Extracerebral cavernous hemangioma typically occurs in cavernous sinus in middle cranial fossa,showing iso-or hypointensity on T1WI,obvious hyperintensity on T2WI,and evident enhancement after contrast administration during magnetic resonance imaging(MRI).In this article we report one case of atypical cavernous hemangioma of the trigeminal nerve,with atypical MRI findings including isotense or slight long T2 signal,dotty short T1 signal,and non-enhancement on T1WI.
Cavernous Sinus ; diagnostic imaging ; Hemangioma, Cavernous ; diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Trigeminal Nerve ; pathology

OBJECTIVETo summarize the magnetic resonance imaging(MRI)features and microsurgical treatment of cavernous sinus hemangiomas(CSH).

METHODSTwenty-three patients with surgically and pathologically verified CSH were reviewed. All patients underwent computed tomography(CT)and MR scan, 19 cases underwent MR diffusion-weighted imaging(DWI)and 7 underwent single voxel (1)H magnetic resonance spectroscopy((1)HMRS)before operation. The microsurgery through modified pterional approach was performed in 11 cases and 12 cases removal was achieved in combined fronto-temporal preauricular subtemporal approach. Nineteen cases with large tumors were treated by Leksell Gamma knife(LGK)before operation.

RESULTSCSHs were single, large, and spherical/lie gourd-shaped tumors across the inside and outside the sella. CSH showed equal or slightly low signal on T1WI, high signal on T2WI and FLAIR, homogeneous or heterogeneous great enhancement on MR enhancement scan 19 cases showed equal or slightly low signal on DWI, 7 cases showed no NAA, Cr, and Cho peak, and 6 cases showed Lip peak on (1)HMRS. In 23 cases, the tumors were totally removed in 18, subtotally removed in 3, and partially removed in 2. No perioperative death was reported. The postoperative symptoms were improved in 17 cases but remained unchanged in 4 cases two patients suffered from new nervous symptoms after the surgery, which were improved or cured after three weeks of treatment. In 5 patients who had received subtotal or partial removal of the lesions, LGK was performed postoperatively, which resulted in smaller residual tumors in 4 cases and unchanged tumor in one patient. CONCLUSIONS CSH has some unique MRI features, and therefore MRI is helpful to improve the preoperative localization and qualitative diagnosis. The microsurgery through modified pterional approach combined with fronto-temporal preauricular subtemporal approach is an effective procedure for CSH.

Cavernous Sinus ; diagnostic imaging ; Hemangioma ; Hemangioma, Cavernous ; diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed

Hemangiomas are the most common benign neoplasms, which frequently involve the region of head and neck. However, cavernous hemangiomas are extremely rare in the parapharyngeal space and there has been only a few case reports regarding the disease found in this region. Recently, we experienced a 57-year-old female patient with cavernous hemangioma involving the infratemporal fossa and parapharyngeal space. This case was surgically managed using the infratemporal fossa approach type B. Preoperatively, it was difficult to differentiate the mass of cavernous hemangioma from a neurogenic tumor and this led to a massive bleeding during the operawtion. The preoperative decision-making process and the role of diagnostic imaging were discussed with literature reviews.
Caves ; Diagnostic Imaging ; Female ; Head ; Hemangioma ; Hemangioma, Cavernous ; Hemorrhage ; Humans ; Middle Aged ; Neck

Glioma is the most malignant tumor in the brain, the origin of glioma is still unknown. Recently some papers indicated that glioma may be developed from cerebral cavernous malformation (CCM). We describe a man with a right temporal lobe CCM, after gamma-knife radiotherapy, the patient developed a low-grade astrocytoma in the area of the preexistent CCM. This case, together with other reports, may indicated an oncogenetic properties of CCM, and we proposed that CCM may be a pre-glioma lesion.
Glioma ; diagnostic imaging ; pathology ; Hemangioma, Cavernous, Central Nervous System ; diagnostic imaging ; pathology ; Humans ; Male ; Radiography

Humans ; Hemangioma, Cavernous/diagnostic imaging* ; Tomography, X-Ray Computed ; Magnetic Resonance Imaging

OBJECTIVETo scrutinize the enhancement pattern at hepatic arterial phase (HAP), portal venous phase (PVP) and delayed phase (DP) by helical CT examination in order to differentiate small hepatocellular carcinoma (SHCC) from small hepatic cavernous hemangioma (SHCH).

