MRI of intramedullary cavernous haemangiomas

We reviewed 11 cases of intramedullary cavernous haemangiomas (IMCH) studied by MRI, to assess its diagnostic value in these lesions. Follow-up MRI was obtained in five patients 7 days-2 years following the initial study. In one case a postoperative examination was obtained. The diagnosis was pathologically proven in ten cases, and supported in the last by a family and personal history of cavernous haemangiomas. A reticulate appearance with areas of mixed signal intensity in both T1-and T2-weighted images was the most common finding. Homogeneous high, low or intermediate signal intensity was each found in one case, Two small lesions gave low signal. A rim of low signal was less common than in cerebral cavernous haemangiomas. In one case, the brain showed more than 20 lesions with the MRI appearances of cavernous haemangiomas. In two of five patients, serial preoperative MRI showed progressive disappearance of high-signal areas on both T1-and T2-weighted images. To find a haemorrhagic intramedullary lesion on MRI is not rare. Although the appearances are not pathognomonic, an IMCH can be suggested. We suggest that the following characteristics may help: (1) a personal and/or family history of cavernous haemangiomas; (2) typical MRI appearances of mixed acute, subacute and chronic haemorrhage; (3) a tendency for signal intensity to decrease on follow-up; (4) normal spinal angiography; and (5) associated brain lesions.     

Pyogenic abscess complicating a resolving cerebral haematoma secondary to a cavernous haemangioma: computed tomography and magnetic resonance imaging findings

A case is discussed of a brain abscess complicating an intracerebral haemorrhage occurring in a cavernous haemangioma. A young child presented with focal seizures as a result of a large intracerebral haemorrhage, occurring in a cavernous haemangioma. The only clue to the underlying vascular malformation was the presence of an associated developmental venous anomaly. The case was complicated by the development of a brain abscess at the site of the intracranial haematoma. The CT and MRI findings are discussed.     

Suprasellar cavernous haemangioma: an important differential diagnosis in the diencephalic tumours

We present three cases of suprasellar cavernous haemangioma with characteristic high-field MRI features. Clinical, CT and MRI data were retrospectively analysed. The patients had progressive neurological, endocrinological and visual complaints. In the three cases CT revealed a high-density suprasellar mass. In all cases the combination of a reticulated core of mized signal intensity with a surrounding rim of decreased signal on T1- and T2-weighted MRI scans suggested the presence of a cavernous haemangioma. Two patients underwent surgical biopsy after their first MRI examination. Cavernous haemangiomas located in the suprasellar area may show typical MRI features. Correspondence to: B. Suarez     

Foramen of Monro mass: MRI appearances permit diagnosis of cavernous haemangioma

Cavernous haemangiomas are most commonly found in the subcortical white matter, the pons and the external capsule. We present a case of a cavernous haemangioma that appeared as an intraventricular mass at the foramen of Monro. Despite the unusual location the diagnosis was established by MRI because of the typical appearance. The differential diagnosis included primary and secondary neoplasms at the foramen of Monro. Received: 10 June 1996 Accepted: 29 June 1996     

The natural history of familial cerebral cavernomas: a retrospective MRI study of 40 patients

Our objective was to determine the natural history and prognostic factors of familial forms of cerebral cavernous malformations (CCM). Cavernomas are one of the most common central nervous system vascular malformations. Familial CCM is increasingly diagnosed, but little is known about its natural history. In a national survey, we analysed clinical and MRI features of 173 patients from 57 unrelated French families. Of these 40 had undergone at least two clinical and MRI examinations. Occurrence of haemorrhage, new lesions, change in signal intensity and size of lesions have been studied by comparison between first and last MRI studies. The CCM were classified according to Zabramski et al. Mean follow-up was 3.2 years (range 0.5–6.5 years). We followed 232 cavernomas (mean 5.9 per patient, range 1–17). Serial MRI demonstrated changes in 28 patients (70 %). Bleeding occurred in 21 lesions (9.1 %) in 14 patients (35 %). The haemorrhagic risk was 2.5 % per lesion-year, higher in type I and brain-stem CCM. We saw 23 new lesions appear in 11 patients (27.5 %), with an incidence of 0.2 lesions per patient year. Signal change was observed in 11 patients (27.5 %), in 14 lesions (6 %), while 9 lesions (3.9 %) in 9 patients (22.5 %) changed significantly in size. Received: 20 May 1999/Accepted: 1 September 1999     

Vertebral haemangiomas with spinal cord compression: the place of preoperative percutaneous vertebroplasty with methyl methacrylate

We report one cervical and two thoracic vertebral haemangiomas with neurological disturbance successfully treated by percutaneous vertebroplasty followed by decompression surgery. Vertebroplasty consolidates the vertebral body and reduces the risk of haemorrhage. Subsequent surgery may be limited to decompressive laminectomy and resection of the epidural extension of the haemangioma. Embolisation was also carried out in one case. Complete neuroimaging workup, including CT, myelo-CT and MRI, is necessary prior to treatment.     

