AUTHOR=Eisenmenger Laura B. , Junn Jacqueline C. , Cooke Daniel , Hetts Steven , Zhu Chengcheng , Johnson Kevin M. , Manunga Jesse M. , Saloner David , Hess Christopher , Kim Helen 

TITLE=Presence of Vessel Wall Hyperintensity in Unruptured Arteriovenous Malformations on Vessel Wall Magnetic Resonance Imaging: Pilot Study of AVM Vessel Wall “Enhancement”

JOURNAL=Frontiers in Neuroscience

VOLUME=Volume 15 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2021.697432

DOI=10.3389/fnins.2021.697432

ISSN=1662-453X

ABSTRACT=Purpose: High-resolution vessel wall magnetic resonance imaging (VW-MRI) could provide a way to identify high risk arteriovenous malformation (AVM) features. We present the first pilot study of clinically unruptured AVMs evaluated by high-resolution VW-MRI.

Methods: A retrospective review of clinically unruptured AVMs with VW-MRI between January 1st, 2016, and December 31st, 2018, was performed documenting the presence or absence of vessel wall “hyperintensity”, or enhancement, within the nidus as well as perivascular enhancement and evidence of old hemorrhage (EOOH). The extent of nidal vessel wall 
“hyperintensity” was approximated into 5 groups: 0%, 1-25%, 26-50%, 51-75%, and 76-100%. 

Results: Of the 9 cases, 8 demonstrated at least some degree of vessel wall nidus “hyperintensity.” Of those 8 cases, 4 demonstrated greater than 50% of the nidus with hyperintensity at the vessel wall, and 3 cases had perivascular enhancement adjacent to nidal vessels. Although none of the subjects had prior clinical hemorrhage/AVM rupture, of the 6 patients with available susceptibility weighted imaging to assess for remote hemorrhage, only two had subtle siderosis to suggest prior sub-clinical bleeds.

Conclusion:  Vessel wall “enhancement” occurs AVMs with no prior clinical rupture. Additional studies are needed to further investigate the implication of these findings.