Periventricular lesions of brain in adults -a pictorial review (original) (raw)
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Enlarged Perivascular Spaces on MRI Are a Feature of Cerebral Small Vessel Disease
Stroke, 2010
Background and Purpose-Enlarged perivascular spaces in the brain are common but generally overlooked and of uncertain pathophysiology. They may reflect underlying cerebral small vessel disease. We determined whether enlarged perivascular spaces were associated with lacunar stroke subtype and white matter hyperintensities, markers of established small vessel disease. Materials and Methods-We prospectively recruited patients with acute ischemic lacunar or cortical stroke. Age-matched nonstroke control subjects were also recruited. We rated basal ganglia and centrum semiovale enlarged perivascular spaces 0 to 4 (0ϭnone, 4ϭϾ40) on T2-weighted MRI and white matter hyperintensities. We compared enlarged perivascular spaces between stroke subtypes and control subjects and assessed associations with vascular risk factors and white matter hyperintensities. Results-We recruited 350 patients; 129 lacunar, 124 cortical stroke, and 97 age-matched control subjects. Adjusting for vascular risk factors and white matter hyperintensities, total enlarged perivascular spaces were associated with lacunar stroke subtype (Pϭ0.04) in the acute stroke group (nϭ253); basal ganglia enlarged perivascular spaces were associated with lacunar stroke subtype (Pϭ0.003), deep (Pϭ0.02) and periventricular white matter hyperintensities (Pϭ0.01); in all 350 subjects, total enlarged perivascular spaces were associated with deep (PϽ0.001) and periventricular (PϽ0.001) white matter hyperintensities.
Perivascular spaces in the brain: anatomy, physiology and pathology
Perivascular spaces include a variety of passageways around arterioles, capillaries and venules in the brain, along which a range of substances can move. Although perivascular spaces were first identified over 150 years ago, they have come to prominence recently owing to advances in knowledge of their roles in clearance of interstitial fluid and waste from the brain, particularly during sleep, and in the pathogenesis of small vessel disease, Alzheimer disease and other neurodegenerative and inflammatory disorders. Experimental advances have facilitated in vivo studies of perivascular space function in intact rodent models during wakefulness and sleep, and MRI in humans has enabled perivascular space morphology to be related to cognitive function, vascular risk factors, vascular and neurodegenerative brain lesions, sleep patterns and cerebral haemodynamics. Many questions about perivascular spaces remain, but what is now clear is that normal perivascular space function is important for maintaining brain health. Here, we review perivascular space anatomy, physiology and pathology, particularly as seen with MRI in humans, and consider translation from models to humans to highlight knowns, unknowns, controversies and clinical relevance.
Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism, 2016
Cerebral perivascular spaces (PVS) are small physiological structures around blood vessels in the brain. MRI visible PVS are associated with ageing and cerebral small vessel disease (SVD). 7 Tesla (7T) MRI improves PVS detection. We investigated the association of age, vascular risk factors, and imaging markers of SVD with PVS counts on 7 T MRI, in 50 persons aged ≥ 40. The average PVS count ± SD in the right hemisphere was 17 ± 6 in the basal ganglia and 71 ± 28 in the semioval centre. We observed no relation between age or vascular risk factors and PVS counts. The presence of microbleeds was related to more PVS in the basal ganglia (standardized beta 0.32; p = 0.04) and semioval centre (standardized beta 0.39; p = 0.01), and white matter hyperintensity volume to more PVS in the basal ganglia (standardized beta 0.41; p = 0.02). We conclude that PVS counts on 7T MRI are high and are related SVD markers, but not to age and vascular risk factors. This latter finding may indicate that ...
Magnetic Resonance Imaging Features of Tumefactive Perivascular Spaces
Cyprus Journal of Medical Sciences, 2020
The perivascular spaces (PVSs) are pia-lined potential spaces filled with interstitial fluid (ISF) and form a network throughout the brain, which is a part of glymphatic system and helps to derange of metabolites from cerebral parenchyma. The enlarged PVSs are the most common cystic lesion of the brain and gradually become prominent with age. Literally, tumefactive PVS is the giant enlargement of PVS, measuring 15 mm and more in size, and thought to be result of blocking of the outlet of ISF for any reason. Typically, they tend to from clusters of cysts, but tumefactive forms are usually solitary. They usually have moderate mass effect and can cause obstructive hydrocephalus when located in mesencephalothalamic region. Although they don't contain cerebrospinal fluid (CSF), they have similar signal to CSF on all magnetic resonance imaging (MRI) sequences and do not enhance. These MRI features are very useful for their differential diagnosis from other congenital, infectious, ischemic and tumoral cystic/necrotic lesions. The precise diagnosis of PVS is critical to prevent patients with "leave-me-alone" lesions, from unnecessary surgical interventions.
Regression of dilated perivascular spaces of the brain
Surgical and Radiologic Anatomy, 2010
Purpose Perivascular, or Virchow-Robin, spaces of the brain represent interstitial Xuid-Wlled spaces continuous with subpial spaces, and not invagination of cerebrospinal Xuid-Wlled subarachnoid spaces. Regression of a dilated, or even giant, perivascular space occurs rarely. The purpose of this paper is to describe magnetic resonance imaging evidence of complete regression of dilated perivascular spaces (dPVSs). Methods Patient 1 was a 76-year-old woman with right hemiparesis and aphasia from a left cranial vault meningioma inWltrating the superior sagittal sinus, and a left temporal lobe giant perivascular space. Patient 2 was a 70-year-old man with pituitary apoplexy, vasospasm, cerebral ischemia, and two dPVSs, one in the right temporal lobe, and one in the left anterior perforate substance. Patient 3 was a 78-year-old man with a generalized seizure, and a right temporal lobe dPVS. Results In all the patients, temporal lobe giant or dPVSs underwent regression, following meningioma subtotal resection (patient 1) or pituitary lesion shrinkage (patient 2), or spontaneously (patient 3). In patient 2, the left anterior perforate substance dPVS was unchanged. Conclusions Temporal lobe giant or dPVSs may regress, eventually together with resection or regression of intracranial tumors, also distant from the PVSs. Cerebral edema does not seem the only factor inXuencing dilatation of PVSs.
Giant tumefactive perivascular spaces mimicking a brain mass lesion: Report of three cases
Clinical and Translational Neuroscience
Virchow–Robin spaces or perivascular spaces are pial-lined fluid-filled interstitial spaces recognized throughout brain parenchyma along the path of penetrating vessels. Occasionally, they may become enlarged, cause mass effect, and be mistaken for cystic neoplasms or infections. We report three cases of giant tumefactive perivascular spaces (GTPVS) incidentally found at brain magnetic resonance imaging (MRI). The lesions were multilocular cystic-appearing, isointense to cerebrospinal fluid on all pulse sequences, and did not enhance. They were located both in typical and atypical locations and in one case associated with hydrocephalus. We describe the key features of GTPVS on MRI and illustrate the need to acknowledge and promptly recognize these entities in daily practice in order to avoid unnecessary treatment.