Duplex Doppler sonography of small (<3 cm diameter) liver tumours: intralesional arterial flow does not exclude cavernous haemangioma

In small liver lesions (<3 cm diameter), detection of internal arterial flow with duplex Doppler sonography is thought to virtually exclude the diagnosis of cavernous haemangioma. We retrospectively reviewed 114 consecutive small lesions confirmed or suspected to be haemangiomas. Doppler sonography revealed intralesional arterial flow in four lesions for which correlative imaging studies were diagnostic of haemangioma, and for which stability was documented with follow-up sonography. We conclude that intralesional arterial flow should not be interpreted as conclusive evidence that a small liver lesion is not a haemangioma. If the presence of arterial flow within a small liver lesion prompts concern that the lesion is not a haemangioma, our findings suggest that a correlative imaging study should be considered before percutaneous biopsy is performed.     

Positron emission tomography of cavernous haemangiomas of the brain

Four cases with lesions suspected to be low-grade intracerebral tumours but later proved to be cavernous haemangiomas are described. The patients were examined with contrast enhanced CT and with positron emission tomography (PET). The lesions were partly calcified with a mild or no mass effect and a slight contrast enhancement at CT. There were signs of disrupture of the blood-lesion barrier also on radionuclide studies. PET with 11C-methionine and 11C-glucose showed a normal or decreased accumulation of the tracers. This combination of findings has not been encountered in intracranial tumours. As a comparison, one case of glioblastoma is described. In this patient, the CT findings suggested a cavernous haemangioma. However, PET showed a markedly increased accumulation of 11C-methionine, which is compatible with brain tumour but not with haemangioma.     

Uterine cavernous haemangioma in a post-menopausal woman: CT and MRI findings mimicking uterine myoma with degeneration

Cavernous haemangioma is a very rare vascular malformation of the uterus. We describe the CT and MRI findings of a cavernous haemangioma in an 81-year-old female with recurrent menorrhagia. CT showed a well-marginated mass with multifocal calcifications and extensive haemorrhage, as well as necrosis in the anterior wall of the uterus. MRI revealed heterogeneous low- to high-signal intensities of the mass on T(1) and T(2 )weighted images as well as portions with poor enhancement of the mass on contrast-enhanced T(1 )weighted images. Although rare, cavernous haemangioma should be included in the differential diagnosis of a calcified haemorrhagic necrotic uterine mass in post-menopausal women.     

Pontine cavernous haemangioma – An incidental autopsy finding

Cavernous haemangiomas belong to a group of vascular malformations that are developmental defects of the vascular bed. Occurrence of an asymptomatic cavernoma in the pons is uncommon and worthy of record. At autopsy, cavernomas have to be differentiated from traumatic haemorrhagic lesions in head injury cases. We hereby report a case in which a pontine cavernous haemangioma was detected at autopsy in a 25-year-old female who died due to burn injuries.     

Cavernous haemangioma in the cavernous sinus: case report and review of the literature

We report a cavernous haemangioma in the left cavernous sinus. This lesions very rarely occurs in this site and is difficult to diagnose correctly preoperatively. CT, angiography and MRI permit differentiation of the cavernous haemangioma from other tumours in this region and thereby contribute to a better surgical approach. The radiological features of cavernous haemangioma reported in the literature are summarised. Received: 24 February 1999 Accepted: 1 September 2000     

Cavernous haemangioma of the breast

Vascular tumours of the breast are rare and most can be classified as either angiosarcomas or haemangiomas. Cavernous haemangiomas are the most common form of mammary haemangioma. We describe a case with unilateral whole breast involvement without associated calcifications, studied with mammography, ultrasound and MRI.     

Sinonasal cavernous haemangioma: a case report

Cavernous haemangiomas arising in the paranasal sinuses are very rare. Even though the lesion is benign in nature, its imaging features are non-specific, leading to an incorrect pre-operative diagnosis in most patients. We present a case of a maxillary sinus cavernous haemangioma in a young male. The clinical presentation and imaging characteristics of this entity are reviewed.     

18F DCFPyL PSMA avid biopsy proven subcutaneous capillary haemangioma as a malignancy mimic in the setting of biochemical recurrent prostate carcinoma

We present a case of a 65-year-old male with a biopsy proven subcutaneous capillary haemangioma identified on imaging for evaluation of further metastatic spread of prostatic carcinoma due to a rise in his prostate-specific antigen biochemistry. He was receiving salvage radiation therapy for his known isolated nodal disease, four years after prostatectomy. An intensely avid prostate-specific membrane antigen positron emission tomography-computed tomography lesion in the left paramedian back at the level of L1 was noted on his scan. A core biopsy revealed a dermal haemangioma with no evidence of metastatic prostatic carcinoma. To our knowledge, only one other incidental case of prostate-specific membrane antigen avid subcutaneous capillary haemangioma has been described in the literature. Whilst uncommon, incidental findings of prostate-specific membrane antigen PET avid dermal lesions are pathognomonic for haemangiomas and can be treated as “no touch” lesions with watchful observation.     

Familial presumed cerebral cavernous angiomas diagnosed by MRI: three generations

Familial cerebral cavernous angiomas are rare, with an autosomal dominant pattern of inheritance. To our knowledge, 25 families with this disorder have been described. We report three family members in a direct line of descent, who all brain had lesions typical of cavernous angiomas on MRI. Received: 10 January 1995 Accepted: 4 October 1995     

Diagnosis of the peripheral cavernous haemangioma: comparison of ultrasound, CT and RBC scintigraphy

Thirty-six patients in whom peripheral cavernous haemangioma was clinically suspected were examined by 99mTc red blood cell scintigraphy. Twenty-five of these patients had a palpable lump, and they also underwent an ultrasound examination. Seven patients also had computed tomography and angiography was performed in one patient prior to surgery. Twenty-nine patients had positive scintigrams showing 35 haemangiomas. The ultrasound features were variable and of little value except in anatomical localization. Computed tomography did not add significant extra information. We conclude that 99mTc red blood cell scintigraphy is the preferred diagnostic technique in the investigation of suspected peripheral haemangiomas.     

CT and MRI in benign mediastinal haemangioma

We report the findings of computed tomography and magnetic resonance imaging in two cases of surgically proven benign cavernous haemangiomas of the mediastinum. Both techniques produced similar results, although both were non-diagnostic for haemangioma as was percutaneous needle biopsy, which was performed in one patient.     

Evaluation of MR imaging findings differentiating cavernous haemangiomas from schwannomas in the orbit

Objective

It is important to distinguish between orbital cavernous haemangioma and schwannoma because the treatments of choice for the two tumours are different. The aim was to evaluate MR imaging findings distinguishing the two tumours.

Methods

Magnetic resonance imaging including T1- and T2-weighted imaging and contrast-enhanced MR imaging was performed in 43 patients with cavernous haemangiomas and 16 patients with schwannomas confirmed by pathology. Location, configuration, margins, signal intensity, homogeneity and enhancement pattern of the tumour were retrospectively evaluated.

Results

There was a significant difference between cavernous haemangiomas and schwannomas regarding the location, configuration and margins of the mass, signal intensity and homogeneity on T1- and T2-weighted imaging, the spread pattern of contrast enhancement, the enhancement pattern and the type of time–intensity curve (P?<?0.05). Markedly homogeneous hyperintensity signal on T2-weighted imaging and the spread pattern of the contrast enhancement favoured cavernous haemangioma rather than schwannoma (P?<?0.01).

Conclusion

Cavernous haemangiomas and schwannomas have different MR imaging features that could be helpful in the differentiation between the tumours. The spread pattern of the contrast enhancement on dynamic contrast-enhanced MR imaging is the most reliable finding distinguishing cavernous haemangiomas from schwannomas.     

Intraosseous haemangioma of the proximal femur: imaging findings

Haemangiomas of bone are uncommon lesions, accounting for approximately 1% of all primary bone tumours. The most frequent sites of involvement are the calvaria and the vertebral column. When haemangiomas involve long tubular bones, they are usually found in the diaphysis or metadiaphysis. Juxta-articular or epiphyseal location for a long bone haemangioma is rare. We present the imaging findings in a case of a histopathologically proven juxta-articular intraosseous haemangioma of the proximal femur. We believe ours is the first report of a haemangioma involving the proximal end of the femur.