Susceptibility - Weighted Imaging for the Evaluation of Large Cavernous Malformation : a case report

Reprint requests to: Dr. Wei-Yu Chen Department of Hematology & Oncology, Chi-Mei Medical Center, Yong-Kang Campus. No. 901, Chung Hwa Road, Yong-Kang, Tainan 710, Taiwan, R.O.C. The diagnosis of a large cavernous malformation may be challenging because its imaging appearance is var iable . Here we reported a 22-year-old man with a large mass in left side temporal lobe. Computed tomography showed a high density intra-axial mass with perifocal edema in left side temporal lobe. Cystic component, a tiny calcif ied spot and partial contrast enhancement of th is lesion were also noted. Magnet ic resonance imag ing d isclosed th is mass was measured about 4.9 × 4.0 ×4.2 cm in size. Intra-tumoral hemorrhage was noted on T1-weighted images. On T2-weighted images, the per ipheral hypointense r im around this mass was shown, which also appeared clearly on susceptibil ity-weighted images. Surgical excision was performed and pathology confirmed the diagnosis of cavernous malformation. Susceptibility-weighted imaging is a magnetic resonance technique that exploits the magnetic susceptibility differences of various tissues, such as blood, iron and calcification. Because of its high degree of sensitivity in identifying venous structures and blood products, it can help to confirm the diagnosis of cavernous malformation in patients presenting with cerebral hemorrhage. Cavernous malformations are vascular anomalies with cavernous spaces lined by endothelial cells and collagen, devoid of smooth muscle or intervening neural t issue, and f illed with blood at various stages of stasis, thrombosis, organization, and calcification [1]. The diagnosis of a large cavernous malformation may be challenging because its imaging appearance is variable [2]. Susceptibilityweighted imaging (SWI) is a magnetic resonance (MR) technique that exploits the magnetic susceptibility differences of various tissues, such as blood, iron and calcification [3]. In this report, we describe the SWI findings of a large cavernous malformation and discuss the helpfulness of SWI for its evaluation.