Hemangioma of the porus acusticus. Impact of imaging studies: case reports

Hemangiomas are tumors. Hemangiomas near the geniculate ganglion or in the internal acoustic meatus are well known but rare. We present two cases of hemangiomas located at the porus acusticus, an even more rare site. MRI showed a millimeter-sized tumor, located in the porus acusticus, developing perpendicular to the axis of the acoustico-facial nerves, surrounding them. They were hyperintense on T1-weighted images, strongly hyperintense on T2-weighted images with a characteristic progressive and marked enhancement after injection of gadolinium DTPA. Similar signal abnormalities were present in the adjacent temporal bone, and CT scan demonstrated a honeycomb appearance with intratumoral bony spicules. These imaging criteria allows differentiation between hemangioma and neurinoma. We hypothesize that this location is related to the presence of a rich vascular plexus of the dura mater in this area.

[Imaging of syringomyelia]

This review reports the value of current imaging techniques in the diagnosis of syringomyelia excluding tumoral causes. The value of imaging techniques for evaluation of extension, detection of associated anomalies, and pre- and postoperative evaluation are detailed.

[Neurocysticercosis]

The neurocysticercosis is an infestation of the central nervous system by larvae of Taenia solium. The disease is endemic in a few countries of Latin America, Asia, and Africa and is becoming increasingly prevalent in the United States and Europe. The immigration of individuals from endemic areas and the tourism in these areas require a good knowledge of this disease. A retrospective study evaluating the neurocysticercosis lesions with MR and CT is proposed. Parenchymal, subarachnoid and intraventricular cysts are evaluated. We were able to recognise four CT and MR stages. MR was useful in detecting the cysts of neurocycticercosis in the first stage but was inferior in the detection of parenchymal calcifications.

[Imaging of syringomyelia]

MRI is the best imaging method to evaluate syringomyelia. It is important to study from the posterior cranial fossa to the sacro-lumbar region and also the supra-tentorial structures. This complete analysis is essential to classify the syringomyelia and to investigate other associated malformations. Radiographs and CT scan are useful to analyze bone structures. For MRI, the new sequences with phased-array coils are also very important to study the entire spinal cord and the posterior fossa. It is essential to study the spinal cord with sagittal and axial spin echo T1 and fast spin echo T2 weighted images with sometimes coronal view, particularly when the patient presents a scoliosis, to have a correct morphological and functional evaluation. MRI gives an excellent study of the spinal cord with an excellent analysis of a primitive or foraminal syringomyelia, but also traumatic, infectious or post arachnoiditis syringomyelia. Spin echo T1 weighted images with injection of gadolinium can be used if an intra-medullary tumor is suspected. MRI is also useful for the post-operative follow up to evaluate the persistence of the medullary cyst and the enlargement of the foramen magnum.

[Anatomic variants of Meckel's cave on MRI]

Magnetic resonance imaging (MRI) gives an accurate analysis of Meckel's cave variability. Images were acquired in 50 patients with several sections for anatomical comparison. Using several sections, MRI is a suitable method for better analysis of the trigeminal cistern. The most frequent findings are symmetrical trigeminal cisterns. Expansion of Meckel's cave or its disappearance has pathological significance.

[Imaging cranial nerves with inframillimetric T2-weighted MRI]

Fifty files were evaluated to determine the normal anatomy of the cranial nerves. All the cranial nerves were studied including the labyrinth, in different planes with a 3DFT-CISS imaging technique. The 3DFT-CISS is especially interesting to study cranial nerves because of the excellent contrast with CSF-fluid and the possibility of thin sections. It might be essential for the diagnosis of neuralgia and cranial nerves paralysis.