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Cerebral Arteriovenous Malformation: Presentation by Three-Dimensional Substraction Color Power Angiography

Background Recent advances in ultrasound technology now allow the sonographer to obtain three-dimensional color power angiography (3D-CPA) vascular images and to enhance these images by rotation and subtraction. The purpose of this report is to demonstrate the sonographic presentation of a cerebral arteriovenous malformation (AVM) using these advanced techniques. Patient During an emergency operation to evacuate a large subdural hematoma, the surgeon noted several aneurysmal veins, suggesting the presence of an underlying AVM. Angiography showed a compact AVM arising from a posterior temporal branch of the right posterior cerebral artery (PCA). Findings Transcranial color Doppler ultrasonography (CDU) revealed an AVM in the right temporal lobe with a feeder arising from the P1 segment of the right PCA. 3D-CPA images of the AVM were then developed, rotated, and subtracted. These enhanced images provided superior definition of the arterial and venous architecture and were comparable to the angiogram. Conclusion 3D-CPA provided high-resolution, accurate, noninvasive images of a cerebral AVM. The added anatomic detail allowed by this technique was complementary to the hemodynamic information provided by CDU.