Posterior fossa hemangioblastomas: MR imaging

The magnetic resonance (MR) imaging findings of 18 surgically proved posterior fossa hemangioblastomas (15 patients) were retrospectively analyzed and correlated with computed tomographic (ten patients) and angiographic (eight patients) findings. Thirteen tumors were located in the cerebellar hemisphere, three in the vermis, and two in the medulla with associated syrinxes. Three patients had von Hippel-Lindau disease, two of whom had multiple cerebellar hemangioblastomas. Seven hemangioblastomas appeared as solid tumors, six as solid masses with central cysts, and five as cysts with mural nodules. Abnormal tumor vessels, with characteristic signal void, were demonstrated in 13 tumors. Associated hemorrhage was present in four tumors. Although angiography is usually required for the diagnosis and preoperative assessment of this tumor, MR imaging demonstration of a posterior fossa mass with abnormal vessels should suggest the diagnosis of hemangioblastoma. Moreover, the combination of a peripheral posterior fossa cyst with a mural nodule supplied by enlarged vessels may be pathognomonic.