BACKGROUND Osseous hemangiomas,especially those located in the manubrium,are rare benign tumors.In a review of the literature,only three case reports of sternal hemangioma were found.A precise diagnosis is difficult b...BACKGROUND Osseous hemangiomas,especially those located in the manubrium,are rare benign tumors.In a review of the literature,only three case reports of sternal hemangioma were found.A precise diagnosis is difficult because of their nonspecific findings on computed tomography(CT)/magnetic resonance imaging(MRI).CASE SUMMARY An 88-year-old woman was suffering from a progressively enlarging mass in the manubrium.Chest CT images showed an osteolytic and expansile lesion with cortical destruction.Vascular malformation was suspected after CT-guided biopsy.On the dynamic MRI scans,the mass showed a bright signal on the T2-weighted image,peripheral nodular enhancement on the early-phase images and progressive centripetal fill-in on the delayed-phase images.Cavernous hemangioma was suspected preoperatively based on the MRI features and finally confirmed by histopathologic analysis.CONCLUSION This uncommon case demonstrates the possible characteristic features of manubrium cavernous hemangioma on dynamic MRI scans;knowledge about these features may prevent patients from developing catastrophic complications,such as rupture or internal hemorrhage,caused by biopsy or surgery.展开更多
AIM:To clarify features of hepatic hemangiomas on gadolinium-ethoxybenzyl-diethylenetriaminpentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) compared with enhanced computed tomography (CT). METH...AIM:To clarify features of hepatic hemangiomas on gadolinium-ethoxybenzyl-diethylenetriaminpentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) compared with enhanced computed tomography (CT). METHODS:Twenty-six patients with 61 hepatic hem- angiomas who underwent both Gd-EOB-DTPA-enhanced MRI and enhanced CT were retrospectively reviewed. Hemangioma appearances (presence of peripheral nodular enhancement, central nodular enhancement, diffuse homogenous enhancement, and arterioportal shunt during the arterial phase, fill-in enhancement during the portal venous phase, and prolonged enhancement during the equilibrium phase) on Gd-EOB-DTPA-enhanced MRI and enhanced CT were evaluated.The degree of contrast enhancement at the enhancing portion within the hemangioma was visually assessed using a five-point scale during each phase. For quantitative analysis, the tumor-muscle signal intensity ratio (SIR), the liver-muscle SIR, and the attenuation value of the tumor and liver parenchyma were calculated. The McNemar test and the Wilcoxon's signed rank test were used to assess the significance of differences in the appearances of hemangiomas and in the visual grade of tumor contrast enhancement between Gd-EOB-DTPA-enhanced MRI and enhanced CT. RESULTS:There was no significant difference between Gd-EOB-DTPA-enhanced MRI and enhanced CT in the presence of peripheral nodular enhancement (85% vs 82%), central nodular enhancement (3% vs 3%), diffuse enhancement (11% vs 16%), or arterioportal shunt (23% vs 34%) during arterial phase, or fill-in enhancement (79% vs 80%) during portal venous phase. Prolonged enhancement during equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than on enhanced CT (52% vs 100%, P < 0.001). On visual inspection, there was significantly less contrast enhancement of the enhancing portion on Gd-EOB-DTPA-enhanced MRI than on enhanced CT during the arterial (3.94 ± 0.98 vs 4.57 ± 0.64, respectively, P < 0.001), portal venous (3.72 ± 0.82 vs 4.36 ± 0.53, respectively, P < 0.001), and equilibrium phases (2.01 ± 0.95 vs 4.04 ± 0.51, respectively, P < 0.001). In the quantitative analysis, the tumor-muscle SIR and the liver-muscle SIR observed with Gd-EOB-DTPA-enhanced MRI were 0.80 ± 0.24 and 1.28 ± 0.33 precontrast, 1.92 ± 0.58 and 1.57 ± 0.55 during the arterial phase, 1.87 ± 0.44 and 1.73 ± 0.39 during the portal venous phase, 1.63 ± 0.41 and 1.78 ± 0.39 during the equilibrium phase, and 1.10 ± 0.43 and 1.92 ± 0.50 during the hepatobiliary phase, respectively. The attenuation values in the tumor and liver parenchyma observed with enhanced CT were 40.60 ± 8.78 and 53.78 ± 7.37 precontrast, 172.66 ± 73.89 and 92.76 ± 17.92 during the arterial phase, 152.76 ± 35.73 and 120.12 ± 18.02 during the portal venous phase, and 108.74 ± 18.70 and 89.04 ± 7.25 during the equilibrium phase, respectively. Hemangiomas demonstrated peak enhancement during the arterial phase, and both the SIR with Gd-EOB-DTPA-enhanced MRI and the attenuation value with enhanced CT decreased with time. The SIR of hemangiomas was lower than that of liver parenchyma during the equilibrium and hepatobiliary phases on Gd-EOB-DTPA-enhanced MRI. However, the attenuation of hemangiomas after contrast injection was higher than that of liver parenchyma during all phases of enhanced CT. CONCLUSION:Prolonged enhancement during the equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than enhanced CT, which may exacerbate differentiating between hemangiomas and malignant tumors.展开更多
