Article Figures & Data
Figures
- FIG 1.
MR imaging characteristics of typical RVCL-S lesions in a 60-year-old man. Periventricular and deep WMLs on sagittal (A) and transverse FLAIR (B) images. On the 3D-T1-weighted Gd image (C), note a rim-enhancing lesion next to the right dorsal horn and a punctiform enhancing lesion next to the left dorsal horn (white arrows). Punctiform SWI artifacts are seen in the center of these lesions (D). High DWI (E) and low ADC signal (F) in the lesions correspond to diffusion restriction.
- FIG 2.
An example of punctiform enhancing lesions in the basal ganglia and cerebellum in a 60-year-old woman. A, Punctiform enhancing lesions (white arrows) in the putamen and caudate head on the right. B, Bilateral punctiform enhancing cerebellar lesions (white arrows).
- FIG 3.
Long-term enhancement and diffusion restriction of a lesion during 31 months of follow-up in a 55-year-old woman. 3D-T1-weighted Gd and diffusion-weighted images acquired at baseline (A) show a punctiform enhancing lesion on the right with subtle diffusion restriction (white arrows), and after 31 months (B), the images show that the lesion migrates to the right ventricle (white arrows). The lesion is now linearly enhancing with partial rim enhancement and diffusion restriction (ADC with low values is not shown).
- FIG 4.
Imaging characteristics of a pseudotumor in a 45-year-old woman. Note a rim-enhancing lesion of 30 mm, craniolateral to the left frontal horn, with multiple dotlike susceptibility artifacts and diffusion restriction in the center of the lesion with extensive surrounding vasogenic edema with mass effect (A, FLAIR. B, 3DT1 Gd. C, SWI. D, DWI).
- FIG 5.
Imaging characteristics and evolution of a pseudotumor in a 60-year-old woman. 3D-T1-weighted Gd, diffusion-weighted, and SWI at baseline (A) show a rim-enhancing lesion with subtle diffusion restriction next to the left dorsal horn with some surrounding edema without mass effect. There were no abnormalities on the SWI. After 10 months (B), the lesion grows with new compression due to edema. Diffusion restriction is still noted, but no SWI abnormalities. After corticosteroid treatment, the enhancing lesion slowly diminished in size, and diffusion restriction disappeared at 31 months (C). A new SWI artefact in the center of the lesion is now noted (white arrow), corresponding to a focal calcification on CT acquired at 32 months, while at 15 months, no calcifications were present (Online Supplemental Data).
Tables
MR Imaging Markers All (n = 29) Younger than 40 Years (n = 11) 40 Years or Older (n = 18) WMLs (mL), median (IQR) 0.97 (0.2–3.9) 0.19 (0.08–0.3) 2.66 (1.0–7.7) Deep WMLs Absent 8 (28) 6 (55) 2 (11) Punctate lesions 18 (62) 5 (45) 13 (72) Beginning confluence 2 (7) 0 2 (11) Large confluent areas 1 (3) 0 1 (6) Periventricular WMLs Absent 19 (66) 9 (82) 10 (55) Caps and bands 2 (7) 2 (18) 0 Smooth halo 5 (17) 0 5 (28) Irregular extending in DWM 3 (10) 0 3 (17) Enlarged perivascular spaces None 12 (41) 4 (36) 8 (44) Mild 14 (48) 6 (55) 8 (44) Moderate 2 (7) 0 2 (11) Frequent 1 (3) 1 (9) 0 Central atrophy None 24 (83) 11 (100) 13 (72) Moderate 5 (17) 0 5 (28) Severe 0 0 0 Cortical atrophy None 27 (93) 11 (100) 16 (89) Moderate 2 (7) 0 2 (11) Severe 0 0 0 Lacunar infarcts 1 (3) 0 1 (6) Note:—IQR indicates interquartile range; DWM, deep white matter.
↵a Data are No. (%) unless otherwise specified.
All Lesions (N = 44) No. (%) Size in mm, median (IQR) 4 (2–8) Location Periventricular 12 (27) Deep/subcortical white matter 17 (39) Basal ganglia/thalamus 15 (34) Characteristics of activity Enhancement Unknowna 2 (4) No enhancement 2 (4) Punctiform enhancement 24 (55) Linear enhancement 6 (14) Rim enhancement 10 (23) Diffusion restriction 22 (50) Other characteristics T2-hyperintensity 33 (75) Susceptibility artifacts 30 (68) Mass effect 0 ↵a In 1 MC, no contrast was administered due to reduced kidney function. Lesions in this MC showed diffusion restriction.
