Hemodynamic Effects of Developmental Venous Anomalies with and without Cavernous Malformations

Perfusion imaging was done in patients with developmental venous anomalies with and without accompanying cavernous malformations. The normal-appearing brain surrounding DVAs showed higher blood volume, longer mean transit time, and variable changes in blood flow. DVAs with cavernomas showed greater MTT prolongation and less blood flow indicating greater restrictive effects upon the adjacent brain. The authors offer some ingenious and interesting explanations for these findings. BACKGROUND AND PURPOSE: Association between developmental venous anomalies is well known, but remains unexplained. Our aim was to study possible hemodynamic differences around developmental venous anomalies with and without cavernous malformations. MATERIALS AND METHODS: In this prospective study approved by the institutional review board, PWI was performed in 24 patients with 25 DVAs (10 with and 15 without CMs) who consented to participate. We calculated relative cerebral blood volume, relative cerebral blood flow, and relative mean transit time for the brain surrounding the DVA tributaries in reference to contralateral mirror image locations. Corresponding control values (cCBV, cCBF, and cMTT) were generated in a similar fashion for remote ipsilateral regions with normal venous drainage, also in reference to contralateral mirror image locations. Perfusion parameters for DVAs and control regions were tested for differences between groups with the t test for independent or paired samples (or the nonparametric equivalents). Similar testing was done for perfusion parameters for DVAs with and without CMs. RESULTS: Normal-appearing brain surrounding DVAs showed increased rCBV (median = 2.98; range = 1.39-6.61), increased rCBF (median = 2.00, range = 0.79-4.43), and increased rMTT (mean = 1.46; 95% confidence interval, 1.32-1.59). These were significantly higher than median cCBV (0.99; 95% confidence interval, 0.89-1.06; P < .01), median cCBF (1.00; 95% confidence interval, 0.94-1.27; P < .01), and mean cMTT (1.00; 95% confidence interval, 0.98-1.02; P < .01), respectively. Mean rMTT (1.70; 95% confidence interval, 1.46-1.93) for DVAs with CMs was higher than mean rMTT (1.29; 95% confidence interval, 1.19-1.40; P < .01) for DVAs without CMs. CONCLUSIONS: DVAs are strongly associated with altered hemodynamics. Significant differences in these hemodynamic alterations for DVAs with and without CMs suggest their possible role in the formation of CMs.