IntroductionDevelopmental venous anomalies (DVA) consist of dilated intramedullary veins that converge into a large collecting vein. The appearance of these anomalies was evaluated on whole-brain computed tomography (CT) digital subtraction angiography (DSA) and CT perfusion (CTP) studies.MethodsCT data sets of ten anonymized patients were retrospectively analyzed. Five patients had evidence of DVA and five age- and sex-matched controls were without known neurovascular abnormalities. CT angiograms, CT arterial-venous views, 4-D CT DSA and CTP maps were acquired on a dynamic volume imaging protocol on a 320-detector row CT scanner. Whole-brain CTP parameters were evaluated for cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), mean transit time (MTT), and delay. DSA was utilized to visualize DVA anatomy. Radiation dose was recorded from the scanner console.ResultsIncreased CTP values were present in the DVA relative to the unaffected contralateral hemisphere of 48%, 32%, and 26%; and for the control group with matched hemispheric comparisons of 2%, −10%, and 9% for CBF, CBV, and MTT, respectively. Average effective radiation dose was 4.4 mSv.ConclusionWhole-brain DSA and CTP imaging can demonstrate a characteristic appearance of altered DVA hemodynamic parameters and capture the anomalies in superior cortices of the cerebrum and the cerebellum. Future research may identify the rare subsets of patients at increased risk of adverse outcomes secondary to the altered hemodynamics to facilitate tailored imaging surveillance and application of appropriate preventive therapeutic measures.

SUMMARY:A patient with suspected giant cell arteritis and prior negative findings on superficial temporal artery biopsy was evaluated with 320-detector row CT angiography (CTA) and whole-brain perfusion. Corticosteroid treatment was initiated on the basis of CT angiography findings of arteritis and a cortical perfusion deficit. The patient's symptoms and perfusion imaging findings resolved following therapy. Whole-brain CTA and imaging was helpful in the diagnosis and monitoring this patient with suspected vasculitis. Large vessel cerebral vasculitis (LVCV) represents involvement of the internal carotid artery (ICA); intracranial vertebral arteries; the basilar artery; and the M1, A1, and P1 segments of the middle, anterior, and posterior cerebral arteries (MCA, ACA, and PCA, respectively).1 There is a wide range of diagnostic imaging strategies for patients with clinically suspected LVCV, including multidetector CT (MDCT), MR imaging, positron-emission tomography (PET), and Doppler sonography.2 Three-hundred-twentyϪdetector row CT enables whole-brain perfusion CT (PCT) and quantitative measurements of regional cerebral blood flow and volume (rCBF and rCBV). Such perfusion imaging potentially allows rapid reliable visualization of the effects of cerebral autoregulation mechanisms in parenchymal ischemia.Combined with CT angiography (CTA), PCT has demonstrated clinical utility in acute ischemia.3,4 The major drawback of PCT to date has been the limited volume coverage achieved with 64-section CT imaging.3 The 320 ϫ 0.5 mm detector configuration overcomes this limitation and enables assessment of the entire brain using iodinated contrast opacification for a period of time, so-called "dynamic volume CT." The specific advantage in vasculitis is that abnormalities may not follow vascular distributions, requiring whole-brain PCT to identify all findings. We report a patient who underwent dynamic volume CT before and after treatment for suspected LVCV. Case ReportA 39-year-old right-handed man presented with a left temporal headache, which did not have specific aggregating or relieving factors. The physical examination findings were normal, with the exception of absent reflexes in the right biceps. Pertinent signs included an elevated erythrocyte sedimentation rate (ESR) of 106 mm/h, a C-reactive protein level of 8 mg/L, and a borderline white blood cell count of 11,000 cellsL/ mm 3 . The patient had normal findings on CSF analysis. The medical history was significant for left-sided headaches and a negative prior biopsy of the left superficial temporal artery (STA) for suspected giant cell arteritis (GCA). The differential diagnosis included primary headaches, vasculitis, transient ischemic attack, and impending stroke. Dynamic volume CT (AquilionONE; Toshiba, Tochigi-ken, Japan) was performed during infusion of 70-mL iodinated contrast media (ioversol, Optiray 350; Mallinckrodt, St. Louis, Mo) at 5 mL/s. Single-rotation whole-brain volume datasets were acquired (80 kV, 100 mA, 1-second rotation) intermittently in 2 st...

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