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Case Reports
. 2023 Apr 30;13(9):1602.
doi: 10.3390/diagnostics13091602.

Giant Tumefactive Perivascular Space: Advanced Fusion MR Imaging and Tractography Study-A Case Report and a Systematic Review

Renata Conforti  1 , Raffaella Capasso  2 , Donatella Franco  1 , Carmela Russo  3 , Fabio Oreste Rinaldi  1 , Giovanna Pezzullo  1 , Simone Coluccino  1 , Maria Chiara Brunese  4 , Corrado Caiazzo  4 , Ferdinando Caranci  1 , Fabio Tortora  5
Affiliations
Case Reports

Giant Tumefactive Perivascular Space: Advanced Fusion MR Imaging and Tractography Study-A Case Report and a Systematic Review

Renata Conforti et al. Diagnostics (Basel). .

Abstract

Perivascular spaces (PVSs) are small extensions of the subpial cerebrospinal space, pial-lined and interstitial fluid-filled. They surround small penetrating arteries, and veins, crossing the subarachnoid space to the brain tissue. Magnetic Resonance Imaging (MRI) shows a PVS as a round-shape or linear structure, isointense to the cerebrospinal fluid, and, if larger than 1.5 cm, they are known as giant/tumefactive PVSs (GTPVS) that may compress neighboring parenchymal/liquoral compartment. We report a rare asymptomatic case of GTPVS type 1 in a diabetic middle-aged patient, occasionally discovered. Our MRI study focuses on diffusion/tractography and fusion imaging: three-dimensional (3D) constructive interference in steady state (CISS) and time of fly (TOF) sequences. The advanced and fusion MR techniques help us to track brain fiber to assess brain tissue compression consequences and some PVS anatomic features as the perforating arteries inside them.

Keywords: advanced magnetic resonance; giant/tumefactive perivascular spaces; magnetic resonance; perivascular spaces.

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Conflict of interest statement

All the authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) Axial non-contrast and (b) enhanced CT scan shows a left cystic-like intraparenchymal area, hisodense to CSF, suggestive of a GTPVS; in (b) note linear enhancing feature inside the cyst. Axial T1, T1 with gadolinium and FLAIR MRI sequences, (c–e) and magnified views; coronal T1, T1 with gadolinium and FLAIR MRI sequences (f–h) of GTPVS. Note in (e) the thin T2 hyperintensity surrounding the GTPVS, responsible for mild compression of neighboring parenchyma. (i) Coronal maximum intensity projection (MiP) TOF arterial 3D surfaces reconstruction of the GTPVS.
Figure 2
Figure 2
Coronal and axial reconstruction of the 3D CISS sequence shows the irregular shape of the GTPVS with multiple linear vascular-like images inside (a,b). (c) 3D SWAN on the axial plane better demonstrates a linear vascular structure within the GTPVS. (f) notes the clearer image of the vessel inside the GTPVS resulting from the fusion of d-TOF and e-CISS images. (d) Coronal TOF and (e) coronal CISS images are fused together in figure (f): notes the clearer image of the vessel inside the GTPVS resulting in the fused image.
Figure 3
Figure 3
Histogram shows the Fractional Anisotropy (FA) mean value of ROIs analysis in specific structures (Cortico-spinal tract: CST; external capsule: EC; anterior thalamic radiation: ATR; uncinate fasciculus: UF), right side value in red and left value in blue. In the images below, it is possible to see DTI VR Fiber Tracking and DTI 32 directions CISS fusion showing displacement and thinning of the fiber bundle, in this case the inferior frontal-orbital (IFO).
Figure 4
Figure 4
Histogram of FA mean value (left blue and right red) of tractography maps obtained between Thalamus-like seed mask and external capsule-like termination mask. FA: Fractional Anisotropy; L: Left; R: Right. Probabilistic tractography from Thalamus as seed region and external capsule as target mask for both sides (blue on the left side and red on the right side). Green ROI highlights the GTPVS. MNI: Montreal Neurologic Institute coordinate system.
See this image and copyright information in PMC

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