Are cerebral cavernomas truly nonenhancing lesions and thereby distinguishable from arteriovenous malformations? MRI findings and histopathological correlation

Abstract

Purpose: The aim of this study was to determine whether cerebral cavernomas are truly nonenhancing lesions on magnetic resonance imaging (MRI), whether they can be distinguished from arteriovenous malformations (AVM) on that basis and to evaluate the incidence of their association with developmental venous anomalies (DVA).

Patients and methods: Thirty-two patients who underwent neurosurgical operation for a cerebral vascular malformation and had a standard MRI conclusive of cerebral cavernoma were retrospectively evaluated for size of the lesions, contrast enhancement of the lesion and the coexistence of DVA. The contrast uptake of these lesions was investigated, and contrast enhancement was classified as none, moderate or marked. The incidence of an associated DVA was also investigated. The radiological findings were subsequently correlated with neurohistopathological findings.

Results: No difference was found between the contrast enhancement of cavernomas and AVMs. Cross tables were calculated for contrast enhancement and size, which demonstrated no statistically significant correlation. Cross tables were calculated for contrast enhancement and histopathological diagnosis, which revealed that both entities presented variable degrees of contrast enhancement and were thereby not distinguishable from each other on the basis of contrast enhancement. We found an association of cavernoma with DVA in 30% of cases.

Conclusion: Neither a correlation between the absence of contrast enhancement and the histopathological diagnosis of cavernoma nor the size and contrast enhancement was found. We conclude that cavernomas present with variable degrees of contrast enhancement on MRI and, thus, are definitely not distinguishable from AVM on the basis of contrast enhanced MRI. We found an association between cavernomas and DVA in approximately one third of patients.