European Radiology

, Volume 27, Issue 6, pp 2629–2639 | Cite as

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

  • Burak Kocak
  • Osman Kizilkilic
  • Buge Oz
  • Dogu Vuralli Bakkaloglu
  • Cihan Isler
  • Naci Kocer
  • Civan Islak



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.

Key Points

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


Flat detector Computed tomography Angiography Cavernous malformation Developmental venous anomaly 



Cavernous malformation


Flat-detector CT angiography


Undefined local venous structure


Developmental venous anomaly


Magnetic resonance imaging


Susceptibility-weighted imaging


Flat-detector CT


Digital subtraction angiography


Arteriovenous malformation


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.


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Burak Kocak
    • 1
  • Osman Kizilkilic
    • 2
  • Buge Oz
    • 3
  • Dogu Vuralli Bakkaloglu
    • 3
  • Cihan Isler
    • 4
  • Naci Kocer
    • 2
  • Civan Islak
    • 2
  1. 1.Department of RadiologyAksaray State HospitalAksarayTurkey
  2. 2.Department of Radiology, Cerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
  3. 3.Department of Pathology, Cerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
  4. 4.Department of Neurosurgery, Cerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey

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