1040. Cavernous brain malformations and inflammation in black blood MRI

Authors: Athanasios Petridis, MD, IFAANS; Marcel Kamp; Jan Cornelius; Rebecca May; Hans Jakob Steiger (Duesseldorf, Germany)

Introduction: Inflammatory responses are seen in pathologies of vascular brain malformations. In aneurysms, such inflammations seem be a risk factor for rupture. Are inflammatory reactions crucial in bleeding of cavernous malformations too? Black blood MRI is a sequence which identifies inflammation in the walls of vascular malformations in the brain and in the present study it is used to detect such a reaction in cavernomas. Methods: Retrospective study of N=15 patients with 17 cavernomas treated in our department in 2017. All patients received black blood MRIs and the results were analysed in correlation with, size and bleeding. Results: 5 cavernomas were classified Zabramski I, 3 Zabramski II, 6 Zabramski III and only 1 Zabramski IV. The other lesions were not distinctly classifiable (9). Only one CCM showed contrast enhancement in the black blood MRI. This was the case of a bleeding brainstem cavernous malformation (22 mm size) in a patient with two lesions. The second lesion did not bleed and was not contrast enhancing. All other lesions showed no contrast enhancement irrespective of size, bleeding, multiplicity, gender, and age. Conclusion: Inflammatory reactions in cavernoma walls as shown by black blood MRI analysis are not correlating with bleeding. Inflammation is a very slow and minimal process in these lesions. There are different mechanisms contributing in rupture of cavernomas unlike in other vascular malformations in the brain in which inflammation plays a crucial role.