Tumefactive perivascular spaces

Tumefactive perivascular spaces (TPVS) is a rare finding of enlargement of perivascular spaces. It is important to recognise this condition as it can be easily mistaken for a neoplasm and also rarely local mass effect from TPVS can result in complication.

Small case series of patient have also shown headache to be a common complaint in TPVS patients 1

Perivascular spaces also known as Virchow-Robin spaces are potential spaces lined by pia mater, which surround the penetrating arterioles and extend into the brain parenchyma for variable distances. Perivascular spaces contain interstitial fluid.

In rare circumstances these perivascular spaces can be enlarged, "tumefactive", which can cause mass effect upon the surrounding structures.

Location

TPVS has been described in the thalamus, basal ganglia, subcortical white matter, midbrain and less frequently in the cerebellum

A special type of perivascular spaces occur in the anterior temporal lobe and can mimic cystic tumours with peripheral oedema. These are discussed separately: anterior temporal lobe perivascular spaces 2-3

MRI

Although TPVS is a rare entity, MRI features are characteristic. Cluster of uniform or variable sized cysts which follows CSF signal intensity on all MRI sequences 1. The orientation of the cyst may follow a radial pattern that is orientated in the direction of the perforating arterioles.

Coronal image is most useful in demonstrating the radial orientation of basal ganglia and thalamus TPVS along the direction lenticulostriate perforators. Gliosis may be seen in the adjacent white matter with minor increase signal intensity on the T2 or FLAIR sequence 1. No enhancement should be demonstrated 1

Midbrain TPVS is orientated in the direction of the thalamostriate perforators and these may be more oval in configuration on the axial image. Rare complications of cerebral aqueduct stenosis with obstructive hydrocephalus have been reported in the literature 1

Share article

Article Information

rID: 28833
Section: Pathology
Tags: refs, cases
Synonyms or Alternate Spellings:
  • Tumefactive perivascular spaces (TPVS)

Support Radiopaedia and see fewer ads

Cases and Figures

  • Drag
    Case 1
    Drag here to reorder.
  • Drag
    Case 2
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.