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Research ArticleBRAIN

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

T.J. Yun, D.G. Na, B.J. Kwon, H.G. Rho, S.-H. Park, Y.-L. Suh and K.-H. Chang
American Journal of Neuroradiology March 2008, 29 (3) 494-500; DOI: https://doi.org/10.3174/ajnr.A0847
T.J. Yun
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D.G. Na
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B.J. Kwon
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H.G. Rho
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S.-H. Park
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Y.-L. Suh
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K.-H. Chang
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    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, ×40). The inset shows hemorrhage with infiltration of siderophages (arrow; hematoxylin-eosin, original magnification, ×200).

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    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.

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    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).

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    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).

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    Table 1:

    The T1 Signal Intensity Ratio of a Perilesional Edema in Patients with Cerebral Acute or Subacute Hemorrhagic Masses (n = 32)

    Diagnosis of Hemorrhagic MassesT1 Signal Intensity Ratio of the Perilesional Edema*P†
    Cavernous angioma (n = 17)1.06 ± 0.15.045
        MR sign (+) (n = 12)1.13 ± 0.10
        MR sign (−) (n = 5)0.91 ± 0.13
    Other hemorrhagic mass (n = 15)0.91 ± 0.06<.001
        Glioblastoma (n = 5)0.89 ± 0.01
        Metastasis (n = 4)0.89 ± 0.08
        Acute or subacute ICH (n = 6)0.92 ± 0.06
    • Note:—Data are mean ± SD. MR sign indicates the MR sign of a T1 hyperintense perilesional signal. ICH indicates intracerebral hemorrhage.

    • * T1 signal intensity ratio indicates the ratio of signal intensity of the edema to that of the contralateral white matter.

    • † Comparison of the T1 signal intensity between the perilesional edema and the contralateral white matter.

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    Table 2:

    MR Features of the Cavernous Angiomas (n = 29)

    MR featuresMR Sign of T1 Hyperintense Perilesional SignalP
    Positive (n = 18)Negative (n = 11)
    Volume of vasogenic edema, cm332.3 ± 22.012.4 ± 9.6.009
    Volume of mass, cm312.3 ± 7.69.1 ± 5.5.220
    Presence of enhancement*93.248
    Time interval between symptom onset and MR imaging, d10.4 ± 9.718.3 ± 11.2.060
    Location
        Cerebral hemisphere165
        Cerebellar hemispheres13
        Brain stem13
    • Note:—Volumes of masses and edemas are mean ± SD.

    • * Enhanced T1-weighted images were not available in 2 patients with positive MR signs of a T1 hyperintense perilesional signal and in 1 patient with no MR sign.

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American Journal of Neuroradiology: 29 (3)
American Journal of Neuroradiology
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T.J. Yun, D.G. Na, B.J. Kwon, H.G. Rho, S.-H. Park, Y.-L. Suh, K.-H. Chang
A T1 Hyperintense Perilesional Signal Aids in the Differentiation of a Cavernous Angioma from Other Hemorrhagic Masses
American Journal of Neuroradiology Mar 2008, 29 (3) 494-500; 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, D.G. Na, B.J. Kwon, H.G. Rho, S.-H. Park, Y.-L. Suh, K.-H. Chang
American Journal of Neuroradiology Mar 2008, 29 (3) 494-500; DOI: 10.3174/ajnr.A0847
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