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

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

BACKGROUND: Multiple endocrine neoplasia type 1 (MEN1) is a rare inherited disorder characterized by the simultaneous occurrence of endocrine tumors in target tissues (mainly the pituitary, endocrine pancreas, and parathyroid glands). MEN1 is caused by mutations in the MEN1 gene, which functions as a tumor suppressor and consists of one untranslated exon and nine exons encoding the menin protein. This condition is usually suspected when we encounter patients diagnosed with tumors in multiple endocrine organs, as mentioned above. METHODS: A 65-year-old woman who underwent surgery for a pancreatic tumor (serous cystadenoma) 5 years previously was referred to our hospital due to neurologic symptoms of diplopia and left ptosis. Brain magnetic resonance imaging revealed a 3.4-cm lesion originating from the cavernous sinus wall and extending into the sellar region. It was thought to be a nonfunctioning tumor from the results of the combined pituitary function test. Incidentally, we found that she also had a pancreatic tumor, indicating the necessity of genetic analysis for MEN1. RESULTS: Genomic analysis using peripheral leukocytes revealed a heterozygous c.1621G>A mutation in the MEN1 gene that was previously reported to be either a pathogenic mutation or a simple polymorphism. We pursued a stereotactic approach to the pituitary lesion, and microscopic findings of the tumor revealed it to be an intrasellar cavernous hemangioma, a rare finding in the sellar region and even rarer in relation to oculomotor palsy. The patient recovered well from surgery, but refused further evaluation for the pancreatic lesion. CONCLUSION: There is great emphasis placed on genetic testing in the diagnosis of MEN1, but herein we report a case where it did not assist in diagnosis, hence, further discussion on the role of genetic testing in this disease is needed. Also, in cases of pituitary tumor with cranial nerve palsy, despite its low prevalence, intrasellar cavernous hemangioma could be suspected.
Aged ; Brain ; Cavernous Sinus ; Cranial Nerve Diseases ; Diagnosis ; Diagnostic Errors* ; Diplopia ; Exons ; Female ; Genetic Testing ; Hemangioma, Cavernous* ; Humans ; Islets of Langerhans ; Leukocytes ; Magnetic Resonance Imaging ; Multiple Endocrine Neoplasia Type 1* ; Neurologic Manifestations ; Paralysis ; Pituitary Function Tests ; Pituitary Neoplasms ; Prevalence

Osseous hemangioma is a benign vascular tumor, and it usually occurs in the vertebrae and the skull. However, hemangiomas of flat bones are rare, and there are very few reports that describe the radiologic findings of osseous hemangioma of the ilium. We report a unique case of large cavernous hemangioma mimicking a chondrogenic malignant bone tumor originated from the ilium in a 22-year-old female. The mass showed stippled calcifications, heterogeneous enhancement with thick septa and enhanced soft tissue components on CT and MR, and also this mass demonstrated heterogeneous 2-fluoro [fluorine-18]-2-deoxy-D-glucose (18F-FDG) uptake on 18F-FDG PET/CT.
Bone Neoplasms/radionuclide imaging ; Diagnosis, Differential ; Female ; Fluorodeoxyglucose F18/*diagnostic use ; Hemangioma, Cavernous/*radionuclide imaging ; Humans ; Ilium/*blood supply ; Magnetic Resonance Imaging ; Positron-Emission Tomography and Computed Tomography ; Radiopharmaceuticals/*diagnostic use ; Young Adult

