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AJNR - American Journal of Neuroradiology

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Giant Cystic Widening of Virchow-Robin Spaces: An Anatomofunctional Study

J. Mathias^a, L. Koessler^b, H. Brissart^c, S. Foscolo^a, E. Schmitt^a, S. Bracard^a, M. Braun^a and S. Kremer^a

^a Service de Neuroradiologie Diagnostique et Interventionnelle, Centre Hospitalier et Universitaire de Nancy, France
^b Laboratoire Imagerie Adaptative Diagnostique et Interventionnelle, Hôpitaux de Brabois, Vandoeuvre-les-Nancy, France
^c Service de Neurologie, Centre Hospitalier et Universitaire de Nancy, Nancy, France

View larger version (61K): [in this window] [in a new window]   Fig 1. Patient 1. Morphologic MR imaging. A and B, respectively, Axial 3D-T1 (TR=13.3 ms, TE=4.2 ms) and axial 3D-T2 (TR=3000 ms, TE=154 ms)-weighted MR images show multiple confluent oval well-defined lesions, isointense to CSF, in the left superior (F1) and inferior (F2) frontal gyri, a portion of the left precentral gyrus, the anterior left cingulate gyrus, and the corpus callosum. These cystic dilations have a mild mass effect, inducing a displacement of the cortical ribbon. C, fMRI (motor task of the right hand) shows a cortical activation in the left motor supplementary area (white curved arrow) in Broadmann areas 4 (white arrowhead) and 6 (white arrow). D, There is also a symmetric cortical activation when the left hand is stimulated. E, The tractography shows a decrease of white matter fibers in the pathologic areas (white arrowhead) compared with the healthy side.

View larger version (73K): [in this window] [in a new window]   Fig 2. Patient 2. Morphologic MR imaging. A and B, respectively, Axial T1 (TR=165 ms, TE=4.2 ms) and axial FLAIR (TR=10 000 ms, TE=155 ms)-weighted MR images show multiple confluent oval well-defined lesions, isointense to CSF, with no mass effect in the left superior and inferior parietal lobules and in the posterior part of the left middle (T2) and inferior (T3) temporal gyri. B, FLAIR-weighted MR image shows a hypersignal interspersed among the cystic dilations, which could correspond to gliosis. C, fMRI (language task) shows a cortical activation in the superior part of the left inferior parietal lobule (Broadmann area 7, arrowhead) in regard to the lesions seen on the morphologic MR imaging. There is also a cortical activation of the left Broadmann area 44 (F3, white arrow), which demonstrates the lateralization of language to the left hemisphere. D, The tractography shows a decrease of white matter fibers in the pathologic areas (white arrow) compared with the healthy side.