Abstract
Introduction
Large Virchow-Robin (VR) spaces may mimic cystic tumor. The anterior temporal subcortical white matter is a recently described preferential location, with only 18 reported cases. Our aim was to identify unique MR features that could increase prospective diagnostic confidence.
Methods
Thirty-nine cases were identified between November 2003 and February 2014. Demographic, clinical data and the initial radiological report were retrospectively reviewed. Two neuroradiologists reviewed all MR imaging; a neuropathologist reviewed histological data.
Results
Median age was 58 years (range 24–86 years); the majority (69 %) was female. There were no clinical symptoms that could be directly referable to the lesion. Two thirds were considered to be VR spaces on the initial radiological report. Mean maximal size was 9 mm (range 5–17 mm); majority (79 %) had perilesional T2 or fluid-attenuated inversion recovery (FLAIR) hyperintensity. The following were identified as potential unique MR features: focal cortical distortion by an adjacent branch of the middle cerebral artery (92 %), smaller adjacent VR spaces (26 %), and a contiguous cerebrospinal fluid (CSF) intensity tract (21 %). Surgery was performed in three asymptomatic patients; histopathology confirmed VR spaces. Unique MR features were retrospectively identified in all three patients.
Conclusion
Large anterior temporal lobe VR spaces commonly demonstrate perilesional T2 or FLAIR signal and can be misdiagnosed as cystic tumor. Potential unique MR features that could increase prospective diagnostic confidence include focal cortical distortion by an adjacent branch of the middle cerebral artery, smaller adjacent VR spaces, and a contiguous CSF intensity tract.
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Abbreviations
- VR:
-
Virchow-Robin
- FLAIR:
-
Fluid-attenuated inversion recovery
- GRE:
-
Gradient-recalled echo
- SPACE:
-
Variable-flip-angle 3D TSE T2W (Siemens, Erlangen, Germany)
- CSF:
-
Cerebrospinal fluid
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We declare that all human and animal studies have been approved by the Human Research Ethics Committee and have therefore been performed in accordance with the ethical standards laid down in the National Statement on Ethical Conduct in Research involving Humans (1999) and its later amendments. Patient consent was waived due to the retrospective nature of this study.
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Lim, A.T., Chandra, R.V., Trost, N.M. et al. Large anterior temporal Virchow-Robin spaces: unique MR imaging features. Neuroradiology 57, 491–499 (2015). https://doi.org/10.1007/s00234-015-1491-y
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DOI: https://doi.org/10.1007/s00234-015-1491-y