Objective To assess the characteristics of magnetic resonance imaging for spinal cavernous angiomas.Methods The examinations of plain scan and contrast enhanced scan of magnetic resonance were performed in three patie...Objective To assess the characteristics of magnetic resonance imaging for spinal cavernous angiomas.Methods The examinations of plain scan and contrast enhanced scan of magnetic resonance were performed in three patients with spinal cavernous angiomas.Results The focus of two cases was located in thorax segment of the spinal cord and one in lower cervical segment.All focuses were single and the shape of spinal cord was normal or slightly thick. MRI characteristic of spinal cavernous angiomas was just like popcorn or mulberry with a jumbled gobbet signal. Low and short T 2 signal appeared around the focus. In all cases, there were no obvious contrast enhanced signal in 2 cases and one case with moderate contrast enhanced signal. The diameter of hemorrhage was smaller than that of the spinal cord.Conclusion MRI has higher sensitivity and specificity in the diagnosis of spinal cavernous angioma.展开更多
Objective To investigate the characteristics of magnetic resonance image (MRI) of spinal cord cavernous hemangioma. Methods Six cases of spinal cord cavernous heman-gioma diagnosed by MRI and confirmed by pathology we...Objective To investigate the characteristics of magnetic resonance image (MRI) of spinal cord cavernous hemangioma. Methods Six cases of spinal cord cavernous heman-gioma diagnosed by MRI and confirmed by pathology were reviewed. The characteristics of MRI were analyzed and correlated with pathological characteristics of spinal cord cavernous hemangioma. Results In 4 cases, the tumors were located in thoracic segment of the spinal cord and 2 in cervical cord. All lesions were solitary and the spinal cords were normal or a little thicker. The MRI showed that the images of focus were ball-like popcorn or mulberry with mixed signal,with short T2 signal around the focus. Under microscope, the hemangioma was composed of highly expanded blood sinusoids and its wall was thin and consisted of flat epithelial cells. There were some red blood cells in the cavity of the sinusoid and a little fibrous tissue in the diazoma between blood sinusoids. And also some fresh and old hemorrhages could be seen in the specimen. Conclusion MRI has high sensitivity and specificity in the diagnosis of spinal cavernous hemangioma.展开更多
AIMTo elucidate the clinical, magnetic resonance imaging (MRI), pathological features of these lesions and asses the incremental value of diffusion-weighted imaging (DWI) in diagnosing them. METHODSFifteen consecutive...AIMTo elucidate the clinical, magnetic resonance imaging (MRI), pathological features of these lesions and asses the incremental value of diffusion-weighted imaging (DWI) in diagnosing them. METHODSFifteen consecutive patients (11 females and 4 males; mean age 40.93 years; age range 13-63 years) with cavernous sinus hemangiomas (CSH) who underwent examination between November 2008 and May 2016 were included for the analysis. MRI, clinical and surgical findings of each patient was retrospectively reviewed. DWI were also analysed and mean-apparent diffusion coefficient (ADC) value was calculated. Eleven patients underwent surgical removal of the lesion and 2 patients had biopsy only. Diagnosis of CSH was confirmed histologically in 13 patients. RESULTSEleven patients (73%) presented with headaches and 10 (66%) had cranial nerve involvement. Extra cavernous sinus extension was noted in 14 (94%). Surgery was performed in 13 (87%) and post-operative radiation was given to 4 (28%) patients. Thirteen patients remained asymptomatic on follow up. Three conspicuous imaging features were highly suggestive of the diagnosis: Lack of diffusion restriction (100%), homogeneous hyperintensity on T2 weighted image sequences (93.3%) and intense post-contrast enhancement (100%). The mean ADC was 1.82 × 10<sup>-3</sup> ± 0.2186 cm<sup>2</sup>/s. CONCLUSIONT1-weighted hypointensity with homogeneous hyperintensity on T2-weighted sequences, intense enhancement and absence of hemosiderin within the lesion on GRE sequence favour the diagnosis. Facilitated diffusion on DWI differentiates CSH from other solid cavernous sinus lesions and significantly improves the diagnostic accuracy, a critical factor for planning surgery.展开更多