METHODSIn 38 patients (41 lesions) with SHCC and 35 patients (45 lesions) with SHCH, the images at HAP, PVP and DP were recorded as to the characteristic of enhancements with the average CT value at the HAP monitored and compared.

RESULTSThe enhancement patterns of SHCC at the HAP, PVP, and DP were assessed as hyper-hypo-hypodense in 20 lesions, hyper-iso-hypodense in 6 lesions, hyper-hyper-hypodense in 3 lesions, hyper-iso-isodense in 5 lesions, iso-hypo-hypodense in 3 lesions, and hypo-hypo-hypodense in 4 lesions. The enhancement patterns of the SHCH were assessed as a peripheral hyperdense nodular at HAP, then progressively enlarged at PVP and turned into a isodense or homogeneous hyperdense nodular at DP in 27 lesions, hyper-hyper-iso or hyperdense in 9 lesions, hyper-iso-isodense in 3 lesions, hypo-hypo-hypodense in 6 lesions. The enhancement CT values at the HAP of homogeneous hyperdense SHCC and SHCH were (40.4 +/- 15.5) Hounsfield Unit (HU) and (102.8 +/- 18.9) HU respectively (P < 0.01).

CONCLUSIONMost of the small hepatocellular carcinoma and small hepatic cavernous hemangioma have typical appearance by triple-phase helical CT examination, and can easily and properly be diagnosed. But it is difficult to distinguish SHCC from SHCH with atypical appearance in isolated cases. Hence differentiation may be difficult. Therefore, further examinations such as MRI, ultra-sonography or isotope scintigraphy are helpful in the differential diagnosis.

Adult ; Aged ; Carcinoma, Hepatocellular ; diagnostic imaging ; Diagnosis, Differential ; Female ; Hemangioma, Cavernous ; diagnostic imaging ; Hepatic Artery ; diagnostic imaging ; Humans ; Liver Neoplasms ; diagnostic imaging ; Male ; Middle Aged ; Portal Vein ; diagnostic imaging ; Tomography, Spiral Computed ; methods

OBJECTIVETo investigate the clinical value of CT perfusion in diagnosing and assessing intracranial neoplasms and tumor-like lesions.

METHODS16-slice helical CT perfusion imaging was performed in 56 patients who were clinically suspected to have intracranial neoplasm or tumor-like lesion. With a GE-Light Speed 16-slice helical CT scanner, routine plain-CT scanning was performed to localize the central slice of the lesion. Perfusion imaging was then carried out using cine scan technique to maintain a slice thickness of 5-10 mm, a total dose of 50-70 ml of contrast-medium at an injection flow rate of 3-5 ml/s, a delay time of 7 s and a total scan time of 50 s. The images were processed using perfusion software in an ADW 4.0 workstation, meanwhile, time-density curves (TDC) of different kinds of lesions were also produced and analyzed.

RESULTSThe pathological types in this series included: 29 gliomas (12 low-grade and 17 high-grade), 2 ependemomas, 2 hemangioblastomas, 1 medulloblastoma, 2 metastatic tumors, 1 lymphoma, 5 meningiomas, 2 schwannomas, 1 germinoma, 1 teratoma in the pineal region, 6 cavernous hemangiomas, 2 inflammatory granulomas, 1 tuberculoma, and 1 hyperplasia of the choroid plexus. TDC of high-grade glioma, low-grade glioma and meningioma was different from each other. The cerebral blood flow (CBF), cerebral blood volume (CBV), particularly, the permeability surface (PS) value of glioma was found to increase significantly with the escalation of tumor differentiation grade. In PS map, margin of the tumor could be clearly showed, which was very useful when hemorrhaging within the tumor occurred. CBF in meningioma was lower than that in high-grade glioma, but there was no statistical difference in CBV, MTT and PS between these two types of tumor. The features of intracranial cavernous hemangioma such as significant prolongation of MTT, different TDCs, and zero perfused areas were diverse on CTP image, which was helpful in differentiating it from the other lesions. The germinoma and teratoma had rather low CBF and CBV value, but a remarkably high PS value, furthermore, they showed a rapid escalated TDC with a slowly and continuously elevated platform. The perfusion features of schwannoma was concordant with its pathological findings. However, no visible specific feature of inflammatory lesion was found on CTP image in this series.

