23/05/2026
SWI is a cornerstone for detecting venous hypertension in intracranial dural arteriovenous fistulas (dAVFs)—but the morphological spectrum and clinical meaning of parenchymal hypointensities are where real-world reading skill matters.
In this single-center cohort, gyral hypointensity (GH) on SWI emerged as a marker of decompensated venous hypertension, identifying high-grade shunts, retrograde leptomeningeal drainage, and exhausted collateral capacity—not a benign incidental finding. Morphology predicts reversibility: brush-like GH reflects early, reversible parenchymal stress that typically resolves after shunt obliteration, while band-like GH signals more advanced venous injury with limited recovery. When GH coexists with FLAIR or DWI abnormalities, it should be read as an imminent-risk sign of venous ischemia and a trigger for timely endovascular treatment—not watchful waiting. The key pitfall: don’t mistake GH for clustered microhemorrhages or hemosiderin.
DOI: 10.1007/s00234-026-03979-w
Prepared by Clemente García-Hidalgo, ESNR Social Media Committee.