AIM: To assess features of cavernous hemangioma (CH) in the orbit revealed by CT and MRI and summarize prediction of preoperative CT and MRI for the adhesion degree of CH in the orbit. METHODS: A total of 97 patients ...AIM: To assess features of cavernous hemangioma (CH) in the orbit revealed by CT and MRI and summarize prediction of preoperative CT and MRI for the adhesion degree of CH in the orbit. METHODS: A total of 97 patients with pathologically confirmed CH in the orbit were examined with axial and coronal CT scan, and axial, coronal, sagittal, and enhanced fat suppression MRI scan. CT and MRI findings and intraoperative adhesion degrees were retrospectively analyzed. RESULTS: There were 47 patients with slight adhesion, for whom CT and MRI showed round masses with well defined margins in the extraocular muscles; 14 patients with mild adhesion, for whom CT and MRI revealed irregular masses with unclear boundary between CH and the optic nerve in coronal images, and emissary veins in the posterior region of masses in contrast-enhanced images; 36 patients with severe adhesion, for whom CT and MRI exhibited an irregular or ovoid mass filling the orbital apex, or showed distorted and even spiky margins in the posterior region of masses in contrast enhanced images at the presence of a transparent triangle between the mass and the orbital apex. CONCLUSION: Preoperative CT and MRI aid in accurate diagnosis, selection of the surgical approach, and assessment of the adhesion degree and surgical risks for CH.展开更多
BACKGROUND Pancreatic cavernous hemangioma(pCH)is a rare type of benign vascular tumor.Making the right diagnosis is challenging due to low clinical suspicion and the lack of existing cross-sectional imaging tools to ...BACKGROUND Pancreatic cavernous hemangioma(pCH)is a rare type of benign vascular tumor.Making the right diagnosis is challenging due to low clinical suspicion and the lack of existing cross-sectional imaging tools to distinguish it from other pancreatic lesions.CASE SUMMARY We describe a male patient,age 18,who presented with a pCH.Computed tomography,magnetic resonance imaging,and ultrasound showed cystic space in the tail of the pancreas.A dark spot sign on the T2 weighted image sequence was observed.Clinically,a mucinous cystic neoplasm with hemorrhage was suspected preoperatively by combining imaging,and the operative indication was clear.The patient underwent a distal pancreatic tumor resection under laparoscopic control.Immunohistochemical staining for CD31 and CD34 was positive;D2-40 was positive in interstitial lymphatic vessels and negative in vascular epithelial cells;and calcium-binding protein was negative.The results support the diagnosis of pCH combined with chronic intracapsular spontaneous hemorrhage.No complications or recurrences were observed during the follow-up period.CONCLUSION Chronic spontaneous hemorrhage may occur in pCH,which may greatly influence the accuracy of diagnosis using imaging modalities.Surgical resection for uncertain pCH seems reasonable with a good outcome.展开更多
BACKGROUND Anastomosing hemangioma(AH)is a rare subtype of benign hemangioma that is most commonly found in the genitourinary tract.Due to the lack of specific clinical and radiologic manifestations,it is easily misdi...BACKGROUND Anastomosing hemangioma(AH)is a rare subtype of benign hemangioma that is most commonly found in the genitourinary tract.Due to the lack of specific clinical and radiologic manifestations,it is easily misdiagnosed preoperatively.Here,we report a case of AH arising from the left renal vein that was discovered incidentally and confirmed pathologically,and then describe its imaging characteristics from a radiologic point of view and review its clinicopathologic features and treatment.CASE SUMMARY A 74-year-old woman was admitted to our department for a left retroperitoneal neoplasm measuring 2.6 cm×2.0 cm.Her laboratory data showed no significant abnormalities.A non-contrast-enhanced computed tomography(CT)scan showed a heterogeneous density in the neoplasm.Non-contrast-enhanced magnetic resonance imaging(MRI)revealed a heterogeneous hypointensity on T1-weighed images and a heterogeneous hyperintensity on T2-weighed images.On contrastenhanced CT and MRI scans,the neoplasm presented marked septal enhancement in the arterial phase and persistent enhancement in the portal phase,and its boundary with the left renal vein was ill-defined.Based on these clinical and radiological manifestations,the neoplasm was initially considered to be a neurogenic neoplasm in the left retroperitoneum.Finally,the neoplasm was completely resected and pathologically diagnosed as AH.CONCLUSION AH is an uncommon benign hemangioma.Preoperative misdiagnoses are common not only because of a lack of specific clinical and radiologic manifestations but also because clinicians lack vigilance and diagnostic experience in identifying AH.AH is not exclusive to the urogenital parenchyma.We report the first case of this neoplasm in the left renal vein.Recognition of this entity in the left renal vein can be helpful in its diagnosis and distinction from other neoplasms.展开更多