CONCLUSIONMulti-slice helical CT perfusion imaging may be helpful in revealing histopathological features and hemodynamic changes as well as differential diagnosis of intracranial neoplasms and tumor-like lesions. When combined with other image and clinical information, CTP can play an important role in pre-operative diagnosis and treatment planning for intracranial neoplasms and tumor-like lesions.

Brain ; blood supply ; Brain Neoplasms ; diagnosis ; diagnostic imaging ; Cerebrovascular Circulation ; Diagnosis, Differential ; Glioma ; diagnosis ; diagnostic imaging ; Hemangioma, Cavernous ; diagnosis ; diagnostic imaging ; Humans ; Meningeal Neoplasms ; diagnosis ; diagnostic imaging ; Meningioma ; diagnosis ; diagnostic imaging ; Reproducibility of Results ; Sensitivity and Specificity ; Tomography, Spiral Computed ; methods

OBJECTIVETo investigate the clinical manifestations, pathologic features and laboratory findings in two Proteus syndrome patients with giant hemangiomas in the spleen and chronic DIC.

METHODSUltrasound imaging and magnetic resonance imaging (MRI) were used for analysing the characteristics of the giant hemangiomas in the spleen. The spleen specimen was examined pathologically for the feature of the hemangioma. Homostatic tests were performed by routine laboratory methods.

RESULTSTwo Proteus syndrome patients with giant hemangiomas in the spleen causing chronic DIC (Kasabach-Merritt syndrome) were first reported. They were recovered after splenectomy.

CONCLUSIONProteus syndrome when accompanied giant hemangioma could cause chronic DIC. Significantly decreased plasma fibrinogen level in this case might be helpful for the differential diagnosis from DIC caused by other diseases.

Adolescent ; Disseminated Intravascular Coagulation ; etiology ; Female ; Hemangioma, Cavernous ; complications ; diagnostic imaging ; surgery ; Humans ; Proteus Syndrome ; complications ; Splenectomy ; Splenic Neoplasms ; complications ; diagnostic imaging ; surgery ; Ultrasonography

Adolescent ; Brachiocephalic Veins ; abnormalities ; surgery ; Hemangioma, Cavernous ; diagnostic imaging ; surgery ; Humans ; Male ; Mediastinal Neoplasms ; diagnostic imaging ; surgery ; Subclavian Vein ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVE: To document the imaging findings of hepatic cavernous heman-gioma detected in cirrhotic liver. MATERIALS AND METHODS: The imaging findings of 14 hepatic cavernous hemangiomas in ten patients with liver cirrhosis were retrospectively analyzed. A diagnosis of hepatic cavernous hemangioma was based on the findings of two or more of the following imaging studies: MR, including contrast-enhanced dynamic imaging (n = 10), dynamic CT (n = 4), hepatic arteriography (n = 9), and US (n =10). RESULTS: The mean size of the 14 hepatic hemangiomas was 0.9 (range, 0.5 -1.5) cm in the longest dimension. In 11 of these (79%), contrast-enhanced dynamic CT and MR imaging showed rapid contrast enhancement of the entire lesion during the early phase, and hepatic arteriography revealed globular enhancement and rapid filling-in. On contrast-enhanced MR images, three lesions (21%) showed partial enhancement until the 5-min delayed phases. US indicated that while three slowly enhancing lesions were homogeneously hypere-choic, 9 (82%) of 11 showing rapid enhancement were not delineated. CONCLUSION: The majority of hepatic cavernous hemangiomas detected in cirrhotic liver are small in size, and in many, hepatic arteriography and/or contrast-enhanced dynamic CT and MR imaging demonstrates rapid enhancement. US, however, fails to distinguish a lesion of this kind from its cirrhotic background.
*Diagnostic Imaging ; Female ; Hemangioma, Cavernous/complications/*diagnosis ; Human ; Liver Cirrhosis/*complications ; Liver Neoplasms/complications/*diagnosis ; Magnetic Resonance Imaging ; Male ; Middle Age ; Retrospective Studies ; Tomography, X-Ray Computed