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Cavernous haemangiomas (angiomas) of the brain: clinically significant lesions
M R Sage1, B P Brophy, C Sweeney
1Department of Radiology, Flinders Medical Centre, Bedford Park, Australia.
Insights
Cavernous haemangiomas are rare brain lesions, found in 0.9% of MRI studies. Magnetic resonance imaging (MRI) and computed tomography (CT) scans help diagnose these lesions, often presenting with seizures.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Cavernous haemangiomas are vascular malformations in the brain.
- Diagnosis can be challenging, requiring advanced imaging techniques.
Purpose of the Study:
- To evaluate the diagnostic utility of MRI and CT in identifying cavernous haemangiomas.
- To correlate imaging findings with clinical presentations.
Main Methods:
- Retrospective review of 2000 MRI brain studies.
- Analysis of clinical, CT, and MRI findings in 23 patients with probable cavernous haemangiomas.
- Comparison of imaging characteristics of identified lesions.
Main Results:
- 18 (0.9%) patients had MRI-confirmed cavernous haemangiomas.
- 33 lesions were identified; 22% of patients had multiple lesions.
- Seizures were the most common presentation (48%), followed by progressive neurological deficits (17%) and hemorrhage (17%).
- T2-weighted MRI showed characteristic mixed signal intensity with a low-signal rim in 73% of lesions.
- CT scans, in the absence of hemorrhage, revealed well-circumscribed, hyperdense lesions without significant mass effect.
Conclusions:
- MRI is highly effective in diagnosing cavernous haemangiomas, showing characteristic features.
- CT findings are suggestive of cavernous haemangiomas, particularly when acute hemorrhage is absent.
- Neurological presentation often correlates with the presence and location of cavernous haemangiomas.
Abstract:
A review of 2000 consecutive magnetic resonance imaging (MRI) brain studies identified 18 (0.9%) patients with lesions that satisfied MRI criteria for cavernous haemangiomas. The clinical, computed tomography (CT) and MRI findings in 23 patients with probable cavernous haemangiomas were compared. Thirty-three lesions were identified with multiple lesions in five (22%) patients. In 19 (82%) patients the neurological presentation corresponded to a cavernous haemangioma. The presenting symptoms were: seizures in 11 patients (48%); progressive neurological symptoms and signs in four (17%); and acute symptoms and signs due to haemorrhage in four (17%). T2 weighted images suggested the diagnosis in all cases, with 24 (73%) lesions showing the typical appearance of an area of mixed signal intensity with a rim of low signal intensity. In the absence of acute haemorrhage, CT demonstrated well circumscribed, round or oval hyperdense lesions without significant mass effect and with normal surrounding brain tissue in the majority of cases. Although not diagnostic, these CT features are strongly suggestive of cavernous haemangiomas.