Question:

What is the criterion imaging standard for diagnosis of a DVA?
1. CT Brain.
2. CT Brain with contrast.
3. Conventional MRI.
4. MRI with susceptibility weighted imaging.
5. Digital subtraction angiography.





Answer:

The correct answer for the question "What is the criterion imaging standard for diagnosis of a DVA?" is:

5. Digital subtraction angiography.



Explanation
Digital subtraction angiography (DSA) is the criterion standard characterizing the micro and macro vascular structure as well as the hemodynamics of a DVA. Conventional CT & MRI sequences are good at identifying high flow lesions but are poor for low flow lesions like venous anomalies. Although gradient echo sequences such as SWI are sensitive for identifying small venous vessels with low flow, they are limited by slice thickness. [Digital subtraction angiography (DSA) is the criterion standard for characterizing the micro and macro vascular structure as well as the hemodynamics of a DVA [2].  DVAs are visualized by CT and conventional MRI sequences. These non invasive methods are however limited in their ability to comprehensively determine the true extent and definitive angioarchitecture of the lesion for an accurate diagnosis.]



From the manuscript:
Pediatric Holohemispheric Developmental Venous Anomaly: Definitive characterization by 3D Susceptibility Weighted Magnetic Resonance Angiography
Radiology Case. 2011 May; 5(5):10-18


This article belongs to the Neuro section.




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From the manuscript

Pediatric Holohemispheric Developmental Venous Anomaly: Definitive characterization by 3D Susceptibility Weighted Magnetic Resonance Angiography

Free full text article: Pediatric Holohemispheric Developmental Venous Anomaly: Definitive characterization by 3D Susceptibility Weighted Magnetic Resonance Angiography

Abstract
We present a case of an incidentally discovered holohemispheric developmental venous anomaly (DVA) in a 12 year old, conclusively characterized by 3D T2* multi-echo sequence susceptibility weighted angiographic imaging (SWAN). For the evaluation of head trauma, abnormal right intraparenchymal and periventricular vascularity was identified by a non contrast head CT scan. Conventional MRI sequences revealed prominent veins with findings suspicious of a DVA. A definitive diagnosis was made by identifying angiographic features typical for DVA by augmented susceptibility weighted angiographic imaging. Using this sequence the entire hemispheric extent of the anomaly without complicating features was definitively characterized, negating the need for a catheter based angiographic study. A holohemispheric DVA in a child to our knowledge has not been previously described.






References



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