T2W – Sagittal & axial scans
T1W – Axial scans
FLAIR – Coronal scans
T2FFE (Gradient) – Axial scans
3D TOF MR angiography of the circle of Willis vessels and MIP reconstruction.
MR venography protocol
FINDINGS:
-Evidence of a focal lesion is noted in the right frontal lobe with characteristic serpentine morphology. It measures about 3.6x3.9x4.0 cm in diameters; picture is suggestive of arterio-venous malformation.
-Feeding artery is the right middle cerebral while draining is by dilated cortical veins through right transverse from posterior inferior aspect of the lesion and superior sagittal sinuses from its postero-superior aspect.
-Brain Parenchyma shows normal grey white matter differentiation and
signal intensities. No focal mass lesion is seen.
-Lateral and third ventricles are normal in size and position. Septum is in midline. There is no midline shift.
-Basal cisterns, cortical sulci and gyri are normal in appearance.
-Corpus callosum shows normal MR morphology.
-Brain stem and cerebellum show normal signal intensities.
-Fourth ventricle is normal in size and is midline in position.
-MR angiography reveals normal course, caliber and outlines of vessels of bilateral CA, ACA, MCA, PCA and their peripheral branches. Vertebro basilar trunk is also normal in appearance.
The AVM shown in the right frontal lobe is feeded by the right middle cerebral artery.
-The superior sagittal sinus, straight sinus, bilateral transverse sinuses, their confluence, bilateral sigmoid sinuses and parts of internal jugular vein visualized, show normal course, caliber and outlines. No obvious evidence of any venous sinus thrombosis is seen at present.
Draining of the AVM is by dilated cortical veins through right transverse sinus from posterior inferior aspect of the lesion and superior sagittal sinus from its postero-superior aspect.
OPINION:
• Right frontal AVM with feeding right middle cerebral artery and drainage to superior sagittal and right transverse sinus as mentioned above.
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