CASE 986 Published on 03.09.2001

Diffusion MRI of a cavernous angioma

Section

Neuroradiology

Case Type

Clinical Cases

Authors

R.N.Sener

Patient

71 years, male

Categories

No Area of Interest ; Imaging Technique MR, MR-Functional imaging

No Procedure ; No Special Focus ;

Show more Show less

Download as PDF Print Show related cases Notify admin

Clinical History

Headaches and visual feed defects

Imaging Findings

The patient presented with intermittent headaches, and visual field defects. An MRI was performed including T1 and T2-weighted images, FLAIR images, and echo-planar diffusion MRI.

Discussion

Histologically, cavernous angiomas consist of thin-walled, endothelial-lined, ectatic blood vessels of varying dimensions. They can be considered as true venous malformations. Cavernous angiomas occur throughout the central nervous system, but are most often located in the supratentorial and subcortical regions. In approximately one third of the cases they are multiple and often familial. Patients are usually asymptomatic. The MR imaging features of cavernous angiomas are usually characteristic especially when a central core of hyperintensity (methemoglobin) is surrounded by a ring of hypointensity (hemosiderin). These are usually best appreciated on spin-echo, and gradient-echo T2-weighted images. FLAIR images also show these. Diffusion MRI reveals further data on these, providing diffusion coefficient rates, especially on apparent diffusion coefficient (ADC) maps.

Differential Diagnosis List

Cavernoma in the occipital lobe

Final Diagnosis

Cavernoma in the occipital lobe

References

[1] Hardy PA, Kucharczyk W, Henkelman RM. Cause of signal loss in MR images of old hemorrhagic lesions.
Radiology. 1990 Feb;174(2):549-55. (PMID: 2296664)

[2] Rigamonti D, Drayer BP, Johnson PC, Hadley MN, Zabramski J, Spetzler RF. The MRI appearance of cavernous malformations (angiomas).
J Neurosurg. 1987 Oct;67(4):518-24. (PMID: 3655889)

[3] Labauge P, Brunereau L, Levy C, Laberge S, Houtteville JP. The natural history of familial cerebral cavernomas: a retrospective MRI study of 40 patients.
Neuroradiology. 2000 May;42(5):327-32. (PMID: 10872151)

[4] Muzumdar DP, Misra BK, Bhaduri AS. Pineal region cavernoma--case report.
Neurol Med Chir (Tokyo). 2000 Jul;40(7):372-9. (PMID: 10927906)

[5] Sener RN. MR angiography applications in pediatric intracranial vascular lesions. Warren, H. Green, St. Louis (1997).

Case information

URL:	https://eurorad.org/case/986
DOI:	10.1594/EURORAD/CASE.986
ISSN:	1563-4086

Figure 1

Cavernoma

FLAIR image reveals a cavernoma in the left occipital lobe with a characteristic hyperintense core (methemoglobin) surrounded by a hypointense rim (hemosiderin).

ADC map from an echo-planar diffusion MRI sequence, reveals the ADC value of hemosiderin as 'zero'. The ADC value of the central region, consisting of methemoglobin has an ADC value of 0.37 X10-3 mm2/sec. (the ADC value of normal brain parenchyma is approximately 0.84 X10-3 mm2/sec)