadelphia; Perelman School of Medicine of the University of Pennsylvania; Philadelphia PA
| | - Laurie A. Loevner
- Department of Radiology, Hospital of University of Pennsylvania; Perelman School of Medicine of the University of Pennsylvania; Philadelphia PA
| | - Robert Hurst
- Department of Radiology, Hospital of University of Pennsylvania; Perelman School of Medicine of the University of Pennsylvania; Philadelphia PA
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22
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Linscott LL, Leach JL, Jones BV, Abruzzo TA. Developmental venous anomalies of the brain in children -- imaging spectrum and update. Pediatr Radiol 2016; 46:394-406; quiz 391-3. [PMID: 26795616 DOI: 10.1007/s00247-015-3525-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/26/2015] [Indexed: 11/25/2022]
Abstract
Developmental venous anomalies (DVAs) are the most common vascular malformation of the brain and are commonly identified on routine imaging of the brain. They are typically considered incidental findings, usually with no clinical significance. However the increasing identification of DVAs as a result of improved imaging technology has led to recognition of their association with a variety of abnormal imaging findings and clinically important conditions. This pictorial essay explores the suspected embryological origin, associated imaging features, and proposed pathophysiological mechanisms of DVAs in the pediatric population. This paper emphasizes newer physiological imaging data, which suggest that DVA drainage has less physiological flexibility than otherwise normal venous drainage development.
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Affiliation(s)
- Luke L Linscott
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.
| | - James L Leach
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - Blaise V Jones
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - Todd A Abruzzo
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
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