Case of the week Details

LEGENDS :-

• A. A well-defined, intra-axial, T2 hyperintense, T1 hypointense lesion measuring 14 x 12 x 9mm noted in the subcortical white matter of the peri-Sylvian right anterior temporal lobe
• B. FLAIR sequence demonstrates mild perilesional edema in the right anterior temporal lobe.Post contrast T1 demonstrates no enhancement and M2 segment of right MCA indenting the antero-superior pole of the lesion
• C. No diffusion restriction in DWI

DIAGNOSIS :-

Giant VR space in the right anterior temporal lobe.

DISCUSSION :-

Definition:

• A special variant of tumefactive perivascular spaces (also known as opercular PVS)
• Notable for imaging mimicry of cystic tumors due to cystic appearance and perilesional changes

Epidemiology:

• Predilection reported in women
• Affected age range: 24–86 years
• Clinical Presentation:
• Usually asymptomatic with no direct clinical manifestations

Pathology & Location:

• Etiology uncertain; possible mechanisms:
• Occlusion of tiny CSF?communicating channels by a vascular loop
• Abnormal CSF dynamics

Locations:

• Anterior temporal lobe (temporal pole)
• Frontal operculum (opercular perivascular spaces)
• Radiographic Features – MRI

Typical MRI characteristics:

• Internal signal identical to CSF on all sequences
• No enhancement after contrast
• Size remains stable over time, even if surrounding signal changes

Specific imaging findings:

• Surrounding perilesional edema (~80% of cases), which may be mild to extensive
• Usually in contact with a branch of the middle cerebral artery (~90%)
• Associated focal cortical thinning

REFERENCES

https://radiopaedia.org/articles/anterior-temporal-lobe-perivascular-spaces
https://pmc.ncbi.nlm.nih.gov/articles/PMC4683889/

https://journals.sagepub.com/doi/full/10.1177/2514183X20905252

https://pubs.rsna.org/doi/abs/10.1148/rg.274065722

DR. RAHUL KARTHIK

LINGUTLA CONSULTANT RADIOLOGIST,MANIPAL HOSPITAL,
YESHWANTHPUR

DR. FATHIMATH ASHILI

KM RADIOLOGY RESIDENT,MANIPAL HOSPITAL,
YESHWANTHPUR