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Research ArticlePediatric Neuroimaging

Infantile Hemangiomas Involving the Neuraxis: Clinical and Imaging Findings

V. Viswanathan, E.R. Smith, J.B. Mulliken, S.J. Fishman, H.P.W. Kozakewich, P.E. Burrows and D.B. Orbach
American Journal of Neuroradiology May 2009, 30 (5) 1005-1013; DOI: https://doi.org/10.3174/ajnr.A1478
V. Viswanathan
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E.R. Smith
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J.B. Mulliken
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S.J. Fishman
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H.P.W. Kozakewich
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P.E. Burrows
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D.B. Orbach
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    Fig 1.

    Gross appearance of cutaneous lesions overlying infantile hemangiomas involving the neuraxis (patient 12). A, A 4-month-old female infant presented with multiple bleeding scalp hemangiomas and anemia (patient 3). B, Another 4-month-old female infant presented with a large flat pink stain over the lower back, with a macular network-like structure consistent with the reticular pattern of spinal hemangioma. This appearance has been associated with underlying ventral-caudal structural anomalies.

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    Fig 2.

    Typical MR imaging findings of neuraxis hemangioma (patient 3). Sagittal precontrast (A) and postcontrast (B), and axial postcontrast T1- (C) and T2-weighted (D) images demonstrate a well-circumscribed lesion in the fourth ventricle with extension into the left foramen of Luschka. The lesion is isointense on T1-weighted imaging, hyperintense on T2-weighted imaging, and enhances avidly and uniformly. Note the lack of normal enhancement within the torcular herophili, consistent with thrombosis.

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    Fig 3.

    Infantile spinal hemangioma (patient 14). Sagittal T1 precontrast (A), postcontrast (B), and T2-weighted (C) images and an axial postcontrast T1-weighted image (D) demonstrate avidly enhancing hemangioma within the extradural compartment of the lower thoracic and upper lumbar spine. Note the prominent flow voids indicative of the proliferative phase of infantile hemangioma.

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    Fig 4.

    Typical CT findings of neuraxis hemangioma (patient 2). Precontrast (A) and postcontrast (B−D) images demonstrate an isoattenuated lobulated intensely enhancing mass within the left periorbital/orbital soft tissues with posterior extension to the left cavernous sinus and the left cerebellopontine angle (B). In addition, focal enhancement is seen within the left internal auditory canal (D). C, Tortuous vessels are noted adjacent to the left internal carotid artery terminus.

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    Fig 5.

    Infantile hemangioma in the right cerebellopontine angle cistern (patient 6). Axial T1 precontrast (A), axial T2 (B), and axial T1 postcontrast (C) images demonstrate a lobulated well-circumscribed avidly enhancing hemangioma in the fourth ventricle with extension through the foramen of Luschka to the right cerebellopontine angle cistern.

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    Fig 6.

    Concomitant regression of extracranial (right orbital/periorbital soft tissues) and intracranial (right lateral ventricle) components of infantile hemangioma (patient 9). A, Postcontrast axial T1-weighted pretreatment image. B, Postcontrast axial T1-weighted image after 3 months of corticosteroid treatment.

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    Fig 7.

    Regression of the prespinal and extradural extension of hemangioma in response to corticosteroid treatment (patient 14). Paramedian sagittal and coronal T2-weighted pretreatment images (A, B, and D) and midine sagittal and coronal T2-weighted images after 3 months of corticosteroid treatment (C and E).

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American Journal of Neuroradiology: 30 (5)
American Journal of Neuroradiology
Vol. 30, Issue 5
May 2009
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V. Viswanathan, E.R. Smith, J.B. Mulliken, S.J. Fishman, H.P.W. Kozakewich, P.E. Burrows, D.B. Orbach
Infantile Hemangiomas Involving the Neuraxis: Clinical and Imaging Findings
American Journal of Neuroradiology May 2009, 30 (5) 1005-1013; DOI: 10.3174/ajnr.A1478

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Infantile Hemangiomas Involving the Neuraxis: Clinical and Imaging Findings
V. Viswanathan, E.R. Smith, J.B. Mulliken, S.J. Fishman, H.P.W. Kozakewich, P.E. Burrows, D.B. Orbach
American Journal of Neuroradiology May 2009, 30 (5) 1005-1013; DOI: 10.3174/ajnr.A1478
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