Coexistence of occult vascular malformations and developmental venous anomalies in the central nervous system : MR evaluation

We sought to determine the prevalence of coexistent occult vascular malformations (OVMs) and developmental venous anomalies (DVAs) and to investigate the relationship between them. One hundred two patients with OVMs were examined with precontrast and postcontrast T1-weighted MR imaging and with noncontrast T2-weighted MR imaging. Seventy-two patients had surgery, with subsequent pathologic confirmation of the final diagnosis. Coexistent DVAs and OVMs were present in 23 (23%) of 102 patients. Seventy-nine patients had OVMs without DVAs, and in this population, multiple OVMs (from two to 10 or more) were seen in 13 patients (16%). In contrast, multiple OVMs were seen in 10 (43%) of 23 patients with coexisting OVMs and DVAs. Twenty-five (83%) of 30 OVMs coexisting with DVAs were infratentorial. In 72 patients with surgically resected OVMs, 49 (68%) had pathologically confirmed cavernous malformations. Among the patients with coexistent DVAs, seven (46%) had cavernous malformations, four (27%) had thrombosed arteriovenous malformations, and four (27%) had vascular malformations that were not classifiable. Our study revealed a high prevalence of OVMs with coexistent DVAs, and a high percentage of these were in the posterior fossa. Contrast-enhanced MR imaging may increase the probability of finding these lesions, and therefore should be considered part of the preoperative evaluation, since the finding of unexpected coexistent lesions may affect surgical management.