I

DIAGNOSTIC IMAGING

CT SCAN

CT scan kepala yang menunjukkan arteriovenous malformation (AVM) oksipital kiri, dengan
banyak phleboliths dan banyak hyperattenuating vaskular channels.

Arteriovenous malformasi (AVM) dari otak. CT scan fossa posterior menunjukkan

pendarahan pada ventrikel keempat, dengan ekstensi ke cerebellum kiri.

MRI
Large Temporal AVM

gambar 1
Menunjukkan penampilan karakteristik dari suatu AVM besar (panah besar). Perhatikan
bahwa predominant feeding dari A.carotid interna sinistra melalui A.cerebri medius (panah
panjang).

gambar 2
Gambaran dalam slightly higher cut, tampilan yang dibesarkan, arteri melebar dan adanya
cavernous chamber

yang merupakan bagian dari malformasi vena (panah terbuka).

Perhatikan efek massa dari AVM yang besarnya tidak biasa ini pada otak. Biasanya AVM
menggantikan jaringgan otak dan menjadi atrofi disekitarnya. Menyebabkan efek massa
minimal atau bahkan tidak ada pada kebanyakan AVMs.

gambar 3
Menunjukkan AVM pada bidang koronal (panah besar). Dalam kasus ini struktur malformasi
arteri yang memberi makan ke dalam vena cavernous besar (panah panjang). Lokasi tepat
dari AVM dan banyak informasi tentang predominant feeding dan aliran AVM dapat
ditentukan dengan pemeriksaan MRI scan.

gambar 4
Menunjukkan adanya makroadenoma (panah melengkung) pada pasien yang sama.

Left Parietal AVM

gambar 1
Menunjukkan sebuah AVM left parietal yang besar. (panah panjang). Nidus dam struktur
aliran vena cavernous perifer dapat ditentukan (panah besar). Terbantuk shunt (panah kecil).
Aliran AVM kebanyakan menuju ke parenkim otak dan V.cerebri interna normal (panah
melengkung)

gambar 2
Menunjukkan temuan yang sama : Nidus (panah panjang), stuktur aliran vena cavernous
(panah besar), dan vena-vena cerebri interna yang normal (panah melengkung).

gambar 3
Post magnevist-injection scan menunjukkan gambaran yang sama. Beberapa peningkatan dari
jaringan vaskular sekitar sekitar. Penemuan ini juga terdapat pada gambaran T2-weighted
tanpa magnevist (panah besar). Karakteristik dari shunt dapat ditentukan (panah kecil).

gambar 4
Menunjukan peningkatan signal pada jaringan sekitar avascular malformation (panah
terbuka), memberi kesan bahwa perubahan ini reaktif dan beberapa gliosis dan keluar dari
pembuluh darah aneurisma (panah melengkung dan anak panah) dari supply arterial utama
untuk A.cerebri media sinistra.

gambar 5
A coronal image demontrates the nidus (arrowhead) ang its
large cavernous venous structures ( arrow). Deep to the
venous malformation is some altered signal (long-stemmed
arrow). Sebuah gambaran coronal menunjukkan nidus (mata
panah) dan venous

Gambar 6
Demontrates in the sagital plane the AVM nidus (long-stemmed arrow) and the cavernous
venous

draining

Extensive Temporal Lobe AVM

structures

(large

arrow).

gambar 1
demontrates a lrge AVM replacing most of the substance of the left temporal lobe(large
arrow). The mail feeding artery in the middle cerebral artery (short-stemmed large arrow).
Note however , that the basilar tip and the portion of the posterior artery are also dilated; this
dilatation may represnt aneurysms. The development of the aneurysms, particularly to the
supplying vessels, is quite common, and in an extensive AVM like this one, vessels from both
sides

of

the

brain

may

be

donating

blood

flow

to

the

malformation.

gambar 2
is a sagittal cut demonstrating the tanggle of artetiovenous structure that has largely replaced
the substance of the brain(large arrowa0. Note, the position of a shunt catheter in the
ventricle

(arrowhead).

gambar 3
demonstrates the large avascular malformation in the coronal plane (large arrow. The
cavernous dilated veins can also be appreciated (long-stemmed arrow). The shunt catheter
can

also

be

identified

in

the

right

ventricle

(arroehead).

gambar 4
demonstrates that the malformation does exert some mass effect. This effect may be
occluding the foramen of Monro, necessitatingthe placement of the shunt (open arrow head ).
The

shunt

catheter

Moderate-Sized Left Parietal AVM

can

again

be

identified

(arrowhead).

gambar 1
demontrates in the axial plane the dilated, predominant feeding vessels of the
interparenchymal AVM (large arrow). In the same image, the predominant draining venous
stracture

can

be

identified

(open

arrowhead).

gambar 2
a slightly higher cut, demonstrates the nidus of the AVM in the parietal lobe ( large arrow).
There is some deep venous drainage (curve arrow), which can be also demontrated.

