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Conforti R, Capasso R, Franco D, Russo C, Rinaldi FO, Pezzullo G, Coluccino S, Brunese MC, Caiazzo C, Caranci F, Tortora F. Giant Tumefactive Perivascular Space: Advanced Fusion MR Imaging and Tractography Study-A Case Report and a Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13091602. [PMID: 37174993 PMCID: PMC10177987 DOI: 10.3390/diagnostics13091602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Perivascular spaces (PVSs) are small extensions of the subpial cerebrospinal space, pial-lined and interstitial fluid-filled. They surround small penetrating arteries, and veins, crossing the subarachnoid space to the brain tissue. Magnetic Resonance Imaging (MRI) shows a PVS as a round-shape or linear structure, isointense to the cerebrospinal fluid, and, if larger than 1.5 cm, they are known as giant/tumefactive PVSs (GTPVS) that may compress neighboring parenchymal/liquoral compartment. We report a rare asymptomatic case of GTPVS type 1 in a diabetic middle-aged patient, occasionally discovered. Our MRI study focuses on diffusion/tractography and fusion imaging: three-dimensional (3D) constructive interference in steady state (CISS) and time of fly (TOF) sequences. The advanced and fusion MR techniques help us to track brain fiber to assess brain tissue compression consequences and some PVS anatomic features as the perforating arteries inside them.
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Affiliation(s)
- Renata Conforti
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Raffaella Capasso
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy
| | - Donatella Franco
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Carmela Russo
- Unit of Neuroradiology, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, AORN, 80129 Naples, Italy
| | - Fabio Oreste Rinaldi
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Giovanna Pezzullo
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Simone Coluccino
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Corrado Caiazzo
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Ferdinando Caranci
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Fabio Tortora
- Unit of Neuroradiology, Department of Advanced Biomedical Sciences, Federico II University, 80138 Naples, Italy
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Yogendran LV, Kalelioglu T, Donahue JH, Ahmad H, Phillips KA, Calautti NM, Lopes MB, Asthagiri AR, Purow B, Schiff D, Patel SH, Fadul CE. The landscape of brain tumor mimics in neuro-oncology practice. J Neurooncol 2022; 159:499-508. [PMID: 35857249 DOI: 10.1007/s11060-022-04087-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Differentiating neoplastic and non-neoplastic brain lesions is essential to make management recommendations and convey prognosis, but the distinction between brain tumors and their mimics in practice may prove challenging. The aim of this study is to provide the incidence of brain tumor mimics in the neuro-oncology setting and describe this patient subset. METHODS Retrospective study of adult patients referred to the Division of Neuro-oncology for a presumed diagnosis of brain tumor from January 1, 2005 through December 31, 2017, who later satisfied the diagnosis of a non-neoplastic entity based on neuroimaging, clinical course, and/or histopathology evaluation. We classified tumor mimic entities according to clinical, radiologic, and laboratory characteristics that correlated with the diagnosis. RESULTS The incidence of brain tumor mimics was 3.4% (132/3897). The etiologies of the non-neoplastic entities were vascular (35%), inflammatory non-demyelinating (26%), demyelinating (15%), cysts (10%), infectious (9%), and miscellaneous (5%). In our study, 38% of patients underwent biopsy to determine diagnosis, but in 26%, the biopsy was inconclusive. DISCUSSION Brain tumor mimics represent a small but important subset of the neuro-oncology referrals. Vascular, inflammatory, and demyelinating etiologies represent two-thirds of cases. Recognizing the clinical, radiologic and laboratory characteristics of such entities may improve resource utilization and prevent unnecessary as well as potentially harmful diagnostic and therapeutic interventions.
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Affiliation(s)
- Lalanthica V Yogendran
- Division of Neuro-Oncology, Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA
| | - Tuba Kalelioglu
- Department of Radiology & Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Joseph H Donahue
- Department of Radiology & Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Haroon Ahmad
- Department of Neurology, University of Maryland, Baltimore, MD, USA
| | - Kester A Phillips
- Department of Neurology, The Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment at Swedish Neuroscience Institute, Seattle, WA, USA
| | - Nicole M Calautti
- Division of Neuro-Oncology, Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA
| | - Maria-Beatriz Lopes
- Department of Pathology, Divisions of Neuropathology and Molecular Diagnostics, University of Virginia, Charlottesville, VA, USA
| | - Ashok R Asthagiri
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Benjamin Purow
- Division of Neuro-Oncology, Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA
| | - David Schiff
- Division of Neuro-Oncology, Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA
| | - Sohil H Patel
- Department of Radiology & Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Camilo E Fadul
- Division of Neuro-Oncology, Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA.
