22-year-old female with history of congenital anomaly of cerebrovascular system. Clinical question: On 3T Scanner, s/p stereotactic radiosurgery for AVM in August, s/p crani for AVM resection. MRI of the brainRedemonstrated is a small tangle of flow voids present in the right perimesencephalic cistern and in the right geniculate nucleus which has not significantly changed proximally, although there has been slight decreased vascular enhancement of distal arborizations. On susceptibility imaging a microhemorrhages are redemonstrated in the right thalamus near the arteriovenous malformation. There is new vasogenic edema throughout this region of AVM, with a new centrally located focus of contrast enhancement measuring 12 mm AP x 10 mm transverse x 17 mm craniocaudal.No diffusion weighted abnormalities are appreciated. The patient is status post left-sided craniotomy for removal of an arteriovenous malformation. Some signal changes at the surgical bed and likely represent gliotic changes, stable in appearance. A punctate microhemorrhage is again noted in the left middle frontal gyrus, stable when compared to the prior examThere are no foci of restricted diffusion. The visualized portions of the paranasal sinuses redemonstrate a small mucus retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.Redemonstrated is a 2 mm aneurysm at the right ophthalmic artery origin.Redemonstrated is a small tangle of vascular structures centered in the expected location of the right geniculate nucleus associated with mild enlargement of the the thalamogeniculate branches of the right posterior cerebral artery. There has been slight pruning of distal AVM arborizations presumably representing a therapeutic response.
1.Redemonstrated is a small tangle of vascular structures centered in the expected location of the right geniculate nucleus associated with mild enlargement of the the thalamogeniculate branches of the right posterior cerebral artery. There has been slight pruning of distal AVM arborizations presumably representing a therapeutic response.2.New associated vasogenic edema with a central focus of new enhancement is suggestive of a therapeutic response to radiosurgery with a small focus of radiation necrosis.3.Redemonstrated is a 2 mm aneurysm at the right ophthalmic artery origin.