Large anterior temporal Virchow-Robin spaces: unique MR imaging features
Anthony T Lim1, Ronil V Chandra, Nicholas M Trost
1Neuroradiology Service, Monash Imaging, Monash Health, Monash University, 246 Clayton Road, Melbourne, Victoria, 3168, Australia.
Introduction:
Large Virchow-Robin (VR) spaces may mimic cystic tumor. The anterior temporal subcortical white matter is a recently described preferential location, with only 18 reported cases. Our aim was to identify unique MR features that could increase prospective diagnostic confidence.
Methods:
Thirty-nine cases were identified between November 2003 and February 2014. Demographic, clinical data and the initial radiological report were retrospectively reviewed. Two neuroradiologists reviewed all MR imaging; a neuropathologist reviewed histological data.
Results:
Median age was 58 years (range 24-86 years); the majority (69 %) was female. There were no clinical symptoms that could be directly referable to the lesion. Two thirds were considered to be VR spaces on the initial radiological report. Mean maximal size was 9 mm (range 5-17 mm); majority (79 %) had perilesional T2 or fluid-attenuated inversion recovery (FLAIR) hyperintensity. The following were identified as potential unique MR features: focal cortical distortion by an adjacent branch of the middle cerebral artery (92 %), smaller adjacent VR spaces (26 %), and a contiguous cerebrospinal fluid (CSF) intensity tract (21 %). Surgery was performed in three asymptomatic patients; histopathology confirmed VR spaces. Unique MR features were retrospectively identified in all three patients.
Conclusion:
Large anterior temporal lobe VR spaces commonly demonstrate perilesional T2 or FLAIR signal and can be misdiagnosed as cystic tumor. Potential unique MR features that could increase prospective diagnostic confidence include focal cortical distortion by an adjacent branch of the middle cerebral artery, smaller adjacent VR spaces, and a contiguous CSF intensity tract.
Insights
Large Virchow-Robin (VR) spaces in the anterior temporal lobe can mimic tumors. Unique MRI features like cortical distortion and CSF tracts aid in accurate diagnosis, improving patient management.
Area of Science:
- Neuroradiology
- Neuroimaging
- Neuropathology
Background:
- Large Virchow-Robin (VR) spaces, particularly in the anterior temporal subcortical white matter, can be misdiagnosed as cystic tumors.
- This location is rare, with only 18 previously reported cases, highlighting the need for improved diagnostic criteria.
Purpose of the Study:
- To identify unique Magnetic Resonance (MR) imaging features that can increase diagnostic confidence for large anterior temporal lobe VR spaces.
- To differentiate these lesions from cystic tumors prospectively.
Main Methods:
- Retrospective review of 39 cases of large anterior temporal lobe VR spaces identified between 2003 and 2014.
- Analysis included demographic and clinical data, initial radiological reports, and detailed review of MR imaging by two neuroradiologists.
- Histopathological data from surgically treated patients were reviewed by a neuropathologist.
Main Results:
- The majority of patients were female, with a median age of 58 years. No specific clinical symptoms were directly attributable to the lesions.
- Perilesional T2 or fluid-attenuated inversion recovery (FLAIR) hyperintensity was observed in 79% of cases. Mean maximal size was 9 mm.
- Unique MR features identified included focal cortical distortion (92%), smaller adjacent VR spaces (26%), and a contiguous cerebrospinal fluid (CSF) intensity tract (21%).
Conclusions:
- Large anterior temporal lobe VR spaces often exhibit perilesional T2/FLAIR signal abnormalities, increasing the risk of misdiagnosis as cystic tumors.
- Specific MR features such as focal cortical distortion by an adjacent middle cerebral artery branch, smaller adjacent VR spaces, and a contiguous CSF tract can significantly enhance diagnostic confidence.
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