Title:Imaging Features and Misdiagnosis of Giant Cerebral Cavernous
Malformations
Volume: 20
Author(s): Mengqiang Xiao, Meng Zhang, Min Lei, Fenghuan Lin, Yanxia Chen, Jingfeng Liu, Jun Chen and Nianyuan Luo*
Affiliation:
- Department of Imaging, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, Guangdong Province, China
Keywords:
Cavernous hemangioma, Computed tomography, Magnetic resonance imaging, Misdiagnosis, Patients, Cerebral cavernous malformation (CCM).
Abstract:
Background:
While cerebral cavernous malformations (CCMs) have been extensively described, few reports have described the imaging appearance of giant
CCMs (GCCMs).
Objective:
To describe the imaging characteristics of GCCMs and study the reasons for preoperative misdiagnosis.
Methods:
We retrospectively analyzed the data of 12 patients (5 men, 7 women; mean age, 35.23 ± 12.64 years) with histopathologically confirmed GCCMs.
Two radiologists analyzed the CT (n = 12) and MRI (n = 10) features: location, number, size, shape, boundary, signal intensity, and enhancement.
Results:
The sellar region, cerebral hemisphere, skull bone, and ventricle were involved in 5, 4, 2, and 1 patients, respectively. Three tumors were
irregularly shaped, while nine were oval. Eleven lesions showed slightly high- and/or high-density on CT; 1 lesion appeared as a low-density cyst.
Calcifications were found in 11 lesions. Four tumors showed uniform hypointensity on T1-weighted imaging (T1WI) and hyperintense signals on
T2-weighted imaging (T2WI). Six tumors showed mixed low-, equal-, and high-intensity signals on T1WI and T2WI. Noticeable contrast
enhancement and gradual strengthening were noted on T1WI. Ten lesions showed hemorrhage and hemosiderin deposition. The GCCMs were
wrongly diagnosed as cartilage-derived tumors/ meningioma (3 patients); tumor and hematoma (2 patients each); and pituitary tumor/ meningioma,
chondroma, chordoma, ependymoma, and macroadenoma (1 patient each).
Conclusions:
GCCMs present as an oval mass with slightly high- and/or high-density calcifications on CT and show hemorrhage and hemosiderin accumulation
on MRI. Therefore, slightly high- and/or high-density calcification and hemosiderin accumulation are critical clinical characteristics of GCCMs.
