IMAGING (L MECHTLER, SECTION EDITOR)
Neuroimaging of Cavernous Malformations
Christopher T. Primiani
Published online: 13 October 2017
Springer Science+Business Media, LLC 2017
Purpose of Review Cerebral cavernous malformations
(CCMs) are common vascular abnormalities often discovered
on imaging as an incidental finding. The most common clin-
ical presentations of CCMs include seizure, headache, focal
neurological deficits, and intracranial hemorrhage. This article
discusses the most recent guidelines including imaging diag-
nostic criteria and radiographic standards of CCMs and re-
views the utility of currently available imaging techniques.
Recent Findings Gradient echo T2*-weighted imaging and
susceptibility-weighted imaging are the recommended imag-
ing protocols for evaluation of suspected CCMs. Diffusion
tensor imaging-based tractography provides visualization of
the eloquent white matter tracks in the brain. This imaging is
increasingly used in clinical practice to assist in selecting the
optimal surgical approach, especially for brainstem lesions.
Quantitative susceptibility mapping and dynamic contrast-
enhanced quantitative perfusion are presently considered ex-
perimental. Its proposed value might prove helpful in the fu-
ture to monitor disease activity and response to treatments.
Summary The choice of imaging modality of CCMs depends on
the goals the clinician expects to achieve, such as establishing the
initial diagnosis, follow-up and monitoring disease activity, pre-
operative, intraoperative, and postoperative evaluation, or re-
search and experimental work on patients with CCM.
Cerebral cavernous malformation
Diffusion tensor imaging
Cerebral cavernous malformations (CCMs), also known as
hemangioma, or cavernoma, are common vascular abnor-
malities typically found in the supratentorial region of the
brain with an estimated prevalence of 0.4% to 0.8% [1, 2].
CCMs account for 5–13% of all the intracranial vascular
malformations. Histologically, cavernous malformations re-
semble a raspberry-like mass of clustered, thin-walled capil-
laries surrounded by hemosiderin. Many patients with CCMs
are asymptomatic and the abnormalities are then found inci-
dentally. The most common clinical presentations of CCM
include headaches, seizures, and focal neurological deficits.
The type and extent of headaches have not been well studied
in patients with CCMs. In a 2011 meta-analysis reviewing 10
natural history studies with a total of 837 patients, 23% pre-
sented with headaches .
The risk of intracranial hemorrhage can be estimated based
on the mode of clinical presentation and CCM location. A
brainstem location, history of hemorrhage, or neurologic def-
icits are associated with an increased risk of intracranial hem-
orrhage over a 5-year period, but there are no known risk
associations with patients’ initial age, gender, or number of
previous CCM lesions . A single lesion characterizes the
sporadic form of CCM. In the heritable autosomal dominant
familial form, patients present with multiple lesions.
Developmental venous anomaly (DVA), also known as cere-
bral venous anomaly, is a congenital malformation often as-
sociated with CCMs.
This article is part of the Topical Collection on Imaging
* Maxim Mokin
Department of Neurosurgery, University of South Florida, 2 Tampa
General Circle, 7th floor, Tampa, FL 33606, USA
Department of Radiology, University of South Florida, Tampa, FL,
Curr Pain Headache Rep (2017) 21: 47