Cerebral cavemous malformation (CCM) is a frequently occurring disease in Latin American populations, but little is known about the prevalence in China. This study enrolled one Chinese family with CCM, comprising 16...Cerebral cavemous malformation (CCM) is a frequently occurring disease in Latin American populations, but little is known about the prevalence in China. This study enrolled one Chinese family with CCM, comprising 16 members; four were diagnosed with CCM which corresponded with autosomal incomplete dominance inheritance. The main clinical manifestations included headache, focal neural dysfunction, and cerebral hemorrhage. The lesions were a mixture of hyperintensity and hypointensity signals on TlWl and T2Wl, with a black hypointensity ring on T2Wl. CCM cranial magnetic resonance imaging T2Wl revealed an iron ring as a result of hemosiderin deposition. Pathological findings of CCM revealed tightly packed and variably thickened vascular channels lacking smooth muscle or elastic tissue. Intralesional hyalinosis, calcification, or bleeding of different phases and perilesional glial hyperplasia were observed, as well as hemosiderin deposition within or around the lesions. These features of this family were consistent with specific genetic, imaging and pathological features of familial CCM. Pathological characteristics reveal repeated hemorrhage, as well as intralesional and perilesional hemosiderin deposition.展开更多
BACKGROUND Aggressive vertebral hemangioma(VH)is an uncommon lesion in the adult population.The vast majority of aggressive VHs have typical radiographic features.However,preoperative diagnosis of atypical aggressive ...BACKGROUND Aggressive vertebral hemangioma(VH)is an uncommon lesion in the adult population.The vast majority of aggressive VHs have typical radiographic features.However,preoperative diagnosis of atypical aggressive VH may be difficult.Aggressive VHs are likely to recur even with en bloc resection.CASE SUMMARY A 52-year-old woman presented with a 3-mo history of numbness and pain in her right lower extremity.Physical examination showed sacral tenderness and limited mobility,and the muscle strength was grade 4 in the right digital flexor.Computed tomography revealed osteolytic bone destruction from S1 to S2.Magnetic resonance imaging(MRI)showed that the mass was compressing the dural sac;it was heterogeneously hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI,and gadolinium contrast enhancement showed that the tumor was heterogeneously enhanced and invading the vertebral endplate of S1.The patient developed progressive back pain and numbness in the bilateral extremities 6 mo postoperatively,and MRI examination showed recurrence of the mass.The mass was larger in size than before the operation,and it was extending into the spinal canal.CONCLUSION The radiographic findings of atypical aggressive VH include osteolytic vertebral bone destruction,extension of the mass into the spinal canal,and heterogeneous signal intensity on T1-,T2-,and enhanced T1-weighted MRI.These characteristics make preoperative diagnosis difficult,and biopsy is necessary to verify the lesion.Surgical decompression and gross total resection are recommended for treatment of aggressive VH.However,recurrence is inevitable in some cases.展开更多
A 50-year-old woman presented with mid-thoracic backache and progressive, spastic, paraparesis for 3 months. Magnetic resonance imaging revealed an epidural mass without bone lesion at the level of thoracic vertebrae ...A 50-year-old woman presented with mid-thoracic backache and progressive, spastic, paraparesis for 3 months. Magnetic resonance imaging revealed an epidural mass without bone lesion at the level of thoracic vertebrae (T7, T8 and T9). The mass had a paraspinal invasion. The spinal cord was compressed ventrally. The lesion was totally excised through an anterolateral transthoracic approach. Histopathological examination revealed a cavernous hemangioma. The patient improved dramatically after the excision of the lesion. We report this case for its rarity.展开更多
