Dynamic nature of cavernous malformations: a prospective magnetic resonance imaging study with volumetric analysis

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Object. Although cavernous malformations (CMs) are not detected in angiographic studies, they have a characteristic appearance on magnetic resonance (MR) images. A number of reports published in the last decade have focused on the behavior of these lesions within the clinical environment. However, little has been published about the evolution of CMs over time, as observed in imaging studies. To understand imaging-documented changes in CMs over time, we analyzed MR images of 114 cavernous malformations in 68 patients who were followed prospectively.

Methods. For each CM the location, volume, and MR imaging signal characteristics were recorded. Volume data were available for 107 lesions from initial images. The mean volume of these 107 CMs was 2779 mm3. The lesions ranged in size from 0.5 to 46,533 mm3 (46.5 cm3). Volume data from a second set of images were available for 76 CMs (mean interval from first imaging session 26 months), and from a third set of images for 24 lesions (mean interval from second imaging session 18 months). Over the first follow-up interval, the mean volume change was −991 mm3 (a decrease of approximately 1 cm3) and over the second interval the mean volume change was −642 mm3. Although these mean volume changes appear modest, volume changes in single lesions during follow-up intervals were more dramatic, with decreases as large as 45,629 mm3 (45.6 cm3) and increases as large as 6,074 mm3 (6 cm3). Serial examinations of the MR imaging signal characteristics of these CMs demonstrate a trend for maturation of blood products from a subacute, to a mixed, and finally to a chronic appearance. Three lesions appeared de novo during the follow-up period.

Conclusions. On the basis of their analysis, the authors conclude that CMs exhibit a range of dynamic behaviors including enlargement, regression, and de novo formation, as well as progression through a series of characteristic MR imaging appearances.

Article Information

Address reprint requests to: Daniele Rigamonti, M.D., Department of Neurosurgery, The Johns Hopkins Hospital, Meyer 5–181, 600 North Wolfe Street, Baltimore, Maryland 21287.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left: Sagittal T1-weighted MR image obtained in October 1986 revealing a large CM in the right basal ganglia and temporal lobe (left). Right: A similar image obtained in the same patient in August 1993 demonstrating a dramatic decrease in the size of this lesion.

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    Left: Coronal T2-weighted MR image obtained in September 1987 revealing a Type II CM in the lateral left temporal lobe. Right: Coronal contrast-enhanced T1-weighted MR image obtained in the same patient in November 1994 revealing an increase in the size of the CM.

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    Left: Axial T2-weighted MR image obtained in May 1993 demonstrating no sign of a lesion in the left temporal lobe. Right: Axial T2-weighted MR image obtained in the same patient in July 1996 revealing a de novo CM in the left temporal lobe. A small right occipital lesion is demonstrated on both images.

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