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

OBJECTIVE: To investigate the relationships between the apparent diffusion coefficients (ADCs) on diffusion-weighted imaging (DWI) and the speed of contrast-enhancement in hepatic hemangiomas. MATERIALS AND METHODS: Sixty-nine hepatic hemangiomas (> or = 1 cm) were evaluated with DWI, by using multiple b values (b = 50, 400, 800 s/mm2), followed by a gadolinium-enhanced dynamic MRI. The lesions were classified into three groups, according to the speed of contrast-enhancement on the portal phase. ADCs were measured on the ADC map automatically, and were calculated by using the two different b values (mADC50-400 with b values = 50 and 400; mADC400-800 with b values = 400 and 800 s/mm2). RESULTS: The mean ADCs (x 10-3 mm2/s) were significantly higher in the rapid group (1.9 +/- 0.44) than in the intermediate (1.7 +/- 0.35, p = 0.046) or the slow groups (1.4 +/- 0.34, p = 0.002). There were significant differences between the rapid and the slow groups in mADC50-400 (2.12 vs. 1.48; p = 0.008) and mADC400-800 (1.68 vs. 1.22, p = 0.010), and between the rapid and the intermediate groups in mADC50-400 (2.12 vs. 1.79, p = 0.049). Comparing mADC50-400 with mADC400-800, there was a significant difference only in the rapid group (p = 0.001). CONCLUSION: Higher ADCs of rapidly-enhancing hemangiomas may be related to richer intralesional vascular perfusion. Also, the restricted diffusion may be attributed to the difference of structural characteristics of hemangioma.
Adult ; Aged ; Contrast Media ; *Diffusion Magnetic Resonance Imaging ; Female ; Gadolinium DTPA/diagnostic use ; Hemangioma, Cavernous/*diagnosis ; Humans ; Image Enhancement ; Liver Neoplasms/*diagnosis ; *Magnetic Resonance Imaging ; Male ; Middle Aged

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

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

OBJECTIVESTo analyze the reliability and clinical value of intraoperative ultrasound combined with neuronavigation for resection of intracranial cavernous malformations.

METHODSFrom January 2007 to December 2009, 40 cases of intracranial cavernous malformations were operated under the application of intraoperative ultrasound combined with neuronavigation. There were 18 male and 22 female, aged 18 to 58 years, with a mean age of 34.5 years. Neuronavigation was used for all patients before operation to display the three-dimensional model of nervous system and lesions, so to design the operative approach and determine the scope of the incision. Lesions were allocated by real-time neuronavigation in order to continuously verify the accuracy of operative approach during the operation, supplemented by real-time monitoring of intraoperative ultrasound to guide the process of surgery and determine the extent of resection of lesions.

RESULTSThe registration error of neuronavigation was 1.3 - 3.2 mm, with an average of 2.0 mm. All the patients' three-dimensional model of nervous system and lesions were satisfactorily displayed, and the area of lesions were all accurately located. Structural brain-shifts occurred in 4 cases in the remove process of the lesion, with shift degree 5.0 - 10.0 mm, and were corrected by intraoperative ultrasound. All lesions were well displayed by intraoperative ultrasound. Gross total resection was achieved in all patients, with no patient infected or dead. Neurological deterioration was seen in 2 patients, the morbidity was 5.0%.

CONCLUSIONSThe combination of neuronavigation and intraoperative ultrasound for resection of intracranial cavernous malformations can provide valuable intraoperative informations of the location and resection level of the lesion, thereby maximize the accuracy of lesion localization and the extent of resection, with less complications and enhanced efficacy of the surgery.

Adolescent ; Adult ; Female ; Hemangioma, Cavernous, Central Nervous System ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Neuronavigation ; Neurosurgery ; methods ; Ultrasonography ; Young Adult

Adolescent ; Adult ; Carcinoma, Embryonal ; diagnosis ; diagnostic imaging ; Child ; Child, Preschool ; Diagnosis, Differential ; Hemangioma, Cavernous ; diagnosis ; diagnostic imaging ; Humans ; Infant ; Lymphoma ; diagnosis ; diagnostic imaging ; Male ; Middle Aged ; Orchitis ; diagnosis ; diagnostic imaging ; Retrospective Studies ; Seminoma ; diagnosis ; diagnostic imaging ; Teratoma ; diagnosis ; diagnostic imaging ; Testicular Neoplasms ; diagnosis ; diagnostic imaging ; Ultrasonography, Doppler, Color ; Young Adult