Cavernoma- Radiological Paradox
19 yr old male with headache shows on MRI, subtly enhancing, well defined ,regular, encapsulated, mixed signal intensity , popcorn shaped, lesion in pons (25mm) blooming on SW and occult on DSA is consistent with cavernoma.
Teaching points by Dr MGK Murthy
- In children consist of 2 to 18% of all vascular malformations(mean age 9-10 yrs) (M=F)
- Congenital, developmental ,vascular malformations of vascular bed (prevalent 0.4 to 0.9%) and can grow over time, hemorrhage more common in children (27 to 78%) versus Adults(8 to 37%)
- Common in pons in children among posterior fossa (20% versus supratentorial 80%) (neurological deficits high)
- Imaging shows 3 components (a) peripheral pseudo capsule (gliotic with haemosiderin) (b) irregular intersecting connective tissue septae separating sinusoids (c) central vascular area of slow flow sinusoids. CT can show calcium (33%)
- MRI blooming on Blood sensitive sequences with mixed signals on others due to all stages of blood products due to repeated bleeding. TOF angio can show flowing blood at times , due to methemoglobin, but phase contrast MR angio with low velocity coding (10 to 20 cms/sec) is silent
- Occult on DSA due to slow flow unless mixed variety (30%) , and can occasionally show nonspecific capillary blush on repeat injection.
Cavernoma- Radiological Paradox Reviewed by Sumer Sethi on Sunday, December 28, 2014 Rating: