Normal perivascular spaces mimicking lacunar infarction: MR imaging

Perivascular (Virchow-Robin) spaces normally surround perforating arteries that enter the medial temporal lobes, corpus striatum, and thalamus. The high soft-tissue sensitivity of magnetic resonance (MR) imaging allows for the frequent detection of such cerebrospinal fluid (CSF)-filled spaces. Especially on axial images, these CSF-filled perivascular spaces may be confused with pathologic lesions, such a lacunar infarcts. Postmortem brain specimens demonstrate the anatomy of perivascular spaces around perforating arteries. Orthogonal images in the living patient help confirm this anatomic relationship. The characteristic CSF signal patterns from these foci are further evidence of their anatomic identification and true benign nature.