Normal perivascular spaces mimicking lacunar infarction: MR imaging.

Abstract

Perivascular (Virchow-Robin) spaces normally surround perforating arteries that enter the medial temporal lobes, corpus striatum, and thalamus. The high soft-tissue sensitivity of magnetic resonance (MR) imaging allows for the frequent detection of such cerebrospinal fluid (CSF)-filled spaces. Especially on axial images, these CSF-filled perivascular spaces may be confused with pathologic lesions, such a lacunar infarcts. Postmortem brain specimens demonstrate the anatomy of perivascular spaces around perforating arteries. Orthogonal images in the living patient help confirm this anatomic relationship. The characteristic CSF signal patterns from these foci are further evidence of their anatomic identification and true benign nature.

Perivascular Spaces in Old Age: Assessment, Distribution, and Correlation with White Matter Hyperintensities

“…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.…”

Expanding lacunae causing triventricular hydrocephalus

“…Magnetic resonance imaging demonstrates enlarged perivascular spaces as tiny-to-large CSF-filled cavities with well-defined smooth margins that are surrounded by normal brain parenchyma and display no enhancement after administration of contrast agent. [11,17] The typical distribution of the perivascular spaces visible on MR imaging includes the basal ganglia, the cerebral white matter, and the midbrain, conforming to the path of the penetrating arteries. In particular, in 20% of patients in whom MR imaging was performed, tiny perivascular spaces were identified at the junction of the substantia nigra and cerebral peduncle, where the penetrating branches of the collicular or accessory collicular arteries are located.…”

“…Magnetic resonance (MR) imaging enables an in vivo demonstration of expanding lacunae and contributes to their differential diagnosis, which includes other brain cysts. [10,11,17] In the current report we describe two patients in whom mesencephalothalamic expanding lacunae were observed on MR imaging and in whom the referring complaints were related to triventricular hydrocephalus that was caused by obstruction and stenosis of the cerebral aqueduct and compression of adjacent brain parenchyma. …”

Magnetic Resonance Imaging of Multiple Brain Abscesses of the Bilateral Basal Ganglia.

“…Recently, several authors have raised the following differential points: lacunae occur in the upper two-thirds of the basal ganglia, are slit-like or ovoid in shape, and are larger than 5 mmin size. Dilated Virchow-Robin spaces locate in the inferior one-third of the putamen, their morphology is round or linear, and they are usually 5 mmor less (13,14). In addition, Virchow-Robin spaces are more symmetric and bilateral than lacunae (15).…”