MRI of intramedullary cavernous haemangiomas

Turjman, Francis; Joly, D; Monnet, O.; Faure, C; Doyon, D; Froment, J

doi:10.1007/bf00588339

Cited by 15 publications

(6 citation statements)

References 24 publications

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“…2 Clinically, whereas capillary hemangiomas are associated with slowly progressive worsening of symptoms, cavernomas often present acutely with symptoms referable to bleeding. Magnetic resonance-depicted features of spinal cord cavernous angiomas include heterogeneous high and low signal intensity consistent with subacute and chronic hemorrhage, as well as a peripheral T-rim related to hemosiderin deposition, 19 a feature lacking in our cases. The distinction of capillary hemangioma from such highly vascular spinal cord tumors as hemangioblastoma and hemangiopericytoma requires histological examination.…”

Section: Discussionmentioning

confidence: 54%

Capillary hemangioma of the spinal cord

Roncaroli¹,

Scheithauer²,

Krauss³

2000

Journal of Neurosurgery: Spine

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✓ The authors describe the clinicopathological features of four cases of capillary hemangioma of the spinal cord. All occurred in adult patients. The presenting symptoms were similar to those of more common intramedullary tumors. Radiologically, they resemble other vascular spinal cord tumors. All patients underwent surgery, and the outcomes varied. Histologically, the lesions resembled capillary hemangioma of skin or of soft tissue that is composed of lobules of small capillaries with associated feeding vessels, all enveloped by a delicate fibrous capsule. Capillary hemangiomas of the central and peripheral nervous system are extremely rare. Although examples of these lesions have been described as occurring in the dura mater and in peripheral nerve, including spinal nerve roots, none has occurred within the spinal cord. Knowledge of their existence may help practitioners to avoid misdiagnosis of tumor and resultant overtreatment of these benign lesions.

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Section: Discussionmentioning

confidence: 54%

Capillary hemangioma of the spinal cord

Roncaroli¹,

Scheithauer²,

Krauss³

2000

Journal of Neurosurgery: Spine

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“…In that study, longitudinal spread of hemorrhage was present in 54.5% (6/11) patients at baseline and was found to be a useful feature differentiating SCMs from hemorrhagic ependymomas 17 . Other smaller case series reported similar findings of hemorrhage extending from SCMs in patients with symptomatic worsening on follow‐up 15,18,20,21 . This appearance has been attributed to repeated episodes of small hemorrhages and oozing of blood followed by reactive vascular proliferation, scarring, gliosis, and accumulation of hemosiderin‐lined macrophages in the cord parenchyma 16,17,24,25 .…”

Section: Discussionmentioning

confidence: 74%

“…Most of these descriptions have been derived from those of cerebral cavernous malformations (CCMs) and not all of these radiological features have been specifically evaluated in large series of SCMs. Prior radiology case series on SCMs have been limited by small sample sizes due to the relative rarity of these lesions 14‐17 . To our knowledge, the largest single‐center retrospective imaging‐based review of SCMs was composed of 11 lesions 14,17 .…”

Section: Introductionmentioning

confidence: 99%

Spinal Cord Cavernous Malformations: MRI Commonly Shows Adjacent Intramedullary Hemorrhage

Diehn

Kim

Bydon

et al. 2020

Journal of Neuroimaging

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BACKGROUND AND PURPOSE: There is a relative paucity of radiology literature on spinal cord cavernous malformations (SCMs). We hypothesized that the classic MRI features of cavernous malformations are not highly prevalent. The purpose was to review MR imaging findings of SCMs with a focus on prevalence of hemorrhagic features, including adjacent intramedullary hemorrhage at initial presentation. METHODS: In this single-institution study, 78 SCMs in 76 patients diagnosed on imaging/pathology were retrospectively evaluated for size, location, cord expansion, exophytic component, popcorn morphology, signal characteristics, including T1 weighted (T1w) and T2w rims, blood-fluid levels, and adjacent intramedullary hemorrhage. Intramedullary hemorrhage was defined as centrally and/or eccentrically located linear or flame shaped non-edematous signal abnormality extending longitudinally away from SCMs, distinct from lesional rim. RESULTS: Sixty-three percent (49/78) of SCMs measured <1 cm in length, 78% (61/78) extended to the cord surface, 65% (51/78) were expansile, and 32% (25/78) were exophytic. Popcorn morphology was seen in 15% (12/78) on T1w and 22% (17/78) on T2w. Internal blood-fluid levels were evident in 4% (3/78). Sixty-nine percent (54/78) showed T2w hypointense rims; the T2w rim was complete/near-complete in 37% (29/78). A rim on T1w was visible in 49% (38/78); this was hyperintense in 58% (22/38). Adjacent intramedullary hemorrhage was seen in 45/78 (58%), was most commonly bidirectional in 67% (30/45) and eccentric in 68% (30/44). Cord edema was seen in 22% (17/78); 53% (9/17) also demonstrated intramedullary hemorrhage with edema. CONCLUSIONS: The classically described popcorn morphology, internal blood-fluid levels, and complete/near-complete T2w hypointense rims are often absent on MRIs in SCMs. Adjacent intramedullary hemorrhage is frequently present, often eccentric and bidirectional.

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“…The clinical presentation of intramedullary cavernomas is variable, they can remain a long time asymptomatic or manifest as a sudden or progressive neurological deficit [11]. The acute manifestation in the form of paraplegia or quadriplegia is often related to intra-tumor bleeding either spontaneous because of minimal trauma, physical exertion or during pregnancy [12][13][14][15].…”

Section: Clinical Aspectsmentioning

confidence: 99%

“…Type IV manifests as an isosignal lesion T1 and T2, visible only in gradient echo. Differential diagnosis can still arise with a tumor intramedullary, especially when it is haemorrhagic (metastasis of melanoma) [15,18]. In that case, the use of gadolinium makes it possible to differentiate them; medullary tumors clearly strengthening, so that the cavernome little or not [19].…”

Section: Paraclinical Diagnosismentioning

confidence: 99%

Intramedullary Cavernoma: Case Report and Literature Review

2019

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Introduction: Cavernomas are benign vascular anomalies consisting of cavities where the blood circulates at low flow and at low pressure. Intramedullary localization is unusual, represents approximately 5 to 12% of spinal vascular malformations and 3% of intra-dural vascular malformations (5% of medullary vascular lesions). Observation: A patient, aged 59, consulted for the abrupt installation of moderate back pain followed by predominant muscle weakness in the two lower limb of progressive worsening, responsible for gait disorders. The patient reported thermal hypoesthesia and heaviness of the two lower limbs that had been evolving for two years. The examination found a dorsal spinal cord compression syndrome. On the MRI, there were abnormalities of intramedullary signal of the dorsal (D11) spinal cord with bleeding stigmas suggestive of intramedullary cavernomas. Conclusion: The management of the medullary cavernoma is essentially neurosurgical with complete microsurgical resection of the malformation. In the absence of surgical treatment, evolution can be to chronic myelopathy or neurological aggravation.

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MRI of intramedullary cavernous haemangiomas

Cited by 15 publications

References 24 publications

Capillary hemangioma of the spinal cord

Capillary hemangioma of the spinal cord

Spinal Cord Cavernous Malformations: MRI Commonly Shows Adjacent Intramedullary Hemorrhage

Intramedullary Cavernoma: Case Report and Literature Review

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