Ultra-high-resolution C-arm flat-detector CT angiography evaluation reveals 3-fold higher association rate for sporadic intracranial cavernous malformations and developmental venous anomalies: a retrospective study in consecutive 58 patients with 60 cavernous malformations
- 160 Downloads
The imaging and surgical literature has confusing association rates for the association between sporadic intracranial cavernous malformations (CMs) and developmental venous anomalies (DVAs). In this study, our purpose was to determine the association rate using ultra-high-resolution C-arm flat-detector CT angiography (FDCTA) and compare it with literature.
Fifty-eight patients with 60 sporadic intracranial CMs that underwent an FDCTA study were included in our retrospective study. Re-evaluation of radiological data was performed based on the criteria defined by authors. Isotropic volumetric reconstructions with ultra-high resolution (voxel size of 102 μm3 for initial; 67 μm3 and 32 μm3 for further evaluation) were used for assessment. Sixteen patients underwent surgery for excision of their CMs.
Fifty-one of all patients (87.9 %) were associated with a DVA. Undefined local venous structures (UD-LVSs) were observed in the remaining 7 patients (12.1 %). The strength of interobserver agreement was excellent [kappa(k) coefficient = 0.923].
Ultra-high-resolution FDCTA evaluation of CMs and DVAs reveals 3-fold higher association rate compared to the literature. FDCTA for patients with sporadic CMs could help identify the associated DVAs that remained undetected or unclear with other imaging modalities, which can be useful in decision-making processes, planning surgery, and during operation.
• FDCTA evaluation reveals the highest (3-fold) association rate in literature
• FDCTA helps detect and define DVAs that remained unclear with other modalities
• Ratio of DVAs/UD-LVSs (“variants” in MRI) increases dramatically with FDCTA
• FDCTA reveals venous angioarchitecture of CMs in high anatomical detail
• FDCTA can be useful in decision-making, planning surgery, and during operation
KeywordsFlat detector Computed tomography Angiography Cavernous malformation Developmental venous anomaly
Flat-detector CT angiography
Undefined local venous structure
Developmental venous anomaly
Magnetic resonance imaging
Digital subtraction angiography
Field of view
The scientific guarantor of this publication is Civan Islak. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (Burak Kocak, MD) has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, performed at one institution.
- 11.Awad IA, Robinson JR, Mohanty S, Estes ML (1993) Mixed vascular malformations of the brain: clinical and pathogenetic considerations. Neurosurgery 33:179–188, discussion 188Google Scholar
- 15.Robinson JR, Awad IA, Masaryk TJ, Estes ML (1993) Pathological heterogeneity of angiographically occult vascular malformations of the brain. Neurosurgery 33:547–554, discussion 554–5Google Scholar
- 17.Abdulrauf SI, Kaynar MY, Awad IA (1999) A comparison of the clinical profile of cavernous malformations with and without associated venous malformations. Neurosurgery 44:41–46, discussion 46–7Google Scholar
- 21.Moriarity J, Wetzel M, Clatterbuck R et al (1999) The natural history of cavernous malformations: a prospective study of 68 patients. Neurosurgery 44:1166–1171, discussion 1172–3Google Scholar
- 23.Bertalanffy H, Benes L, Miyazawa T et al (2002) Cerebral cavernomas in the adult. Review of the literature and analysis of 72 surgically treated patients. Neurosurg Rev 25:1–53, discussion 54–5Google Scholar
- 26.Wurm G, Schnizer M, Fellner FA (2007) Cerebral cavernous malformations associated with venous anomalies: surgical considerations. Neurosurgery 61:390–404, discussion 404–6Google Scholar
- 34.Russel D, Rubinstein L (1959) Tumors and harmatomas of the blood vessels. In: DS R, LJ R (eds) Pathol tumors Nerv Syst. Arnold, London, p 72–92Google Scholar
- 36.Bruner J, Tien R, McLendon R (1986) Tumors of vascular origin. In: DD B, RE M, JM B (eds) Russel Rubinstein’s Pathol tumors thenervous Syst. Arnold, London, p 239–293Google Scholar
- 38.Johnson P, Wascher T, Golfinos J (1993) Definition and pathologic features. In: Awad I, Barrow D (eds) Cavernous malformations. AANS, Park Ridge, pp 1–11Google Scholar
- 47.Pozzati E, Acciarri N, Tognetti F et al (1996) Growth, subsequent bleeding, and de novo appearance of cerebral cavernous angiomas. Neurosurgery 38:662–669, discussion 669–70Google Scholar