The Zabramski classification of cerebral cavernomas has been proposed as a way of classifying cerebral cavernous malformations, and although not used in clinical practice it is useful in scientific publications that seek to study cavernous malformations.
The classification was proposed in 1994 1, and at the time of writing (mid 2024) remains the most commonly used classification of cavernous malformations in the literature.
Classification
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type I: subacute hemorrhage
T1: hyperintense
T2: hypo or hyperintense
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type II: most common type - classic "popcorn" lesion
T1: mixed signal intensity centrally
T2: mixed signal intensity centrally
T2*: low signal rim with blooming
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type III: chronic hemorrhage
T1: hypointense to isointense centrally
T2: hypointense centrally
T2*: low signal rim with blooming
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type IV: multiple punctate microhemorrhages
T1: difficult to identify
T2: difficult to identify
T2*: "black dots" with blooming
difficult to distinguish from small capillary telangiectasias
It is worth noting a couple of points about type IV cavernous malformations.
Firstly, the classification proposed in 1994 by Zabramski predates SWI and as such some authors have suggested that care should be taken in assuming that lesions only seen on SWI (but not on T2* sequences) are type 4 cavernous malformations 2,3.
Secondly, how these differ from microhemorrhages from other causes (e.g. cerebral amyloid angiopathy and diffuse axonal injury) is unclear in the absence of genetic evidence of familial multiple cavernous malformation syndrome or histology, as the absence of central T1 or T2 abnormality makes a definite diagnosis of cavernous malformation difficult 4.
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