Intraparenchymal extravasation of gadolinium mimicking an enhancing brain tumor

Abstract

Gadolinium (Gd)-enhanced magnetic resonance imaging plays an essential role in the detection, characterization, and staging of intracranial neoplasms and vascular abnormalities. Although Gd is helpful in a majority of situations, it can lead to diagnostic misinterpretation in the setting of active vascular extravasation. Scarce reports of intracranial extravasation of Gd are present in the literature. Here, we report the first case of surgically proven spontaneous intraparenchymal extravasation of Gd mimicking an enhancing intra-axial neoplasm in a pediatric patient. Early and accurate recognition of Gd extravasation is critical in obtaining the accurate diagnosis and triaging patients expeditiously into proper avenues of care.

Unique enlarging cavernous malformation secondary to abnormal arteriovenous shunting through an associated developmental venous anomaly

“…Cavernous malformations are slow-flowing collections of dilated sinusoidal vessels which exhibit a "popcorn"like appearance on T2-weighted MRI due to multiloculated blood products of varying age. 3 They also demonstrate a peripheral hemosiderin rim and blooming artifact on susceptibility-weighted images, sometimes referred to a "halo." CMs are also often associated with an adjacent DVA, as congenital cerebral vascular malformations composed of radially arranged medullary veins which join together to drain into a central dilated vein.…”

“…Cavernous malformations are slow-flowing collections of dilated sinusoidal vessels which exhibit a “popcorn”-like appearance on T2-weighted MRI due to multiloculated blood products of varying age. 3 They also demonstrate a peripheral hemosiderin rim and blooming artifact on susceptibility-weighted images, sometimes referred to a “halo.”…”

Hyperacute intracranial hemorrhage with extensive contrast extravasation and rapid hematoma expansion imaged at onset with magnetic resonance imaging

“…1 Since hyperacute hemorrhage demonstrates isointense signal on pre-contrast T1-weighted sequences, a potential pitfall is to confuse active extravasation with an enhancing brain tumor. 10 If available, a comparison with prior studies is recommended to evaluate for any prior existing lesion. Additionally, the absence of perihematomal edema with precise hematoma margins suggests that the findings are acute and not secondary to an underlying neoplasm.…”

A New Frontier in Fighting Brain Cancer: Cutting Edge Magnetic Resonance Imaging Techniques

“…75 Brain tumors' contrast agents usually extravasates (leaks out from blood vessels) due to the presence of immature hyperpermeable vessels. 76 Measuring this extravasation is useful in two ways: differentiating mature tumor vessels from immature ones and identifying the tumor-vessel permeability 77 ; both can be utilized as a biomarker for brain tumor progression. 77 DCE perfusion MRI, in order to function, requires complex data acquisition and analysis that the DSC perfusion MRI does not.…”

“…76 Measuring this extravasation is useful in two ways: differentiating mature tumor vessels from immature ones and identifying the tumor-vessel permeability 77 ; both can be utilized as a biomarker for brain tumor progression. 77 DCE perfusion MRI, in order to function, requires complex data acquisition and analysis that the DSC perfusion MRI does not. 78 First, determination of T1 values in brain tissue before contrast injection is required for the calculation of tissue contrast concentration curve with time.…”