Ruptured arteriovenous malformations are a frequently encountered pathology with significant associated morbidity and mortality. Identifying and securing the rupture point is mandatory; however, this can often be difficult. Black blood vessel wall magnetic resonance imaging is a promising technique for identifying ruptured saccular aneurysms and has been used in cases of multiple aneurysms. Here we describe a case of using this imaging technique to identify the rupture point in a ruptured arteriovenous malformation with histopathological correlation.
MastHYoungWLKoenneckeHCet al.Risk of spontaneous haemorrhage after diagnosis of cerebral arteriovenous malformation. Lancet Lond Engl1997; 350: 1065–1068.
3.
MeiselHJMansmannUAlvarezHet al.Cerebral arteriovenous malformations and associated aneurysms: analysis of 305 cases from a series of 662 patients. Neurosurgery2000; 46: 793–800. discussion 800–802.
4.
HademenosGJMassoudTF. Risk of intracranial arteriovenous malformation rupture due to venous drainage impairment. A theoretical analysis. Stroke1996; 27: 1072–1083.
NagahataSNagahataMObaraMet al.Wall enhancement of the intracranial aneurysms revealed by magnetic resonance vessel wall imaging using three-dimensional turbo spin-echo sequence with motion-sensitized driven-equilibrium: a sign of ruptured aneurysm?Clin Neuroradiol2016; 26: 277–283.
7.
KondoRYamakiTMouriWet al.[Magnetic resonance vessel wall imaging reveals rupture site in subarachnoid hemorrhage with multiple cerebral aneurysms]. No Shinkei Geka2014; 42: 1147–1150.
8.
OmodakaSEndoHFujimuraMet al.High-grade cerebral arteriovenous malformation treated with targeted embolization of a ruptured site: wall enhancement of an intranidal aneurysm as a sign of ruptured site. Neurol Med Chir (Tokyo)2015; 55: 813–817.
9.
MatoukCCCordBJYeungJet al.High-resolution vessel wall magnetic resonance imaging in intracranial aneurysms and brain arteriovenous malformations. Top Magn Reson Imaging TMRI2016; 25: 49–55.
Le FeuvreDTaylorA. Target embolization of AVMs: identification of sites and results of treatment. Interv Neuroradiol J Peritherapeut Neuroradiol Surg Proced Relat Neurosci2007; 13: 389–394.
12.
MatoukCCMandellDMGünelMet al.Vessel wall magnetic resonance imaging identifies the site of rupture in patients with multiple intracranial aneurysms: proof of principle. Neurosurgery2013; 72: 492–496; discussion 496.
13.
NagahataSNagahataMObaraMet al.Wall enhancement of the intracranial aneurysms revealed by magnetic resonance vessel wall imaging using three-dimensional turbo spin-echo sequence with motion-sensitized driven-equilibrium: a sign of ruptured aneurysm?Clin Neuroradiol2016; 26: 277–283.
14.
HuPYangQWangD-Det al.Wall enhancement on high-resolution magnetic resonance imaging may predict an unsteady state of an intracranial saccular aneurysm. Neuroradiology2016; 58: 979–985.
15.
LarsenNvon der BrelieCTrickDet al.Vessel wall enhancement in unruptured intracranial aneurysms: an indicator for higher risk of rupture? High-Resolution MR Imaging and Correlated Histologic Findings. AJNR Am J Neuroradiol2018; 39: 1617–1621.
16.
EdjlaliMGentricJ-CRégent-RodriguezCet al.Does aneurysmal wall enhancement on vessel wall MRI help to distinguish stable from unstable intracranial aneurysms?Stroke J Cereb Circ2014; 45: 3704–3706.
17.
EdjlaliMGuédonABen HassenWet al.Circumferential thick enhancement at vessel wall MRI has high specificity for intracranial aneurysm instability. Radiology Epub ahead of print 3 July 2018. DOI: 10.1148/radiol.2018172879.
18.
TexakalidisPHilditchCALehmanVet al.Vessel wall imaging of intracranial aneurysms: systematic review and meta-analysis. World Neurosurg2018; 117: 453–458e.
19.
HasanDMAmansMTihanTet al.Ferumoxytol-enhanced MRI to Image inflammation within human brain arteriovenous malformations: a pilot investigation. Transl Stroke Res2012; 3(Suppl. 1): 166–173.
