Is arterial spin labelling necessarily low perfusion for cavernous sinus venous malformation? A case of hyperperfusion cavernous sinus venous malformation

TL;DR

This paper discusses a rare case where a cavernous sinus venous malformation showed high blood flow, challenging the usual imaging patterns.

Contribution

The paper presents a novel case where cavernous sinus venous malformation exhibited hyperperfusion due to an associated arteriovenous fistula.

Findings

Cavernous sinus venous malformation typically shows low perfusion but can show hyperperfusion when associated with arteriovenous fistula.

Arterial spin labelling (ASL) can help differentiate cavernous vascular malformations from meningiomas.

Hyperperfusion in ASL imaging may indicate the presence of an arteriovenous fistula in venous malformations.

Abstract

Generally, due to the complexity of the skull base structures, it is difficult to differentiate cavernous vascular malformation and meningioma in the cavernous sinus area using conventional imaging studies. Cavernous sinus venous malformation are characterized by increased capillary masses without a direct arterial supply, typically leading to low perfusion. On the other hand, meningiomas receive arterial blood supply to the tumour and often exhibit high perfusion. So, arterial spin labelling (ASL) can be helpful in distinguishing between the 2 tumour types. However, in our specific case of a cavernous sinus venous malformation, the ASL imaging showed hyperperfusion. Further analysis revealed that this hyperperfusion on ASL can occur when cavernous sinus venous malformation is associated with arteriovenous fistula malformation.

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