Keywords
Intracranial
CT
MRI
Diagnosis
Submitted : 2024-07-10
Accepted : 2024-07-25
Published : 2024-08-09
Abstract
Objective: To investigate the computed tomography (CT) and magnetic resonance imaging (MRI) features of cavernous hemangioma malformation (CHM) to enhance diagnostic accuracy. Methods: The CT and MRI findings and clinical information of 23 patients with CHM were retrospectively analyzed. Results: CT examinations were conducted in 7 cases, while MRI was utilized in 23 cases. Additionally, SWI was employed in 5 cases and enhanced imaging techniques were applied in 14 cases. Among the observed lesions, 20 cases presented with a singular lesion, whereas 3 cases exhibited multiple lesions. The lesions were located in 8 frontal lobes, 6 cerebellums, 2 brainstems, 6 temporal lobes, 1 basal ganglia, 3 parieto-occipital lobes, and 2 thalamus regions. The nodules appeared as quasi-circular lesions with clear or well-defined boundaries. They presented as isodense lesions on CT scans, with one lesion showing peritumoral edema. On MRI, T1-weighted imaging (T1WI) demonstrated isointense signals, while T2-weighted imaging (T2WI) showed isointense and hyperintense signals. Additionally, 10 lesions exhibited a low signal ring on T2WI. Diffusion-weighted imaging (DWI) revealed nodular or isointense low signals, while susceptibility-weighted imaging (SWI) displayed enlarged areas of low signal. Fourteen lesions underwent contrast-enhanced scanning, with 2 lesions showing no obvious enhancement, 1 lesion demonstrating mild to moderate enhancement, and 11 lesions exhibiting significant enhancement. Notably, 6 of these enhanced lesions were surrounded by small blood vessels. Conclusion: Cavernous hemangioma malformation is more commonly found in individual cases. CT alone lacks specificity, making it prone to misdiagnosis. A more comprehensive evaluation of cavernous hemangioma malformation can be achieved through a combination of MRI, DWI, SWI, and enhanced examination, providing valuable references for clinical assessment.
References
Chehuen Bicalho V, da Fontoura Galvao G, Lima Fontes-Dantas F, et al., 2021, Asymptomatic Cerebral Cavernous Angiomas Associated with Plasma Marker Signature. J Clin Neurosci, 89: 258–263. https://doi.org/10.1016/j.jocn.2021.04.024
Awad IA, Polster SP, 2019, Cavernous Angiomas: Deconstructing A Neurosurgical Disease. J Neurosurg, 131(1): 1–13. https://doi.org/10.3171/2019.3.JNS181724
Mujkic A, Mujagic S, Mehmedovic Z, et al., 2023, The Visualization and Frequency of Cerebral Cavernous Angioma on Magnetic Resonance. Acta Inform Med, 32(1): 28–31. https://doi.org/10.5455/aim.2024.32.28-31
Zhang S, Ma L, Wu C, et al., 2020, A Rupture Risk Analysis of Cerebral Cavernous Malformation Associated with Developmental Venous Anomaly Using Susceptibility-Weighted Imaging. Neuroradiology, 62(1): 39–47. https://doi.org/10.1007/s00234-019-02274-1
Tsutsumi S, Ogino I, Kondo A, et al., 2022, Cerebral Cavernous Malformations Confined in the Cerebral Sulci. Neurol India, 70(2): 822–823. https://doi.org/10.4103/0028-3886.344604
Bernotas G, Rastenyte D, Deltuva V, et al., 2009, Cavernous Angiomas: An Uncontrolled Clinical Study of 87 Surgically Treated Patients. Medicina (Kaunas), 45(1): 21–28.
Rumalla K, Srinivasan VM, Gaddis M, et al., 2021, Cavernous Malformation Surgery in the United States: Validation of a Novel International Classification of Disease, 10th Edition, Clinical Modification Code Search Algorithm and Volume-Driven Surgical Outcomes. World Neurosurg, 150: e66–e73. https://doi.org/10.1016/j.wneu.2021.02.081
Ganz JC, 2022, Cavernous Malformations. Prog Brain Res, 268(1): 115–132. https://doi.org/10.1016/bs.pbr.2021.10.029
Lanfranconi S, Piergallini L, Ronchi D, et al., 2021, Clinical, Neuroradiological and Genetic Findings in A Cohort of Patients with Multiple Cerebral Cavernous Malformations. Metab Brain Dis, 36(7): 1871–1878. https://doi.org/10.1007/s11011-021-00809-1
Wang KY, Idowu OR, Lin DDM, 2017, Radiology and Imaging for Cavernous Malformations. Handb Clin Neurol, 143: 249–266. https://doi.org/10.1016/B978-0-444-63640-9.00024-2
Alfaraj D, Alismail M, Almulhim H, et al., 2023, Behavioral Seizure in a Patient With a Cavernous Malformation Finding in CT: A Case Report. Cureus, 15(2): e34731. https://doi.org/10.7759/cureus.34731. Erratum in Cureus, 15(2): c104. https://doi.org/10.7759/cureus.c104
Rivera PP, Willinsky RA, Porter PJ, 2003, Intracranial Cavernous Malformations. Neuroimaging Clin N Am, 13(1): 27–40. https://doi.org/10.1016/s1052-5149(02)00060-6
Kurihara N, Suzuki H, Kato Y, et al., 2020, Hemorrhage Owing to Cerebral Cavernous Malformation: Imaging, Clinical, and Histopathological Considerations. Jpn J Radiol, 38(7): 613–621. https://doi.org/10.1007/s11604-020-00949-x
Kang K, Ju Y, Wang D, et al., 2018, Cerebral Venous Malformations in a Chinese Population: Clinical Manifestations, Radiological Characteristics, and Long-Term Prognosis. World Neurosurg, 120: e472–e479. https://doi.org/10.1016/j.wneu.2018.08.106
Lee C, Shin YS, Choi JH, 2020, Primary Brainstem Angiosarcoma Mimicking Cavernous Malformation. World Neurosurg, 139: 232–237. https://doi.org/10.1016/j.wneu.2020.04.084
Carrion-Penagos J, Zeineddine HA, Polster SP, et al., 2020, Subclinical Imaging Changes in Cerebral Cavernous Angiomas During Prospective Surveillance. J Neurosurg, 134(3): 1147–1154. https://doi.org/10.3171/2020.1.JNS193479
Kearns KN, Chen CJ, Tvrdik P, et al., 2020, Outcomes of Basal Ganglia and Thalamic Cavernous Malformation Surgery: A Meta-Analysis. J Clin Neurosci, 73: 209–214. https://doi.org/10.1016/j.jocn.2019.12.019
Antonelli V, Maimone G, Fuschillo D, et al., 2023, De Novo Cavernous Angiomas Associated with Developmental Venous Anomaly: A Mini-Series and Literature Review. J Neurosurg Sci, 67(6): 758–766. https://doi.org/10.23736/S0390-5616.21.05512-0