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Normal perivascular spaces mimicking lacunar infarction: MR imaging
C A Jungreis1, E Kanal, W L Hirsch
1Department of Radiology, University of Pittsburgh School of Medicine, Presbyterian University Hospital, PA 15213.
Radiology
|October 1, 1988
Summary
Perivascular spaces, often seen on MRI scans, are normal fluid-filled spaces around brain arteries. These spaces can mimic lesions like lacunar infarcts but are benign when identified correctly.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Perivascular spaces, also known as Virchow-Robin spaces, are anatomical structures surrounding perforating arteries in the brain.
- These spaces are typically found in the medial temporal lobes, corpus striatum, and thalamus.
- Magnetic resonance (MR) imaging's high soft-tissue sensitivity frequently detects these cerebrospinal fluid (CSF)-filled spaces.
Purpose of the Study:
- To differentiate between normal perivascular spaces and pathologic lesions on MR imaging.
- To highlight the potential for confusion between CSF-filled perivascular spaces and lacunar infarcts, particularly on axial images.
- To provide guidance on confirming the benign nature of these findings.
Main Methods:
- Review of postmortem brain specimens to illustrate the anatomy of perivascular spaces.
- Utilizing orthogonal imaging views in living patients to confirm the anatomic relationship of these spaces.
- Analysis of characteristic CSF signal patterns on MR imaging.
Main Results:
- Perivascular spaces are normal findings surrounding perforating arteries.
- CSF-filled perivascular spaces can be mistaken for lacunar infarcts on MR imaging.
- Orthogonal imaging and characteristic CSF signal patterns aid in accurate identification.
Conclusions:
- Accurate identification of perivascular spaces is crucial to avoid misdiagnosis of pathologic lesions.
- MR imaging techniques, including orthogonal views and signal pattern analysis, are effective in confirming the benign nature of perivascular spaces.
- Understanding the anatomy of perivascular spaces enhances diagnostic confidence in neuroimaging.