Vertebral hemangiomas are common benign lesions of the spine, characterized by abnormal vascular proliferation, being commonly asymptomatic incidental findings, presenting symptoms in only a small portion of affected ...Vertebral hemangiomas are common benign lesions of the spine, characterized by abnormal vascular proliferation, being commonly asymptomatic incidental findings, presenting symptoms in only a small portion of affected individuals. In a smaller number of cases, however, hemangiomas can present an expansive effect and extra-osseous extension, determining a mass effect and neurological symptoms, being therefore called aggressive hemangiomas. On MRI, aggressive hemangiomas are characterized by having a larger vascular component and a smaller fat component, thus producing a low signal on T1-weighted images. We illustrate the case of a young male patient who presented with pain in the upper thoracic spine, who developed paraparesis and ascending sensory deficit and progressive lower limbs, progressing to paraplegia and loss of sphincter control.展开更多
文摘BACKGROUND Osseous hemangiomas,especially those located in the manubrium,are rare benign tumors.In a review of the literature,only three case reports of sternal hemangioma were found.A precise diagnosis is difficult because of their nonspecific findings on computed tomography(CT)/magnetic resonance imaging(MRI).CASE SUMMARY An 88-year-old woman was suffering from a progressively enlarging mass in the manubrium.Chest CT images showed an osteolytic and expansile lesion with cortical destruction.Vascular malformation was suspected after CT-guided biopsy.On the dynamic MRI scans,the mass showed a bright signal on the T2-weighted image,peripheral nodular enhancement on the early-phase images and progressive centripetal fill-in on the delayed-phase images.Cavernous hemangioma was suspected preoperatively based on the MRI features and finally confirmed by histopathologic analysis.CONCLUSION This uncommon case demonstrates the possible characteristic features of manubrium cavernous hemangioma on dynamic MRI scans;knowledge about these features may prevent patients from developing catastrophic complications,such as rupture or internal hemorrhage,caused by biopsy or surgery.
文摘AIM:To clarify features of hepatic hemangiomas on gadolinium-ethoxybenzyl-diethylenetriaminpentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) compared with enhanced computed tomography (CT). METHODS:Twenty-six patients with 61 hepatic hem- angiomas who underwent both Gd-EOB-DTPA-enhanced MRI and enhanced CT were retrospectively reviewed. Hemangioma appearances (presence of peripheral nodular enhancement, central nodular enhancement, diffuse homogenous enhancement, and arterioportal shunt during the arterial phase, fill-in enhancement during the portal venous phase, and prolonged enhancement during the equilibrium phase) on Gd-EOB-DTPA-enhanced MRI and enhanced CT were evaluated.The degree of contrast enhancement at the enhancing portion within the hemangioma was visually assessed using a five-point scale during each phase. For quantitative analysis, the tumor-muscle signal intensity ratio (SIR), the liver-muscle SIR, and the attenuation value of the tumor and liver parenchyma were calculated. The McNemar test and the Wilcoxon's signed rank test were used to assess the significance of differences in the appearances of hemangiomas and in the visual grade of tumor contrast enhancement between Gd-EOB-DTPA-enhanced MRI and enhanced CT. RESULTS:There was no significant difference between Gd-EOB-DTPA-enhanced MRI and enhanced CT in the presence of peripheral nodular enhancement (85% vs 82%), central nodular enhancement (3% vs 3%), diffuse enhancement (11% vs 16%), or arterioportal shunt (23% vs 34%) during arterial phase, or fill-in enhancement (79% vs 80%) during portal venous phase. Prolonged enhancement during equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than on enhanced CT (52% vs 100%, P < 0.001). On visual inspection, there was significantly less contrast enhancement of the enhancing portion on Gd-EOB-DTPA-enhanced MRI than on enhanced CT during the arterial (3.94 ± 0.98 vs 4.57 ± 0.64, respectively, P < 0.001), portal venous (3.72 ± 0.82 vs 4.36 ± 0.53, respectively, P < 0.001), and equilibrium phases (2.01 ± 0.95 vs 4.04 ± 0.51, respectively, P < 0.001). In the quantitative analysis, the tumor-muscle SIR and the liver-muscle SIR observed with Gd-EOB-DTPA-enhanced MRI were 0.80 ± 0.24 and 1.28 ± 0.33 precontrast, 1.92 ± 0.58 and 1.57 ± 0.55 during the arterial phase, 1.87 ± 0.44 and 1.73 ± 0.39 during the portal venous phase, 1.63 ± 0.41 and 1.78 ± 0.39 during the equilibrium phase, and 1.10 ± 0.43 and 1.92 ± 0.50 during the hepatobiliary phase, respectively. The attenuation values in