Radiology, Vol 183, 719-724, Copyright © 1992 by Radiological Society of North America
Clinically documented hemorrhage in cerebral arteriovenous malformations: MR characteristics
PM Chappell, GK Steinberg and MP Marks
Department of Radiology, Stanford University Medical Center, CA 94305.
This study assessed the ability of magnetic resonance (MR) imaging to
identify vascular characteristics of cerebral arteriovenous malformations
(AVMs) which are predictive of hemorrhage. The study also evaluated the
sensitivity and specificity of spin-echo (SE) and gradient-recalled-echo
(GRE) imaging in the detection of prior clinical hemorrhage on the basis of
location of the hemorrhage (parenchymal, intraventricular, or
subarachnoid). Fifty patients with high-flow AVMs were evaluated.
Twenty-four (48%) patients had prior clinical hemorrhage documented at
computed tomography or MR imaging at the time of bleeding. Central venous
drainage (P less than .001), central AVM location (P less than .001), and
peri- or intraventricular AVM location (P less than .01) correlated
positively with prior clinical hemorrhage. Intranidus aneurysms and
angiomatous change could not be detected with MR. Nineteen of the 24
patients with prior hemorrhage underwent both SE and GRE imaging.
Hypointensity, indicating the presence of iron from prior hemorrhage, was
demonstrated in 14 of 19 T2-weighted SE images (sensitivity, 74%) and in 18
of 19 GRE images (sensitivity, 95%). No patient without a prior episode of
clinical bleeding demonstrated evidence of iron deposition at MR imaging
(specificity, 100%).
