Ultra-high-resolution C-arm flat-detector CT angiography evaluation reveals 3-fold higher association rate for sporadic intracranial cavernous malformations and developmental venous anomalies: a retrospective study in consecutive 58 patients with 60 cavernous malformations.

OBJECTIVES: The imaging and surgical literature has confusing association rates for the association between sporadic intracranial cavernous malformations (CMs) and developmental venous anomalies (DVAs). In this study, our purpose was to determine the association rate using ultra-high-resolution C-arm flat-detector CT angiography (FDCTA) and compare it with literature.

METHODS: Fifty-eight patients with 60 sporadic intracranial CMs that underwent an FDCTA study were included in our retrospective study. Re-evaluation of radiological data was performed based on the criteria defined by authors. Isotropic volumetric reconstructions with ultra-high resolution (voxel size of 102 μm3 for initial; 67 μm3 and 32 μm3 for further evaluation) were used for assessment. Sixteen patients underwent surgery for excision of their CMs.

RESULTS: Fifty-one of all patients (87.9 %) were associated with a DVA. Undefined local venous structures (UD-LVSs) were observed in the remaining 7 patients (12.1 %). The strength of interobserver agreement was excellent [kappa(k) coefficient = 0.923].

CONCLUSIONS: Ultra-high-resolution FDCTA evaluation of CMs and DVAs reveals 3-fold higher association rate compared to the literature. FDCTA for patients with sporadic CMs could help identify the associated DVAs that remained undetected or unclear with other imaging modalities, which can be useful in decision-making processes, planning surgery, and during operation.

KEY POINTS: • FDCTA evaluation reveals the highest (3-fold) association rate in literature • FDCTA helps detect and define DVAs that remained unclear with other modalities • Ratio of DVAs/UD-LVSs ("variants" in MRI) increases dramatically with FDCTA • FDCTA reveals venous angioarchitecture of CMs in high anatomical detail • FDCTA can be useful in decision-making, planning surgery, and during operation.