BOLD-MR Angiography as a Diagnostic Tool for Asymptomatic Cavernomas in Children

Purpose: The purpose of this study was to evaluate the diagnostic potential of a high resolution MR venography technique in a child with asymptomatic cerebral cavernomas. The blood oxygen level dependent (BOLD) venography method is based on susceptibility-induced phase contrast and is sensitive not only to the oxygen content of intravascular blood but also to breakdown products such as hemosiderin, due to increased signal dephasing. Methods and Materials: We studied a 12-month-old asymptomatic girl with a history of familiar multiple cavernomas. Imaging was performed on a 1.5 T MR unit (Siemens, Vision plus) using a standard head coil. Conventional MRI consisted of T₁- and T₂-weighted SE sequences, FLAIR and susceptibility sensitive EPI sequences (slice thickness 6mm). 2D TOF-MR angiography was performed. A high-resolution 3D highly T₂*-weighted gradient echo sequence with first-order flow compensation, and radiofrequency spoiling was created for BOLD-venography (TR 45–67 ms, TE 25–40ms, flip angle 60°, 32–64 partitions, FOV 240–270mm, 512 matrix, bandwidth 78Hz/pixel). Magnitude and phase images were reconstructed. Results: Using standard spin echo sequences and the susceptibility EPI sequence only three cavernoma-suspicious lesions could be detected. Seven cavernous angiomas could be detected with high-resolution BOLD venography. Highly detailed information about the veins was obtained. Discussion: Cavernous angiomas may bleed and cause neurological deficits or seizures. Using BOLD venographic imaging, cavernomas can be evaluated at a spatially high resolution. The assignment between anatomical and vascular structures may be of importance for the evaluation of cavernomas and their risk of possible bleeding.