Zabramski classification of cerebral cavernous malformations
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 (June 2016) 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
- low signal rim with blooming on T2* sequences
-
type III: chronic hemorrhage
- T1: hypointense to isointense centrally
- T2: hypointense centrally
- low signal rim with blooming on T2* sequences
-
type IV: multiple punctate microhemorrhages
- T1: difficult to identify
- T2: difficult to identify
- T2* Gradient Echo: "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.
Related Radiopaedia articles
Vascular tumours and malformations
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vascular malformations and tumors
- classifications
- vascular tumors
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hemangioma
- infantile hemangioma
- congenital hemangiomas (RICH and NICH)
- tufted angioma (with or without Kasabach Merritt syndrome)
- Kaposiform hemangioendothelioma (with or without Kasabach Merritt syndrome)
- spindle cell hemangioendothelioma
- other, rare hemangioendotheliomas
- dermatologic acquired vascular tumors
-
hemangioma
- slow-flow vascular malformations
- capillary malformation (CM)
- venous malformation (VM)
- common sporadic venous malformation
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cavernous venous malformation (cavernoma or cavernous hemangioma)
- cerebral cavernous venous malformation
- orbital cavernous venous malformation
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hepatic cavernous venous malformation (hepatic hemangioma)
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atypical hepatic venous malformation (atypical hepatic hemangioma)
- giant hepatic venous malformation (giant hepatic hemangioma)
- flash filling hepatic venous malformation (flash filling hepatic hemangioma)
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atypical hepatic venous malformation (atypical hepatic hemangioma)
- splenic cavernous venous malformation (splenic hemangioma)
- breast venous malformation (breast hemangioma)
- retroperitoneal venous malformation
- soft tissue venous malformation
- primary intraosseous venous malformation
- cardiac venous malformations
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cavernous venous malformation (cavernoma or cavernous hemangioma)
- Bean syndrome
- familial cutaneous and mucosal venous malformation
- glomuvenous malformation (glomangioma)
- Maffucci syndrome
- common sporadic venous malformation
- lymphatic malformation (LM)
- fast flow vascular malformations
- arterial malformation
- ectasia
- coarctation
- aneurysm
- arterial malformation
- arteriovenous fistulae (with one or more shunts)
- arteriovenous malformations (with a nidus of multiple shunts)