Detection of AVM's - MRI, CT angiogram, and CT angiography?

Has anyone else experienced the following? Prior to discovering my 1st, 2nd and 3rd avm’s, none of them showed up on MRIs or CT angiograms. My avm’s were only discovered with CT angiography, the in- patient procedue where a large needle is put into your groin which is threaded up to your brain. A contrast is added and to my knowledge this is considered the gold standard to detect avms. As far as I know, just because you get the all clear from an MRI and CT angiogram it doesn’t mean you may not still have an avm. It just isn’t showing up.

I haven’t experienced my AVM and aneurysm not showing up on the MRIs, but for the first four years after my bleed the doctors here thought what they were seeing was one cavernous angioma. When I finally had my first angiogram both the AVM and aneurysm were detected. So there were two malformations, and they weren’t at all what was originally thought.

I’ve heard before about MRIs and CT scans not picking up various kinds of malformations, so I don’t think it’s such an uncommon thing to have happen. Sometimes too they do show, but the person reading the pictures might miss it, and later someone else sees it on the same film read by whoever didn’t see it to begin with.

When I look at those pictures I’m always amazed that anyone - even with all that training and experience - can make out anything!

But aside from missing something on a film, it does happen that a malformation may not show up. Maybe it has something to do with the quality of the pictures to begin with, and also maybe the size and/or locations of the malformations.

Mine was found on an MRI. Then I had a follow up cta. They wanted to embolize it, so I had an arteriogram, which showed not only the avm, but an aneurysm. I think it all depends on how good the radiologist is that is reading it.

This is my esperience and understanding. My son had regular CT scans, CT-A scans, MRI-A scans, and angiograms. They all give the doctors different information. A regular CT scan shows intracranial blood, not the blood vessels, so it won’t detect the AVM, just the presence of free blood in the brain. The cerebral angiogram (catheter and dye through the femoral artery) is used to trace the blood flow through the brain, and is what is used to detect the AVM. If the smaller blood vessels fill too quickly, you have an AVM. CT-angiogram and MRI-angiogram use dyes that highlight the blood vessles. They give you a 3-D picture of the known AVM, but aren’t used to diagnose the AVM, just to locate one. So, in answer to your question, you can get an all clear from a CT-scan and an MRI and still have an AVM. Only cerebral angiograms give the doctors the right information.

Mine was initially discovered via MRI. I had another MRI with contrast dye the following day. I eventually had three cranial angiograms, about a dozen CT scans and more contrast dye MRIs than I can count. My neurosurgeon said that while MRI and CT are good for being able to track any growth or obvious bleeding, angiography via cathedarization was the only way to get a live image of the blood flowing through the vessels to see exatcly how they are formed.

Hello! I can relate with your frustrating experience. All this was many years ago so bear with my memory. I had a major brain bleed and the neurosurgeon in care of me in the ER said the results from the images from the CT and MRI did not reveal enough info for him to procede so he sent me to a specialist neurosurgeon who did more tests of the same and additional gammate of tests. He stated I had an AVM in the cerebellum and we prepared for the (one time brain surgery) HAHAHA! The 1st was 18hrs, the 2nd 14hrs, 3rd 10hrs and during a check-up using cerebral angiography he came to tell me that there was an aneurysm on one of the feeder vessels to the rest of the AVM that did not show up on ALL the previous tests- some of which were the very same test that revealed it. VERRRY FRUSTRATING! Good luck to you and your family. Godspeed!

Hi Sue,

I apologize for not replying sooner as I’ve been quite busy.

In response to your question I am basing it on my own personal experience. In my case I underwent a series of CT scans and as was explained to me an Angiography & MRI would provide a more detailed view. It was only after these tests were conducted that I was given the all clear. Now, keep in mind that these were tests conducted well over two decades ago and it would seem to me at least that our medical advancements up to the present should be more precise.

The most important question I can remember asking was “Will this ever happen again?”. My neurosurgeon replied, “You’d have better odds being struck by a meteorite”. And, to this day I’m still waiting for that meteorite to show up!

Take care and good luck!