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Yes, a vein of Galen malformation (VOGM) can sometimes be missed on early neonatal MRI, though this is uncommon and usually depends on several factors:
1. Timing of Imaging
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Very early MRI (first 1–2 days of life) might miss VOGM if:
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The venous system hasn't fully developed postnatally.
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There is minimal flow or the lesion is small at the time.
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However, VOGM is typically visible on prenatal imaging (especially fetal MRI or detailed ultrasound in the third trimester), and often presents shortly after birth with symptoms like high-output cardiac failure or hydrocephalus.
2. Type of MRI Sequences Used
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If MR angiography (MRA) or MR venography (MRV) was not included, a vascular lesion may be overlooked.
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Routine brain MRI without contrast or without flow-sensitive sequences may not clearly show abnormal vessels.
3. Subtle or Atypical Presentations
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Small or low-flow variants of VOGM may be more difficult to detect.
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Sometimes, other venous anomalies can mimic or obscure the findings.
4. Radiologist Experience
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Interpretation by someone not familiar with neonatal cerebrovascular anomalies can result in missed diagnosis.
Suggestion:
If there is clinical suspicion (e.g., unexplained hydrocephalus, heart failure, cranial bruit), and the early MRI was negative or unclear, repeat imaging with MR angiography or CT angiography, or even ultrasound with Doppler, may be warranted.
Would you like to go over how VOGM typically appears on imaging or what symptoms would prompt reevaluation?
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