Dynamic enhancement features of cavernous sinus cavernous hemangiomas on conventional contrast-enhanced MR imaging

Abstract

Background and purpose: The reported MR imaging characteristics of cavernous sinus cavernous hemangiomas (CSCHs) in the literature are nonspecific. The purpose of our study was to explore dynamic enhancement features of CSCHs on conventional contrast-enhanced MR imaging and to correlate these features with histopathologic subtypes.

Materials and methods: Twenty-one patients (8 male and 13 female; age range, 13-63 years; average age, 42.6 years) with surgically confirmed CSCHs were retrospectively investigated. Preoperative MR study was performed in all cases, consisting of T1-weighted axial imaging, T2-weighted axial imaging, T1-weighted sagittal imaging, and contrast-enhanced T1-weighted axial, sagittal, and coronal images.

Results: There were 4.8% (1/21) that showed homogeneous enhancement on all 3 contrast-enhanced sequences, whereas 95.2% (20/21) demonstrated heterogeneous enhancement on the first contrast-enhanced sequence. Among the 20 lesions, on subsequent contrast-enhanced sequences, 55.0% (11/20) showed homogeneous enhancement, whereas 35.0% (7/20) of lesions showed progressive contrast "filling in." The remaining 10% (2/20) exhibited no apparent enhancement changes. The 95.2% (20/21) of lesions with heterogeneous enhancement on the first contrast-enhanced sequence correlated with type B or type C pathologic findings, whereas 4.8% (1/21) with homogeneous enhancement correlated with type A pathologic findings. Among the 20 type B or type C lesions, 80% (16/20) achieved total or near-total resection.

Conclusion: Progressive contrast "filling in" in the tumors on conventional contrast-enhanced MR images can aid in differentiating between cavernous sinus lesions and suggest the diagnosis of cavernous hemangiomas.

Fig 1.

A 52-year-old woman presented with a 1-year history of blurred vision in both eyes. A, T1-weighted axial image exhibits a hypointense dumbbell-shaped mass involving both sellar and parasellar regions. B, The mass demonstrates marked hyperintensity on T2-weighted axial imaging, and encasement of the right internal carotid artery can be seen. C, Strong homogeneous enhancement can be found in the mass on postcontrast T1-weighted axial imaging. D, Microphotograph of surgical specimen reveals large numbers of thin-walled vascular sinusoids, with a single layer of endothelium-lined capillaries, and scanty connective tissue (type A pathologic features; hematoxylin and eosin [H&E], original magnification, × 40).

Fig 2.

A 48-year-old man was admitted with an 8-year history of intermittent headache. A, Postcontrast T1-weighted coronal image shows a heterogeneously enhanced mass in the right parasellar region. B, On subsequent T1-weighted axial image, the mass exhibits homogeneous enhancement. C, Microphotograph of surgical specimen shows a combination of both types A and B composition (type C pathologic features; H&E, original magnification, × 40).

Fig 3.

A 45-year-old woman presented with right facial numbness of 1-year duration. A, Contrast-enhanced T1-weighted axial image shows inhomogeneous enhancement of a mass in the right parasellar region. B, On subsequent T1-weighted coronal image, progressive contrast “filling in” in the mass can be found. C, Postcontrast delayed T1-weighted axial image obtained 6 minutes after intravenous administration of contrast material reveals nearly homogenous enhancement in the mass. D, Microphotograph of surgical specimen shows ample solid parenchyma and well-formed vasculature and connective tissue (type B pathologic features; H&E, original magnification, × 40).