the tumor and liver parenchyma observed with enhanced CT were 40.60 ± 8.78 and 53.78 ± 7.37 precontrast, 172.66 ± 73.89 and 92.76 ± 17.92 during the arterial phase, 152.76 ± 35.73 and 120.12 ± 18.02 during the portal venous phase, and 108.74 ± 18.70 and 89.04 ± 7.25 during the equilibrium phase, respectively. Hemangiomas demonstrated peak enhancement during the arterial phase, and both the SIR with Gd-EOB-DTPA-enhanced MRI and the attenuation value with enhanced CT decreased with time. The SIR of hemangiomas was lower than that of liver parenchyma during the equilibrium and hepatobiliary phases on Gd-EOB-DTPA-enhanced MRI. However, the attenuation of hemangiomas after contrast injection was higher than that of liver parenchyma during all phases of enhanced CT. CONCLUSION:Prolonged enhancement during the equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than enhanced CT, which may exacerbate differentiating between hemangiomas and malignant tumors.
文摘Objective To assess the characteristics of magnetic resonance imaging for spinal cavernous angiomas.Methods The examinations of plain scan and contrast enhanced scan of magnetic resonance were performed in three patients with spinal cavernous angiomas.Results The focus of two cases was located in thorax segment of the spinal cord and one in lower cervical segment.All focuses were single and the shape of spinal cord was normal or slightly thick. MRI characteristic of spinal cavernous angiomas was just like popcorn or mulberry with a jumbled gobbet signal. Low and short T 2 signal appeared around the focus. In all cases, there were no obvious contrast enhanced signal in 2 cases and one case with moderate contrast enhanced signal. The diameter of hemorrhage was smaller than that of the spinal cord.Conclusion MRI has higher sensitivity and specificity in the diagnosis of spinal cavernous angioma.
文摘Objective To investigate the characteristics of magnetic resonance image (MRI) of spinal cord cavernous hemangioma. Methods Six cases of spinal cord cavernous heman-gioma diagnosed by MRI and confirmed by pathology were reviewed. The characteristics of MRI were analyzed and correlated with pathological characteristics of spinal cord cavernous hemangioma. Results In 4 cases, the tumors were located in thoracic segment of the spinal cord and 2 in cervical cord. All lesions were solitary and the spinal cords were normal or a little thicker. The MRI showed that the images of focus were ball-like popcorn or mulberry with mixed signal,with short T2 signal around the focus. Under microscope, the hemangioma was composed of highly expanded blood sinusoids and its wall was thin and consisted of flat epithelial cells. There were some red blood cells in the cavity of the sinusoid and a little fibrous tissue in the diazoma between blood sinusoids. And also some fresh and old hemorrhages could be seen in the specimen. Conclusion MRI has high sensitivity and specificity in the diagnosis of spinal cavernous hemangioma.
文摘AIMTo elucidate the clinical, magnetic resonance imaging (MRI), pathological features of these lesions and asses the incremental value of diffusion-weighted imaging (DWI) in diagnosing them. METHODSFifteen consecutive patients (11 females and 4 males; mean age 40.93 years; age range 13-63 years) with cavernous sinus hemangiomas (CSH) who underwent examination between November 2008 and May 2016 were included for the analysis. MRI, clinical and surgical findings of each patient was retrospectively reviewed. DWI were also analysed and mean-apparent diffusion coefficient (ADC) value was calculated. Eleven patients underwent surgical removal of the lesion and 2 patients had biopsy only. Diagnosis of CSH was confirmed histologically in 13 patients. RESULTSEleven patients (73%) presented with headaches and 10 (66%) had cranial nerve involvement. Extra cavernous sinus extension was noted in 14 (94%). Surgery was performed in 13 (87%) and post-operative radiation was given to 4 (28%) patients. Thirteen patients remained asymptomatic on follow up. Three conspicuous imaging features were highly suggestive of the diagnosis: Lack of diffusion restriction (100%), homogeneous hyperintensity on T2 weighted image sequences (93.3%) and intense post-contrast enhancement (100%). The mean ADC was 1.82 × 10<sup>-3</sup> ± 0.2186 cm<sup>2</sup>/s. CONCLUSIONT1-weighted hypointensity with homogeneous hyperintensity on T2-weighted sequences, intense enhancement and absence of hemosiderin within the lesion on GRE sequence favour the diagnosis. Facilitated diffusion on DWI differentiates CSH from other solid cavernous sinus lesions and significantly improves the diagnostic accuracy, a critical factor for planning surgery.
