Spinal cavernous angioma complicated by hemorrhage: susceptibility-weighted imaging findings

Angioma cavernoso medular complicado por hemorragia: achados na RM ponderada em susceptibilidade magnética

A 16-year-old boy presented with posterior cervical pain radiating to the right upper limb. Cervical magnetic resonance imaging (MRI) revealed an intramedullary cavernous angioma (CA) in the level of C2. Susceptibility-weighted imaging (SWI) showed longitudinal hypointensity from the bulb to the level of T1, which was suggestive of a longitudinal fiber-dissecting hemorrhage ( Figure ).

Intramedullary CAs are associated with an increased risk of hemorrhage. SWI is optimized for detection of magnetic susceptibility effects of blood products ¹ . SWI is more sensitive for detection of CAs in the brain ² , but the usefulness of SWI in cases of spinal CAs is not known.

Figure. 1
T1- (A) and T2-weighted (B) images show a nodular lesion, with a hyperintense central focus in both images and a peripheral halo of hypointensity in the T2-weighted image, suggestive of a CA. (C) SWI showing a longitudinal hypointensity in the posterior portion of the medulla, which extends from the medulla oblongata to the level of T1. The T1- and T2-weighted images do not obviously show the hemorrhage or its extension. In the T2-weighted image, the perilesional hemorrhage is characterized by a discrete longitudinal image, but SWI shows its extension more conspicuously.

References

• ¹
  Mittal S, Wu Z, Neelavalli J, Haacke EM. Susceptibility-weighted imaging: technical aspects and clinical applications, part 2. AJNR Am J Neuroradiol 2009;30:232-252.
• ²
  de Souza JM, Domingues RC, Cruz LC Jr, Domingues FS, Iasbeck T, Gasparetto EL. Susceptibility-weighted imaging for the evaluation of patients with familial cerebral cavernous malformations: a comparison with T2-weighted fast spin-echo and gradient-echo sequences. AJNR Am J Neuroradiol 2008;29:154-158.

Publication Dates

• Publication in this collection
  Oct 2013

History

• Received
  27 Mar 2013
• Reviewed
  26 Apr  2013
• Accepted
  03 May 2013