Radiation diagnostics of cerebral cavernous malformations

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Abstract

Cerebral cavernous malformations are a fairly common vascular pathology at the moment, with the number of detected cases increasing dramatically in recent years. This is because modern neuroimaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI) have been introduced into clinical practice and are widely available. Prior to the advent of CT and MRI technologies, it was extremely difficult to diagnose this pathology, and the diagnosis was usually made intraoperatively or based on autopsy data. Further, the literature review is devoted to the radiological diagnosis of cerebral cavernous malformations (CM). The role of neuroimaging methods in the diagnosis of cavernous malformations, as well as the use of MRI for CM visualization, was analyzed. The advantages of MRI over other neuroimaging methods for this pathology have been demonstrated. Pulse sequences of MRI and signaling characteristics of various foci were characterized, depending on the morphological substrate. The significance of the susceptibility-weighted imaging sequence was also evaluated for the detection of multifocal lesions in cases of familial CM. The study of the main pulse sequences of MRI for visualization of CM will improve the protocol algorithm for the timely diagnosis of this pathology and the selection of therapeutic approach.

About the authors

Elena N. Girya

Sklifosovsky Research Institute for Emergency Medicine

Author for correspondence.
Email: mishka_77@list.ru
ORCID iD: 0000-0001-5875-1489
SPIN-code: 4793-7748

Radiologist of Radiosurgery Department

Russian Federation, Moscow, Bol'shaya Sukharevskaya ploshcad', 3, 129010

Valentin E. Sinitsyn

Lomonosov Moscow State University

Email: vsini@mail.ru
ORCID iD: 0000-0002-5649-2193
SPIN-code: 8449-6590

MD, PhD, DSc, Professor, Head of the Department of Radiation Diagnostics

 
Russian Federation, Moscow, Lomonosovsky prospect, 27, bldg. 10, 119192

Alexey S. Tokarev

Sklifosovsky Research Institute for Emergency Medicine; Moscow Health Department

Email: alex_am_00@mail.ru
ORCID iD: 0000-0002-8415-5602
SPIN-code: 1608-0630

MD, Cand. Sci. (Med.), Deputy Head of Moscow Health Department, Neurosurgeon of Radiosurgery Department 

Russian Federation, Moscow; Moscow, Oruzheyny lane, 43, 127006

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Supplementary files

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2. Fig. 1. CT sections of the brain in the axial view performed before (a) and after contrast agent administration (b). The images show a hyperdensive focus in the right frontal lobe, without clear contours, and without contrast uptake.

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3. Fig. 2. MR images of the brain in the axial view in the T1–WI (a, c), T2–WI (b), and T2*GRE (d) modes demonstrate a more detailed visualization of the CM structure (the same case as in Fig. 1). The images show a focal lesion of a characteristic cellular structure with a hypointensive peripheral signal on T2–WI. The T2*GRE sequence emphasizes the florid effect of hemosiderin.

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4. Fig. 3. T2*GRE image in the axial view shows a large cavernous angioma in the left occipital lobe. Despite the significant size of the lesion, no perifocal edema and mass effect on the surrounding structures are found.

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5. Fig. 4. MR images of the brain in the axial view in the T2*GRE (A) and SWI (B) modes. SWI images can reveal additional CM lesions not visible in the T2*GRE.

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Copyright (c) 2021 Girya E.N., Sinitsyn V.E., Tokarev A.S.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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