文摘AIM: To assess features of cavernous hemangioma (CH) in the orbit revealed by CT and MRI and summarize prediction of preoperative CT and MRI for the adhesion degree of CH in the orbit. METHODS: A total of 97 patients with pathologically confirmed CH in the orbit were examined with axial and coronal CT scan, and axial, coronal, sagittal, and enhanced fat suppression MRI scan. CT and MRI findings and intraoperative adhesion degrees were retrospectively analyzed. RESULTS: There were 47 patients with slight adhesion, for whom CT and MRI showed round masses with well defined margins in the extraocular muscles; 14 patients with mild adhesion, for whom CT and MRI revealed irregular masses with unclear boundary between CH and the optic nerve in coronal images, and emissary veins in the posterior region of masses in contrast-enhanced images; 36 patients with severe adhesion, for whom CT and MRI exhibited an irregular or ovoid mass filling the orbital apex, or showed distorted and even spiky margins in the posterior region of masses in contrast enhanced images at the presence of a transparent triangle between the mass and the orbital apex. CONCLUSION: Preoperative CT and MRI aid in accurate diagnosis, selection of the surgical approach, and assessment of the adhesion degree and surgical risks for CH.
文摘BACKGROUND Pancreatic cavernous hemangioma(pCH)is a rare type of benign vascular tumor.Making the right diagnosis is challenging due to low clinical suspicion and the lack of existing cross-sectional imaging tools to distinguish it from other pancreatic lesions.CASE SUMMARY We describe a male patient,age 18,who presented with a pCH.Computed tomography,magnetic resonance imaging,and ultrasound showed cystic space in the tail of the pancreas.A dark spot sign on the T2 weighted image sequence was observed.Clinically,a mucinous cystic neoplasm with hemorrhage was suspected preoperatively by combining imaging,and the operative indication was clear.The patient underwent a distal pancreatic tumor resection under laparoscopic control.Immunohistochemical staining for CD31 and CD34 was positive;D2-40 was positive in interstitial lymphatic vessels and negative in vascular epithelial cells;and calcium-binding protein was negative.The results support the diagnosis of pCH combined with chronic intracapsular spontaneous hemorrhage.No complications or recurrences were observed during the follow-up period.CONCLUSION Chronic spontaneous hemorrhage may occur in pCH,which may greatly influence the accuracy of diagnosis using imaging modalities.Surgical resection for uncertain pCH seems reasonable with a good outcome.
基金the People’s Livelihood Science and Technology Innovation Project of the Bureau of Science and Technology of Jiaxing City,No.2019AD32201。
文摘BACKGROUND Anastomosing hemangioma(AH)is a rare subtype of benign hemangioma that is most commonly found in the genitourinary tract.Due to the lack of specific clinical and radiologic manifestations,it is easily misdiagnosed preoperatively.Here,we report a case of AH arising from the left renal vein that was discovered incidentally and confirmed pathologically,and then describe its imaging characteristics from a radiologic point of view and review its clinicopathologic features and treatment.CASE SUMMARY A 74-year-old woman was admitted to our department for a left retroperitoneal neoplasm measuring 2.6 cm×2.0 cm.Her laboratory data showed no significant abnormalities.A non-contrast-enhanced computed tomography(CT)scan showed a heterogeneous density in the neoplasm.Non-contrast-enhanced magnetic resonance imaging(MRI)revealed a heterogeneous hypointensity on T1-weighed images and a heterogeneous hyperintensity on T2-weighed images.On contrastenhanced CT and MRI scans,the neoplasm presented marked septal enhancement in the arterial phase and persistent enhancement in the portal phase,and its boundary with the left renal vein was ill-defined.Based on these clinical and radiological manifestations,the neoplasm was initially considered to be a neurogenic neoplasm in the left retroperitoneum.Finally,the neoplasm was completely resected and pathologically diagnosed as AH.CONCLUSION AH is an uncommon benign hemangioma.Preoperative misdiagnoses are common not only because of a lack of specific clinical and radiologic manifestations but also because clinicians lack vigilance and diagnostic experience in identifying AH.AH is not exclusive to the urogenital parenchyma.We report the first case of this neoplasm in the left renal vein.Recognition of this entity in the left renal vein can be helpful in its diagnosis and distinction from other neoplasms.
