Giant Intracranial Cavernous Malformations: A Review on Magnetic Resonance Imaging Characteristics

• Published in: The Indian journal of radiology & imaging 2024-07, Vol.34 (3), p.511-521
• Main Authors: Demir, Mustafa Kemal, Kılıc, Deniz, Zorlu, Emre, Kılıc, Turker
• Format: Article
• Language: English
• Subjects: cavernoma; cavernous angioma; cavernous malformation; giant; magnetic resonance imaging; Review
• ISSN: 0971-3026; 1998-3808
• DOI: 10.1055/s-0044-1779587

Intracranial cavernous malformations (CMs), commonly known as cavernomas or cavernous angiomas, are low-flow, well-circumscribed vascular lesions composed of sinusoidal spaces lined by a single layer of endothelium and separated by a collagenous matrix without elastin, smooth muscle, or other vascular wall elements. A diameter greater than 3 cm for a CM is unlikely. These lesions may have atypical appearances on magnetic resonance imaging (MRI). MRI with advanced techniques such as a susceptibility-weighted image or T2-gradient echo, a diffusion-weighted image and corresponding apparent diffusion coefficient map, and diffusion tensor tractography have revolutionized the diagnostic approach to these lesions.  The present study reviews the etiopathogenesis, clinical manifestations, MRI strategy, and MRI appearances of the CMs, with a few examples of the giant CMs from our archive.  Intracranial giant CMs may have unexpected locations, sizes, numbers, and varied imaging appearances due to repeated hemorrhages, unusual enhancement patterns, intense perifocal edema, and unusual associations, making the differential diagnosis difficult.  Familiarity with the MRI appearances of the giant intracranial CMs and the differential diagnosis improves diagnostic accuracy and patient management.