The MRI appearance of cavernous malformations (angiomas)

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✓ The angiographic, computerized tomography (CT), and magnetic resonance imaging (MRI) findings were compared in 10 patients with a total of 16 pathologically verified cavernous angiomas. Only three lesions had abnormal vasculature in the form of venous pooling or a capillary blush. The CT scans were positive in seven patients and detected 14 lesions, while high-field strength (1.5 Tesla) MRI was positive in each case and demonstrated 27 distinct lesions. On T2-weighted MRI, the combination of a reticulated core of mixed signal intensity (SI) with a surrounding rim of decreased SI strongly suggests the diagnosis of a cavernous malformation. Smaller lesions appear as areas of decreased SI (black dots). The sensitivity of MRI is based on magnetic susceptibility and possibly diffusion effects related to field heterogeneity that is more conspicuous on high-field imaging and caused by the presence of excessive iron (hemosiderin).

Article Information

Address reprint requests to: Robert F. Spetzler, M.D., Editorial Office, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 7. Left: Computerized tomography scan with contrast enhancement. The medulla is obscured by a transverse artifact. Center: Axial magnetic resonance image (TR 600 msec, TE 20 msec) showing a prominent core of increased signal intensity (methemoglobin) surrounded by a rim of decreased signal (hemosiderin). The rim was better seen on the spin-echo sequence (TR 2500 msec, TE 80 msec) T2-weighted images. Right: Sagittal magnetic resonance image (TR 600 msec, TE 20 msec) showing the cavernous angioma more clearly localized in the posterior medulla in the sagittal plane.

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    Case 2. Left: Computerized tomography scan with contrast enhancement showing a calcified, minimally enhancing lesion. Right: Magnetic resonance image (TR 2500 msec, TE 80 msec) showing the same lesion as a central core of mixed increased and decreased signal intensity (SI) surrounded by a dense black rim of decreased SI due to hemosiderin-laden macrophages. The arrows point to a smaller lesion characterized by a core of predominantly decreased SI (“black dots”).

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    Case 6. Axial magnetic resonance images (TR 2500 msec, TE 40 msec) showing discrete well-circumscribed lesions consisting of a reticulated core of mixed increased and decreased signal intensity surrounded by a black hemosiderin rim.

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    Case 9. Axial magnetic resonance image (TR 2500 msec, TE 80 msec) showing a reticulated mixture of increased and decreased signal intensity in the right medial temporal lobe with a prominent border of markedly decreased signal (hemosiderin) typical of cavernous angioma.

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    Photomicrographic appearance of a cavernous angioma showing thin-walled vascular channels with little intervening brain. Several channels have old hyalinized thrombi (asterisks). Hemosiderin-laden macrophages can easily be seen (arrows) in the adjacent gliotic brain. H amp; E, × 64.

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    Fixed specimen from Case 9, with Perls staining for ferric iron. The prominently increased iron around the cavernous angioma stains a deep blue. This shows a gradation in intensity, and is most intense immediately adjacent to the angioma. Rule is in centimeters.

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    Gradient reversal acquisition technique images obtained with TR 300 msec, TE 12 msec, and a 60° flip angle showing some large and many small areas of decreased signal intensity (SI) due to hemosiderin deposition. These images are extremely sensitive to the magnetic susceptibility effects produced by hemosiderin (decreased SI) while blood vessels are seen as linear increased SI's.

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