基金the Medical Health Science and Tech-nology General Program of Guangzhou,No. 2009-YB-042
文摘Cerebral cavemous malformation (CCM) is a frequently occurring disease in Latin American populations, but little is known about the prevalence in China. This study enrolled one Chinese family with CCM, comprising 16 members; four were diagnosed with CCM which corresponded with autosomal incomplete dominance inheritance. The main clinical manifestations included headache, focal neural dysfunction, and cerebral hemorrhage. The lesions were a mixture of hyperintensity and hypointensity signals on TlWl and T2Wl, with a black hypointensity ring on T2Wl. CCM cranial magnetic resonance imaging T2Wl revealed an iron ring as a result of hemosiderin deposition. Pathological findings of CCM revealed tightly packed and variably thickened vascular channels lacking smooth muscle or elastic tissue. Intralesional hyalinosis, calcification, or bleeding of different phases and perilesional glial hyperplasia were observed, as well as hemosiderin deposition within or around the lesions. These features of this family were consistent with specific genetic, imaging and pathological features of familial CCM. Pathological characteristics reveal repeated hemorrhage, as well as intralesional and perilesional hemosiderin deposition.
文摘BACKGROUND Aggressive vertebral hemangioma(VH)is an uncommon lesion in the adult population.The vast majority of aggressive VHs have typical radiographic features.However,preoperative diagnosis of atypical aggressive VH may be difficult.Aggressive VHs are likely to recur even with en bloc resection.CASE SUMMARY A 52-year-old woman presented with a 3-mo history of numbness and pain in her right lower extremity.Physical examination showed sacral tenderness and limited mobility,and the muscle strength was grade 4 in the right digital flexor.Computed tomography revealed osteolytic bone destruction from S1 to S2.Magnetic resonance imaging(MRI)showed that the mass was compressing the dural sac;it was heterogeneously hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI,and gadolinium contrast enhancement showed that the tumor was heterogeneously enhanced and invading the vertebral endplate of S1.The patient developed progressive back pain and numbness in the bilateral extremities 6 mo postoperatively,and MRI examination showed recurrence of the mass.The mass was larger in size than before the operation,and it was extending into the spinal canal.CONCLUSION The radiographic findings of atypical aggressive VH include osteolytic vertebral bone destruction,extension of the mass into the spinal canal,and heterogeneous signal intensity on T1-,T2-,and enhanced T1-weighted MRI.These characteristics make preoperative diagnosis difficult,and biopsy is necessary to verify the lesion.Surgical decompression and gross total resection are recommended for treatment of aggressive VH.However,recurrence is inevitable in some cases.
文摘A 50-year-old woman presented with mid-thoracic backache and progressive, spastic, paraparesis for 3 months. Magnetic resonance imaging revealed an epidural mass without bone lesion at the level of thoracic vertebrae (T7, T8 and T9). The mass had a paraspinal invasion. The spinal cord was compressed ventrally. The lesion was totally excised through an anterolateral transthoracic approach. Histopathological examination revealed a cavernous hemangioma. The patient improved dramatically after the excision of the lesion. We report this case for its rarity.
文摘Vertebral hemangiomas are common benign lesions of the spine, characterized by abnormal vascular proliferation, being commonly asymptomatic incidental findings, presenting symptoms in only a small portion of affected individuals. In a smaller number of cases, however, hemangiomas can present an expansive effect and extra-osseous extension, determining a mass effect and neurological symptoms, being therefore called aggressive hemangiomas. On MRI, aggressive hemangiomas are characterized by having a larger vascular component and a smaller fat component, thus producing a low signal on T1-weighted images. We illustrate the case of a young male patient who presented with pain in the upper thoracic spine, who developed paraparesis and ascending sensory deficit and progressive lower limbs, progressing to paraplegia and loss of sphincter control.