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Kim J, Joo B, Kim JW, Park M, Ahn SJ, Park SK, Suh SH. Aggravation of Enlarged Perivascular Spaces in the Centrum Semiovale of Patients with Aneurysmal Subarachnoid Hemorrhage. Clin Neuroradiol 2021; 32:79-87. [PMID: 34618170 DOI: 10.1007/s00062-021-01098-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to investigate whether enlarged perivascular spaces (ePVS) within the basal ganglia (BG) or centrum semiovale (CSO) aggravate in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS We retrospectively evaluated 139 patients who had undergone brain magnetic resonance imaging (MRI) within 1 month of aSAH occurrence from January 2007 to November 2018. Follow-up brain MRI of 99 patients were available. We scored ePVS in the BG and CSO on a score of 0-4 (0 = no ePVS, 4 ≥ 40 ePVS) on initial and follow-up T2-weighted MRI. Aggravation of ePVS was defined as an ePVS score increase of ≥ 1 on follow-up MRI compared to the initial score. We compared the characteristics between patients with and without aggravation of ePVS and investigated associated variables using logistic regression. RESULTS Aggravation of ePVS in the CSO and BG was noted in 31 (31.3%) and 6 (6.1%) patients, respectively. After adjusting for age, sex, and the MRI follow-up period, aggravation of ePVS in the CSO was independently associated with a high Fisher grade (p = 0.007) and high burden of initial ePVS in the CSO (p = 0.049). CONCLUSION Aggravation of ePVS, particularly those in the CSO, had occurred in the long-term follow-up of aSAH patients. This was independently associated with a high burden of aSAH. The amount of subarachnoid blood might have aggravated the drainage of interstitial fluid through glymphatic dysfunction.
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Affiliation(s)
- Jina Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 63-gil 20, Gangnam-gu, Seoul, Korea (Republic of)
| | - Bio Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 63-gil 20, Gangnam-gu, Seoul, Korea (Republic of)
| | - Jin Woo Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 63-gil 20, Gangnam-gu, Seoul, Korea (Republic of)
| | - Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 63-gil 20, Gangnam-gu, Seoul, Korea (Republic of).
| | - Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 63-gil 20, Gangnam-gu, Seoul, Korea (Republic of)
| | - Sang Kyu Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 63-gil 20, Gangnam-gu, Seoul, Korea (Republic of)
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 63-gil 20, Gangnam-gu, Seoul, Korea (Republic of)
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Capasso R, Negro A, Cirillo S, Iovine S, Puoti G, Cirillo M, Conforti R. Large anterior temporal Virchow–Robin spaces: Evaluating MRI features over the years—Our experience and literature review. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2020. [DOI: 10.1177/2514183x20905252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dilated Virchow–Robin spaces (VRSs) are expansions of the normal perivascular spaces with a short axis greater than 2 mm or, according to some authors, greater than 3 mm. They are usually documented at the basal ganglia, at the convexity white matter (WM) and centrum semiovale, and at the mesencephalon. The anterior temporal WM is a recently described preferential location for large (≥5 mm) VRSs. The aim of our study was to evaluate the magnetic resonance imaging (MRI) features and their modifications during a long-term follow-up period (≥24 months) of the anterior temporal VRSs with a retrospective analysis among all brain MRI studies performed at our institution between January 2010 and January 2017. In our study, the presence and the stability of characteristic MRI features certainly increased our diagnostic confidence allowing us to continue conservative approach while the surrounding signal change, as reported in the literature, should not in itself prompt alternative diagnoses to be entertained.
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Affiliation(s)
- Raffaella Capasso
- Neuroradiology Unit PO CTO, University of Campania Luigi Vanvitelli, Viale Colli Aminei 21, Napoli, Italy
| | - Alberto Negro
- Neuroradiology Unit PO, Ospedale del Mare, ASL Napoli 1, Via Enrico Rossi, Napoli, Italy
| | - Sossio Cirillo
- Neuroradiology Unit PO CTO, University of Campania Luigi Vanvitelli, Viale Colli Aminei 21, Napoli, Italy
| | - Silvia Iovine
- Dipartimento di Medicina di Precisione, University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Gianfranco Puoti
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate (DAMSS), University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Mario Cirillo
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate (DAMSS), University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Renata Conforti
- Dipartimento di Medicina di Precisione, University of Campania Luigi Vanvitelli, Napoli, Italy
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