Case Of the Week (COW) 09 Nov 2014
Answer:
Developmental venous anomaly.
Findings:
Sequences: 1.T2 weighted 2.Susceptibility weighted imaging (SWI) 3.SWI – MIP 4.Filtered phase image.
Round flow void in right cerebellar hemisphere in T2 weighted images, On SWI and filtered phase images- Stellate enlarged medullary veins converge towards collector vein in right cerebellar hemisphere giving medusa head like appearance. Susceptibility weighted imaging is used for the identification of small amounts of haemorrhage / blood product or calcium. Both demonstrate signal drop out and blooming in SWI The filtered phase images is used to distinguish between the two as diamagnetic and paramagnetic compounds will affect phase differently (veins / haemorrhage and calcification will appear of opposite signal intensity in filtered phase images)
Discussion:
Developmental venous anomaly is characterized by the CAPUT MEDUSA SIGN of medullary veins draining into single large collecting vein which in turn drains into either dural venous sinus or into deep ependymal vein. Most common locations are frontoparietal region with draining into frontal horn of lateral ventricle and cerebellar hemisphere draining towards fourth ventricle. 20% of cases are associated with cavernous malformation and referred as mixed vascular malformation.
Contributed By:
Prof.S. Babu Peter, Dr. R.Rajalakshmi
Barnard Institute of Radiology
Answer:
Developmental venous anomaly.
Findings:
Sequences: 1.T2 weighted 2.Susceptibility weighted imaging (SWI) 3.SWI – MIP 4.Filtered phase image.
Round flow void in right cerebellar hemisphere in T2 weighted images, On SWI and filtered phase images- Stellate enlarged medullary veins converge towards collector vein in right cerebellar hemisphere giving medusa head like appearance. Susceptibility weighted imaging is used for the identification of small amounts of haemorrhage / blood product or calcium. Both demonstrate signal drop out and blooming in SWI The filtered phase images is used to distinguish between the two as diamagnetic and paramagnetic compounds will affect phase differently (veins / haemorrhage and calcification will appear of opposite signal intensity in filtered phase images)
Discussion:
Developmental venous anomaly is characterized by the CAPUT MEDUSA SIGN of medullary veins draining into single large collecting vein which in turn drains into either dural venous sinus or into deep ependymal vein. Most common locations are frontoparietal region with draining into frontal horn of lateral ventricle and cerebellar hemisphere draining towards fourth ventricle. 20% of cases are associated with cavernous malformation and referred as mixed vascular malformation.
Contributed By:
Prof.S. Babu Peter, Dr. R.Rajalakshmi
Barnard Institute of Radiology