American Journal of Neuroradiology 26:298-305, February 2005
© 2005 American Society of Neuroradiology
BRAIN
Giant Tumefactive Perivascular Spaces
a Department of Radiology, University of Utah, Salt Lake City, Utah
b Department of Neurosurgery, University of Utah, Salt Lake City, Utah
c Department of Radiology, State University of New York, Downstate Medical Center, Brooklyn, NY
d Department of Radiology, Wessex Neurological Centre, Southampton General Hospital, UK
e Radiology Medical Group, San Diego, CA
f Clinical Neurosciences, University of Southampton School of Medicine, Southampton General Hospital, UK
Address reprint requests to Karen L. Salzman, MD., Department of Radiology, 1A71 University Hospital, 50 N. Medical Drive, Salt Lake City, UT 84132
BACKGROUND AND PURPOSE: The brain perivascular spaces (PVSs) are pial-lined, interstitial fluid-filled structures that accompany penetrating arteries. When enlarged, they may cause mass effect and can be mistaken for more ominous pathologic processes. The purpose of this study was to delineate the broad clinical and imaging spectrum of this unusual condition.
METHODS: Thirty-seven cases of giant PVSs were identified from 1988 to 2004 and were retrospectively reviewed. Clinical data collected included patient demographics, presenting symptoms, and follow-up. Histopathologic data were reviewed when available. Images were evaluated for size and location of the giant PVSs, associated mass effect, hydrocephalus, adjacent white matter changes, and contrast enhancement.
RESULTS: There were 24 men and 13 women with an age range of 6–86 years, (mean 46 years). The most common presenting feature was headache (15 patients). Thirty-two cases had multilocular clusters of variably sized cysts. Five lesions were unilocular. All lesions had signal intensity comparable to CSF and did not enhance. The most common location for the giant PVSs was the mesencephalothalamic region (21/36). Fourteen were located in the cerebral white matter; two were in the dentate nuclei. Nine giant mesencephalothalamic PVSs had associated hydrocephalus, which required surgical intervention.
CONCLUSION: Giant tumefactive PVSs most often appear as clusters of variably sized cysts that are isointense relative to CSF and do not enhance. They are most common in the mesencephalothalamic region and may cause hydrocephalus. Although they may have striking mass effect, giant PVSs should not be mistaken for neoplasm or other diseases.
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