Radiologic characterization and clinical management of multinodular and vacuolating neuronal tumor (MVNT): a...

Multinodular and vacuolating neuronal tumor (MVNT) is a rare, benign entity first recognized by the World Health Organization in 2016. Given that patients with MVNT often present incidentally or with nonspecific symptoms, understanding imaging characteristics and treatment strategies is critical to effective management. This study describes the radiologic characteristics and clinical outcomes of individuals with MVNT through a large retrospective cohort.

A tertiary academic center's radiology database was queried for individuals with "Multinodular and Vacuolating Neuronal Tumors," "MVNT," or "T2-hyperintense nodules." Of 190 patients, 27 were identified with radiologically determined MVNT by two expert neuroradiologists. Clinical, imaging, and management data were collected through retrospective chart review.

The median age at radiologic discovery of MVNT was 43 years (6-81 years). The most common symptoms at presentation included headaches (11/26, 42.3%) and seizures (7/26, 26.9%). On MRI, MVNTs were often subcortical, nodular lesions that appeared hypointense on T1-weighted imaging (25/27, 92.6%), hyperintense on T2-weighted imaging (27/27, 100%), fluid-attenuated inversion recovery hyperintense (27/27, 100%), and non-contrast enhancing (23/27, 85.2%). Most individuals pursued conservative management with imaging (23/26, 88.5%), though three patients underwent surgery (3/26, 11.5%). Presenting symptoms improved in most conservatively managed (16/23, 69.6%) and both surgical (2/2, 100%) cases by the last follow-up. Neither progression nor recurrence was observed in any case.

This study highlights the nonspecific presentation and characteristic MRI features of MVNT. Our findings support conservative imaging follow-up for most patients with MVNT, though surgery may benefit select patients with severe symptoms, including drug-resistant epilepsy.