MR Imaging and Histologic Features of Subinsular Bright Spots on T2-weighted MR Images: Virchow-Robin Spaces of the Extreme Capsule and Insular Cortex

Song, Chang June; Kim, J. H.; Kier, E. Leon; Bronen, Richard A.

doi:10.1148/radiology.214.3.r00mr17671

Cited by 67 publications

(49 citation statements)

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“…7,8 In case of widening, they can be seen on MR imaging as round, oval, or curvilinear well-defined cystic lesions with smooth margins, isointense to CSF.…”

Section: Discussionmentioning

confidence: 99%

Giant Cystic Widening of Virchow-Robin Spaces: An Anatomofunctional Study

Mathias¹,

Koessler²,

Brissart³

et al. 2007

American Journal of Neuroradiology

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SUMMARY:We describe 2 patients with unusual white matter cystic dilations, which could correspond to widening of the perivascular spaces. They underwent morphologic MR imaging with tractography, functional MR imaging (fMRI), and neuropsychological evaluation. fMRI examination showed no functional reorganization of cortical areas. Tractography showed an apparent decrease of white matter tract vectors into the regions of concern. Findings of the neuropsychological examination were normal. It seems that even an extensive cystic dilation of white matter does not deteriorate brain function.A n extreme widening of Virchow-Robin spaces is a rare entity, because fewer than 10 cases have been reported in the literature. [1][2][3][4][5][6] We report 2 patients showing unilateral intraparenchymal extensive cystic dilations suspected of corresponding to perivascular spaces. These abnormalities were fortuitously discovered on CT. Both patients underwent a morphologic and functional MR imaging evaluation (tractography, fMRI) associated with a neuropsychological examination. Case Reports Patient 1A 45-year-old man, because of benign head trauma, underwent a nonenhanced CT scan, which revealed a left frontal hypoattenuated lesion. The clinical neurologic and neuropsychological examination findings were normal.A morphologic MR imaging examination was performed and showed extensive cystic dilations into the left superior (F1) and inferior (F2) frontal gyri, a portion of the left precentral gyrus, the anterior left cingulate gyrus, and the corpus callosum ( Fig 1A, -B).An fMRI of the right-and left-handed motor tasks (block paradigm, finger tapping, T2* echo-planar imaging [EPI], TR ϭ 2500 ms, TE ϭ 30 ms, matrix ϭ 64 ϫ 64, FOV ϭ 25 cm, 130 frames, image preprocessing [ie, section timing, realigning, coregistering]) and statistical analyses (P Ͻ .001) were performed by using SPM2 (Wellcome Department of Cognitive Neurology, Queen's College, London; http://www.fil.ion.ucl.ac.uk/spm), and a diffusion tensor imaging acquisition (TR ϭ 7000 ms, TE ϭ 78.6 ms, b ϭ 1000 s/mm 2 , 15 directions, matrix ϭ 128 ϫ 128, FOV ϭ 26 cm, section thickness ϭ 3 mm) with fiber tracking (Fibertrack; FuncTool software, Version 3.1.22, GE Healthcare, Milwaukee, Wis) was performed. fMRI ( Fig 1C, -D) showed a cortical activation in the left motor supplementary area in Broadmann areas 4 and 6 after right-handed finger tapping. After the left-handed movement, the activations were identical and symmetric to the right side. Tractography (Fig 1E) showed a decrease of white matter fibers in the pathologic areas compared with the healthy side. Patient 2A 57-year-old woman presenting with stability disorders underwent a nonenhanced CT scan, which revealed a left temporoparietal hypoattenuated lesion. The clinical neurologic and neuropsychological examination findings were normal.A morphologic MR imaging was performed and showed extensive cystic dilations into the left superior and inferior parietal lobules and in the posterior part of the left middle (T2) and inferi...

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“…7,8 In case of widening, they can be seen on MR imaging as round, oval, or curvilinear well-defined cystic lesions with smooth margins, isointense to CSF.…”

Section: Discussionmentioning

confidence: 99%

Giant Cystic Widening of Virchow-Robin Spaces: An Anatomofunctional Study

Mathias¹,

Koessler²,

Brissart³

et al. 2007

American Journal of Neuroradiology

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“…For each level separately, we divided the total number of VRs in both hemispheres together into three arbitrary semi-quantitative categories: 1) lower than 20 ("low"), 2) between 20 and 50 ("moderate") and 3) higher than 50 ("high"). The criteria for VRs were: 1) round, oval or linear shape with a smooth margin, 2) signal intensity equal to that of the cerebrospinal fluid on T2-images (larger VRs can be visible as hypointense lesions on FLAIR images, but always without hyperintense rim), and 3) absence of mass effect [2,18,19]. Fig.…”

Section: Methodsmentioning

confidence: 99%

Virchow-Robin spaces relate to cerebral small vessel disease severity

et al. 2008

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“…Indeed, PVS are correlated with increasing age, 4,9,13 though some earlier studies have shown equal distribution of PVS through a range of ages. 14,15 In addition, a sex difference in the distribution of PVS in the basal ganglia has been reported, with men having more PVS than women. 11,13,16 The most common etiologies proposed for the widening of the originally virtual PVS to become visible on MR imaging are hypertension 13,17 and amyloid deposition, at least in patients with Alzheimer disease.…”

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confidence: 99%