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AJNR - American Journal of Neuroradiology

Published ahead of print on November 26, 2007
doi: 10.3174/ajnr.A0847

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A T1 Hyperintense Perilesional Signal Aids in the Differentiation of a Cavernous Angioma from Other Hemorrhagic Masses

T.J. Yun^a, D.G. Na^a, B.J. Kwon^a, H.G. Rho^c,e, S.-H. Park^b, Y.-L. Suh^d and K.-H. Chang^a

^a Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
^b Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
^c Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
^d Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
^e Department of Radiology, Kunkuk University Hospital, Kunkuk University College of Medicine, Seoul, Korea

View larger version (49K): [in this window] [in a new window]   Fig 1. A 54-year-old woman with a cavernous angioma. A, An axial T2-weighted image (TR/TE/NEX, 3700/104/2 ms) shows a hemorrhagic mass with heterogeneous signal intensity and a severe surrounding edema in the right temporal lobe. B, An unenhanced T1-weighted image (TR/TE/NEX, 467/8/1 ms) demonstrates obvious hyperintensity within the vasogenic edema (T1 hyperintense perilesional signal intensity sign; long arrows). The T1 hyperintense perilesional signal intensity sign is not obviously observed in the peripheral area of the vasogenic edema (short arrow). C, An enhanced T1-weighted image (TR/TE/NEX, 467/8/1 ms) shows heterogeneous enhancement of the round mass at the center of hemorrhagic mass. D, Surgery was performed 1 day after MR imaging. A histologic photomicrograph shows a relatively well-demarcated cavernous angioma with hematoma formation (arrow) and microscopic diffuse perilesional hemorrhage in the surrounding white matter (hematoxylin-eosin, original magnification, x40). The inset shows hemorrhage with infiltration of siderophages (arrow; hematoxylin-eosin, original magnification, x200).

View larger version (74K): [in this window] [in a new window]   Fig 2. An 11-year-old boy with a cavernous angioma. A, An axial T2-weighted image (TR/TE/NEX, 3683/104/2 ms) shows a large hemorrhagic mass with heterogeneous signal intensity and peripheral hypointense rims in the right frontal lobe. A perilesional massive edema and mass effect is seen. There is a hypointense lesion in the periventricular white matter of the left parietal lobe and a few small hypointense lesions that were also found in both hemispheres on a T2* gradient-echo image (data not shown), which indicate possible multiple cavernous angiomas. B, An axial T1-weighted image (TR/TE/NEX, 500/9/2 ms) shows a T1 hyperintense perilesional signal intensity sign and mild hyperintensity of a perilesional edema at the deep area abutting the hemorrhagic mass (arrows). Note the centripetal pattern of the T1 hyperintense perilesional signal intensity sign in which T1 hyperintensity within the perilesional edema is observed only in the deep area around the hemorrhagic mass; it is not observed at the periphery of edema.

View larger version (55K): [in this window] [in a new window]   Fig 3. A 17-year-old girl with a glioblastoma. A, An unenhanced CT image shows a hyperattenuated acute hemorrhagic mass in the right temporal lobe. B, An axial T2-weighted image (TR/TE/NEX, 5000/96/2 ms) shows a hemorrhagic mass with heterogeneous signal intensity and a mild peritumoral edema. C, An axial enhanced T1-weighted image (TR/TE/NEX, 500/12/1 ms) demonstrates mild hypointensity or isointensity of the peritumoral edema (arrows) and mild heterogeneous enhancement of the hemorrhagic mass, which was hyperintense on an unenhanced T1-weighted image (data not shown).

View larger version (65K): [in this window] [in a new window]   Fig 4. A 48-year-old man with a cerebral metastasis from a hepatocellular carcinoma. A, An unenhanced CT image shows an acute hemorrhagic mass with a surrounding edema in the left temporooccipital lobe. B, An axial T2-weighted image (TR/TE/NEX, 5000/99/2 ms) demonstrates an acute hematoma with a profound perilesional edema and mass effect. C, An axial enhanced T1-weighted image (TR/TE/NEX, 500/12/1 ms) demonstrates hypointensity of the perilesional edema (arrows).