Magnetic Resonance Spectroscopy Facilitates the Understanding of the Pathophysiology of Cerebellar Arteriovenous Malformations

Magnetic resonance spectroscopy (MRS) is a non-invasive imaging technique that facilitates the observation of tissue metabolism. It holds potential not only in research but also in clinical settings for understanding pathophysiology. This report presents the case of a 73-year-old woman with cerebellar arteriovenous malformation (AVM) in which MRS contributed to understanding the condition. Preoperative magnetic resonance imaging revealed T2/fluid-attenuated inversion recovery hyperintensity in the right cerebellar hemisphere. MRS of the same site showed an increase in lactate (Lac) and a decrease in N-acetylaspartate (NAA) levels. Through examination, she was diagnosed with a micro-AVM. Although transarterial embolization was performed on another day, completely occluding the shunt and treating the AVM, MRS showed a persistent decrease in NAA and elevated Lac levels and suggested that irreversible brain tissue damage had occurred due to the progression of venous congestion. The use of MRS in patients with suspected cerebellar AVMs allows for evaluating the degree of brain damage due to venous congestion, providing valuable insights for treatment decisions, in addition to evaluating treatment outcomes.