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MR Imaging of Normal Perivascular Space Expansion at Midbrain

Naokatsu Saekia, Motoki Satoa, Motoo Kubotaa, Yoshio Uchinoa, Hisayuki Muraia, Yuichiro Nagaia, Hiroshi Ishikuraa, Seitaro Nomuraa, Iichiro Matsuuraa and Akira Yamauraa

a From the Departments of Neurological Surgery and Pathology, Chiba University Graduate School of Medicine



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  		FIG 1. MR images obtained in a 32-year-old woman who presented with headache and progressive right hemiparesis; MR images revealed multilobular CSF-filled expanding spaces at the MDJ and ventricular dilatation. She underwent endoscopic fenestration of the cyst wall and became free of the neurologic deficits. (Reproduced with permission from reference 12.)

T1-weighted axial (A), coronal (B), and sagittal (C) images reveal multilobular, CSF-filled, expanding spaces at the MDJ.



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  		FIG 2. MR images obtained in a 48-year-old-man who presented with double vision due to the left nerve palsy.

A, Coronal section at the anterior midbrain. Expanded PV spaces are visible as round or ovoid hypointense lesions at the PMJ and the MDJ.

B, Coronal section at the cerebral peduncle. Expanded PV spaces are visible at the level of the PMJ, corresponding to the tentorial margin. The largest segment of the PV space is graded 4.

C, Axial section at the lower midbrain. Multiple ovoid and round PV spaces are visible between the cerebral peduncle and substantia nigra and in the cerebral peduncle.

D, Axial section, two sections rostral to Figure 2C. Small PV spaces are visible behind the cerebral peduncle.

E, Sagittal section, two sections lateral to the midline. Expanded PV spaces are visible between the pons and midbrain.

F, Axial section, four sections lateral to the midline. Large and small PV spaces are visible at the PMJ and MDJ.



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  		FIG 3. A 19-year-old female patient who complained of retro-orbital pain.

A, Coronal section at the cerebral peduncle. Round and ovoid PV spaces are visible at the level of the MDJ. The largest size is graded 1.

B, Coronal section two sections posterior to Figure 2A. Small PV spaces are visible at the PMJ and at the level of tentorial margin. The largest one is grade 0.

C, Axial section at the lower midbrain. Ovoid and linear PV spaces are visible between the cerebral peduncle and substantia nigra and in the cerebral peduncle.

D, Axial section, two sections rostral to Figure 3C. Small PV spaces are visible behind the cerebral peduncle.



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  		FIG 4. A, Axial section of the right upper midbrain. Kluver-Barrera stain (magnification x4). Section line between ventral and dorsal halves is noted in the center. Aqueduct, periaqueductal gray matter, red nucleus, cerebral peduncle, and optic tract are demonstrated. Behind the cerebral peduncle, there is an ovoid space.

B, Magnified axial section demonstrating the PV space at the upper midbrain. H&E stain (magnification x50). The ovoid space includes a vessel (arrow) and is lined by a pial layer (arrowhead). No necrotic or ischemic changes were visible in the surrounding brain tissue in this magnified view. Histologic findings histologically a PV space (1–5).





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X