Identification of a T2-hyperintense Perivascular Space in Brain Arteriovenous Malformations

Thomas Wälchli; Kartik Dev Bhatia; Will Guest; Jeroen Bisschop; Leonardo Olijnyk; Hans Kortman; Paul E Constanthin; Patrick Nicholson; Philippe P Monnier; Aristotelis Kalyvas; Ethan A Winkler; Moncef Berhouma; Timo Krings; Ivan Radovanovic

doi:10.21873/invivo.13826

Identification of a T2-hyperintense Perivascular Space in Brain Arteriovenous Malformations

In Vivo. 2025 Jan-Feb;39(1):280-291. doi: 10.21873/invivo.13826.

Authors

Thomas Wälchli^#^{1

2

3

4}, Kartik Dev Bhatia^{5

6}, Will Guest⁵, Jeroen Bisschop^{7

2

3

4

8}, Leonardo Olijnyk⁷, Hans Kortman^{5

9}, Paul E Constanthin¹⁰, Patrick Nicholson^{5

11}, Philippe P Monnier⁸, Aristotelis Kalyvas^{12

13}, Ethan A Winkler^{14

15

16

17}, Moncef Berhouma¹⁸, Timo Krings^{5

19}, Ivan Radovanovic^#^{20

2

21

22}

Affiliations

¹ Group Brain Vasculature and Perivascular Niche, Division of Experimental and Translational Neuroscience, Krembil Brain Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; [email protected].
² Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
³ Group of CNS Angiogenesis and Neurovascular Link, Neuroscience Center Zürich, and Division of Neurosurgery, University and University Hospital Zürich, Zürich, Switzerland.
⁴ Division of Neurosurgery, University Hospital Zürich, Zürich, Switzerland.
⁵ Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada.
⁶ Department of Medical Imaging (K.D.B.), Sydney Children's Hospital Network, Westmead, NSW, Australia.
⁷ Group Brain Vasculature and Perivascular Niche, Division of Experimental and Translational Neuroscience, Krembil Brain Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
⁸ Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁹ Department of Radiology, Section Interventional Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands.
¹⁰ Department of Neurosurgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
¹¹ Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland.
¹² Attikon Hospital, Department of Neurosurgery, National and Kapodistrian University of Athens, Athens, Greece.
¹³ Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
¹⁴ Department of Neurological Surgery, University of California, San Francisco, CA, USA.
¹⁵ Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research, University of California, San Francisco, CA, U.S.A.
¹⁶ Weill Institute for Neurosciences, University of California, San Francisco, CA, U.S.A.
¹⁷ Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, U.S.A.
¹⁸ Department of Neurosurgery, University Hospital of Dijon, Bourgogne, France.
¹⁹ Lahey Hospital and Medical Center, TH Chan School of Medicine, University of Massachusetts, Boston, MA, U.S.A.
²⁰ Group Brain Vasculature and Perivascular Niche, Division of Experimental and Translational Neuroscience, Krembil Brain Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; [email protected].
²¹ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
²² Division of Neurosurgery, Sprott Department of Surgery, University of Toronto, Toronto, ON, Canada.

^# Contributed equally.

PMID: 39740916
DOI: 10.21873/invivo.13826

Abstract

Background/aim: Brain arteriovenous malformations (AVMs) are vascular malformations characterized by dysmorphic, aberrant vasculature. During previous surgeries of compact nidus brain AVMs (representing the majority of cases), we have observed a "shiny" plane between nidal and perinidal AVM vessels and the surrounding grey and white matter and hypothesized that preoperative neuroimaging of brain AVMs may show a neuroradiological correlate of these intraoperative observations.

Patients and methods: We retrospectively reviewed and analyzed multiplanar and multisequence 3-Tesla magnetic resonance (3T MR) imaging in five consecutive brain AVMs with special attention on imaging characteristics of the brain-AVM interface, i.e., the perivascular and perinidal regions.

Results: In all five patients, we identified T2-hypertinense perivascular perinidal spaces, which were predominantly observed around the AVM nidus and less prominently around the feeding arteries or draining veins.

Conclusion: The identification of T2-hypertinense perivascular spaces surrounding brain AVMs on neuroradiological imaging may provide insights into the anatomico-radiological relationships of brain AVMs and the surrounding grey and white matter parenchyma. These findings could have future implications for our understanding of brain AVM biology and may influence neurosurgical approaches to these lesions.

Keywords: Brain AVMs; T2-hyperintense perivascular rim around AVM nidus; Virchow-Robin space; neuroradiological characterization; perivascular (perinidal) space.

MeSH terms

Adult
Brain / blood supply
Brain / diagnostic imaging
Brain / pathology
Female
Humans
Intracranial Arteriovenous Malformations* / diagnosis
Intracranial Arteriovenous Malformations* / diagnostic imaging
Intracranial Arteriovenous Malformations* / pathology
Magnetic Resonance Imaging* / methods
Male
Middle Aged
Retrospective Studies