Abstract
Background Intracranial cavernous malformations (CMs), commonly known as cavernomas or cavernous
angiomas, are low-flow, well-circumscribed vascular lesions composed of sinusoidal
spaces lined by a single layer of endothelium and separated by a collagenous matrix
without elastin, smooth muscle, or other vascular wall elements. A diameter greater
than 3 cm for a CM is unlikely. These lesions may have atypical appearances on magnetic
resonance imaging (MRI). MRI with advanced techniques such as a susceptibility-weighted
image or T2-gradient echo, a diffusion-weighted image and corresponding apparent diffusion
coefficient map, and diffusion tensor tractography have revolutionized the diagnostic
approach to these lesions.
Materials and Method The present study reviews the etiopathogenesis, clinical manifestations, MRI strategy,
and MRI appearances of the CMs, with a few examples of the giant CMs from our archive.
Results Intracranial giant CMs may have unexpected locations, sizes, numbers, and varied
imaging appearances due to repeated hemorrhages, unusual enhancement patterns, intense
perifocal edema, and unusual associations, making the differential diagnosis difficult.
Conclusion Familiarity with the MRI appearances of the giant intracranial CMs and the differential
diagnosis improves diagnostic accuracy and patient management.
Keywords
cavernous malformation - cavernoma - cavernous angioma - giant - magnetic resonance
imaging
