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Table 3: Sample MR imaging–based protocol for brain VM screening in children with HHT (see also Vella et al¹⁷)
MR imaging brain with and without contrast
 DWI and ADC: assess for acute ischemia
 ASL: evaluate for asymmetric perfusion that can identify arteriovenous shunting
 FLAIR: sensitive for edema or gliosis related to VMs
 SWI: most sensitive for evidence of hemorrhage or microhemorrhage
 T1-weighted pre and postcontrast: differentiate intrinsic T1 shortening from enhancement
 High-resolution 3D postcontrast: most sensitive sequence for small HHT-related shunting AVMs and nonshunting capillary malformations
 High-resolution 3D T2-weighted: sensitive for edema or gliosis related to VMs
MRA head
 Obtain TOF images from skull base to vertex (“whole head” MRA) because VMs can occur anywhere in brain parenchyma, not just near the circle of Willis