Vein of Galen

At Children’s Hospital Boston, we know that an early and accurate diagnosis of vein of Galen malformation (VOGM) is crucial for the most effective treatment.

How early can vein of Galen malformation (VOGM) be detected?

Vein of Galen malformation (VOGMs) may be detected at a range of possible ages, from detection in utero on a prenatal ultrasound during the third trimester to detection soon after birth or even later.

What diagnostic tests are used for VOGM?

The diagnostic tests your child might require include:

• Ultrasound: both during the third trimester of pregnancy and soon after birth (with dedicated head ultrasound), ultrasound is the critical first imaging test that leads to a diagnosis of VOGM. While a firm diagnosis of VOGM can usually be made using ultrasound, important details about the overall state of the brain and the morphology and complexity of the VOGM can only emerge from other kinds of imaging.

• Magnetic resonance imaging (MRI): the main tool in diagnosing VOGMs, this imaging procedure uses a combination of large magnets, radiofrequency energy pulses, and sophisticated computer algorithms to produce detailed images of brain structure and give a detailed picture of the overall health of the brain.

• Magnetic resonance venography (MRV): acquired at the same time as MRI, this is a tool that uses the same magnetic fields and radiofrequency energy to produce detailed images of the veins in the brain

• Magnetic resource angiogram (MRA):  also acquired at the same time as MRI, this is another type of imaging test that focuses on producing detailed images of the arteries in the brain

• Computerized tomography angiogram (CTA): an imaging tool that uses a combination of x-rays and powerful computer technology to create detailed images of the child blood vessels, with greater detail than can be achieved with MRA. However, unlike MRI/MRA/MRV, CTAs involve exposure to radiation from the x-rays, which we attempt to minimize, particularly in newborns. For this and other reasons, MRI/MRA/MRV are generally chosen over CTA scans.

• Angiogram: cerebral angiograms play a critical role in the diagnosis and treatment of VOGM. Angiography is performed with a catetheter: a long, thin, flexible, hollow tube, which is usually inserted into an artery in the leg, and which is advanced, under imaging guidance, to the arteries that lead to the brain. In each artery, a special dye, contrast, is injected, providing detailed images of the blood vessels supplying the brain, as well as the blood vessels that make up the VOGM. Especially in young infants, angiography is almost always performed together with embolization: the procedure for closing down the VOGM.

• Echocardiogram:  an ultrasound scan of the heart to assess its structure and function. Every child with VOGM will have this procedure to assess how much the heart function is being impacted by the malformation, if at all.