Dilated perivascular spaces mimicking a multicystic neoplasm

Case contributed by Mohamed Saber
Diagnosis almost certain

Presentation

Chronic headache.

Patient Data

Age: 20 years
Gender: Male

Initial non-contrast study

mri

MRI study shows left parietal periventricular deep white matter intra-axial lesion comprising of a cluster of small cysts. The cysts elicit CSF-like signals in all pulse sequences especially attenuate fully on FLAIR but, they are embedded in a region of increased signal in T2 and FLAIR. The diffusion study demonstrates a facilitated diffusion of the whole area. No surrounding edema or associated mass effect.

Other bilateral periventricular multiple scattered small cysts are also noted.

Complementary contrast MRI...

mri

Complementary contrast MRI & MR spectroscopy

The contrast-enhanced MRI study shows that this lesion shows no enhancement.

MR spectroscopy revealed normal metabolites with no elevated choline and normal all ratios (NAA/Cr, NAA/Cho, and Cho/Cr).

Case Discussion

Clustered dilated perivascular spaces may mimic multicystic neoplasms as DNET, gangliocytoma, ganglioglioma, MVNT, the latter could be differentiated with the lack of attenuation on FLAIR.

Dilated perivascular spaces may be associated with adjacent white matter signal changes in T2 and FLAIR. The cause of this phenomenon is unknown, possibly related to gliosis or spongiosis, or maybe related to very tight clustered spaces that could not be discriminated separately on MR imaging. This occurs in more than 30% of the neurologically intact adult population 1.

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