gambar 3
in the coronal plane, demontrated the feeding artery (open arrowhead), the nidus and the
predominant drainage (arrowhead).

gambar 4
in the sagittal plane, demontrates the nidus (large arrow) and the surrounding draining venous
structures (arrow)

Thalamic AVM

gambar 1
demontrates of an AVM nidus replacing the right thalamic region (large arrow). The
predominant

drainage

is

into

the

central

venous

structures

(small

arrow).

gambar 2
is

coronal

image

demonstrating

the

AVM

nidus

(large

arrow).

gambar 3
a slightly more posterior coronal cut, demonstrated the nelarged venous structure draining
the

malformation.

gambar 4
a T2-weighted image at the same level as figure 1. Demonstrates the vascular nidus to better
effect

(large

arrow).

gambar 5
figure 3 corellates fairly closely with the figure 5, an anteroposterior right vertebral
angiogram, demonstrating the nidus (arrow). Feeding vessels from the posterior cerebral
circulation (large short arrow), and the immediate vizualisation of the deep draining venous
structures

(long-stemmed

arrows).

gambar 6
is a lateral view deminstrating the thalamic AVM nidus (arrow). Feeding vessels (shortstemmed arrow)

and the venous structures (long-stemmed arrow) can also be seen.

Occult or Cryptic AVM

gambar 1
demonstrates a small focus of increase signal surrounded by decreased signal in a T1weighted

image

of

the

left

parietal

region

(small

arrow).

gambar 2
a T2-weighted image, again demonstrates a smaall focus of high signal surrounded by a lowsignal

ring.

gambar

a slightly lower cut, demonstrates the same change. The low signal extend toward the
calvarium,

suggesting

the

presence

of

small

draining

vein.

gambar 4
demonstrates that this area exhibits contrast enhancement. The presence of a small a mount of
blood, the absence of any mass effect, ang the suggestion of a small draining vein all a low
the diagnosis of a small AVM. These malformation were previosly considered cryptic or
occult becaause on angiography the vessels of the AVM can not be demontrated. These can
be symptomatic secondary to tiny bleeding episodes. They are extremely difficult to
defferentiate from tiny metastases that have undergone central haemorrhage. However, in this
case i think that the suggestion of a draining vessel helps weight the diagnosis of favor of an
AVM.

Venous Angioma with Small Bleed

gambar 1
demontrates of small signal void

area consistent with a vessel (open arrowhead).

gambar 2
slightly lower cut, this structures is outline by some increased signal (long-stemmed arrow).
The lumen of the structures can be identified (small arrow). It appears to communicates with
the

talamostirate

vein

(large

arrow).

gambar 3
demonstrates the superior course of the abnormal vein and its relation to the ventricle
(arrowhead).

gambar 4
a CT scan obtain at the same time, demontrates a small a mount of haemorrhage in this
portion of the right frontal lobe (long-stemmed arrow).
There is no evidence of any arterial feeding, and the abnormal connection to the normal
venous structures suggest a diagnosis of venous angioma. These angiomas has been reported
to

undergo

Left Cerebellar Hemisphere AVM

spontaneous

haemorrhage.

gambar 1
is an axial cut with T1-weighting demonstrating serpiginous structures replacing the lateral
portion

of

the

left

cerebellar

hemisphere

(arrowhead).

gambar 2
a sagittal cut trough the same area, demonstrates the nidus of the AVM (long-stemmed arrow)
and

suggest

that

there

its

lot

surface

draining

vein

(short

arrow).

gambar 3
a coronal image, demonstrates the lack of mass effect and the replacement of the atrophide
brain tissue by the AVM.
The AVM, because of its lack of capillary network, by passes the brain tissue, depleting the
oxygen content ; hance the surrounding tissue atrophies. Ussually the surrounding brain
tissue is replaced by the malformation. Because the malformation becaome large in size, as
seen in previous cases, there can be a mass effect severe enough to cause hydrocephalus.

ANGIOGRAPHY

Angiogram dari carotid lateral kiri menunjukkan suatu mixed pial-dural arteriovenous
malformation(AVM). Arterial dan feeders A.oksipitalis meluas ke nidus melalui cabang distal
A.cerebri medius.

Arteriovenous malformasi (AVM) dari otak. Angiogram anteroposterior right

carotid menunjukkan pasokan sekunder A.cerebri anterior untuk vaskular steal.
Perhatikan bahwa A.cerebri anterior

tidak opak setelah pemberian suntikan

kontras pada ipsilateral carotid (lihat juga gambar sebelumnya).

Arteriovenous malformation (AVM) otak. Angiogram lateral left vertebral menunjukkan

sebuah A. Cerebri posterior sinistra huge feeder pada nidus.

Arteriovenous malformation (AVM) otak. Sebuah angiogram anteroposterior left

vertebral..

Arteriovenous malformation (AVM) otak. Fase vena dari sebuah angiogram

vertebral menunjukkan sejumlah aliran vena superficial dan profunda.