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Brain, Capillary Telangiectasia: Imaging
Updated: Apr 21, 2009
Computed Tomography
Findings
Nonenhanced CT studies typically do not depict CTS, and most lesions are not visible even after the administration of contrast medium. When visible, CTSs appear as a small area of subtle contrast enhancement. Rarely, a tiny calcification may be associated with the lesion.
Degree of Confidence
Negative CT findings do not exclude CTS because most lesions are occult. The appearance on contrast-enhanced CT scans is nonspecific.
Magnetic Resonance Imaging
Axial contrast-enhanced T1-weighted MRI obtained through the pons demonstrates an area of mild enhancement without mass effect in a patient with a capillary telangiectasia (same patient as in Image below).
Axial T2-weighted MRI demonstrates no obvious abnormality; this finding confirms the diagnosis of capillary telangiectasia (same patient as in Image above).
Pontine capillary telangiectasia in a 39-year-old woman with dizziness. Note the lacy enhancement characteristic of this lesion. No abnormality was present on the T2-weighted MRI.
Axial enhanced T1-weighted MRI demonstrates the typical lacy enhancement pattern of a capillary telangiectasia. Image courtesy of Dr. Robert Koenigsberg, Professor of Radiology, MCP Hahnemann University.
Findings
MRI findings in CTS are variable, but contrast enhancement is required for diagnosis or even detection in almost all cases. Lee et al evaluated 18 patients and found enhancement in all patients, with little or no abnormal signal intensity on T2-weighted images12 ; however, increased signal intensity may be seen occasionally. T1-weighted images may show isointensity. The enhancement pattern is described as lacelike (see Images above and Images 1, 3, 9 in Multimedia) and usually subtle.
Occasionally, an associated prominent draining vein is present (see Image below and Image 5 in Multimedia).
Axial fast low-angle shot gradient-recalled echo MRI obtained through the pons shows a linear area of decreased signal extending from the inferior edge of the malformation (arrows). This finding indicates that the lesion may be a combined capillary telangiectasia and developmental venous anomaly because it has characteristics of both.
Use of susceptibility-weighted MRI to diagnosis pontine CTS has been reported.13 The patient's lesion did not demonstrate signal loss on conventional gradient-echo MRI, but susceptibility-weighted MRI showed marked signal loss of the lesion.
Gradient-echo sequences can facilitate the detection and diagnosis of CTS (see Image below and Image 4 in Multimedia). Both Barr et al14 and Lee et al12 describe susceptibility dephasing in all CTS lesions that are imaged by using GRE sequences. The exact reason why this susceptibility occurs is not clear, because hemosiderin and calcifications are not typically found on pathologic analysis. However, Lee and colleagues surmise that the hemoglobin within may be only partly converted to deoxyhemoglobin because the blood is relatively stagnant due to capillary dilatation; therefore, it has only a mild paramagnetic effect. This theory explains the imaging differences between cavernous angiomas and CTSs.
Axial fast low-angle shot MRI demonstrates decreased signal intensity associated with the brain capillary telangiectasia. This finding is characteristic of capillary telangiectasia, but it is also seen in developmental venous anomalies. The decreased signal intensity is not a result of hemorrhage, but rather, it is from the deoxyhemoglobin in the blood flowing in the malformations.
Axial contrast-enhanced T1-weighted MRI demonstrates a subtle area of enhancement in the right parietal subcortical white matter in a patient with capillary telangiectasia (arrow) (same patient as in Image below).
Coronal contrast-enhanced T1-weighted MRI reveals enhancement without mass effect in a patient with capillary telangiectasia (arrow) (same patient as Images above and below).
Fluid-attenuated inversion recovery MRI obtained at the same level as in Image above shows no abnormal signal intensity in this area; this finding confirms the diagnosis of capillary telangiectasia. No abnormalities were present on the T2-weighted or nonenhanced T1-weighted images (same patient as in Image above).
Because cavernous angiomas demonstrate susceptibility dephasing on GRE images, as a result of the presence of hemosiderin and sometimes calcifications, they also have markedly decreased signal intensity on T2-weighted images. Conversely, T2-weighted images of CTSs typically show no abnormality because the deoxyhemoglobin should not cause decreased signal intensity (see Images below and Images 2, 6-8 in Multimedia).
Degree of Confidence
The finding of a small area of enhancement without an abnormality or mass effect on a T2-weighted image and the finding of susceptibility dephasing on GRE images is strongly suggestive of a CTS, particularly if it the lesions is in the pons. If doubt exists, short-term follow-up studies can be performed to document stability of the lesion.
Although capillary telangiectasia is usually not visible on T2-weighted and nonenhanced T1-weighted images, abnormalities on T2-weighted images can be associated with capillary telangiectasias. However, the presence of such signal intensity should prompt consideration of alternative diagnoses.
Angiography
Findings
Angiography of any sort (ie, magnetic resonance angiography, computed tomographic angiography, conventional angiography) is not indicated because CTSs are typically angiographically occult. However, tiny capillary vessels may be seen on the venous phase.
More on Brain, Capillary Telangiectasia |
| Overview: Brain, Capillary Telangiectasia |
 Imaging: Brain, Capillary Telangiectasia |
| Follow-up: Brain, Capillary Telangiectasia |
| Multimedia: Brain, Capillary Telangiectasia |
| References |
| Further Reading |
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References
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Further Reading
Related eMedicine topics
Intracranial Arteriovenous Malformation
Vascular Malformations of the Spinal Cord
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Chiari I Malformation
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Brain, Cavernous Angiomas
Clinical guidelines
Stereotactic radiosurgery for patients with intracranial arteriovenous malformations (AVM). IRSA - Professional Association. 2003 Sep. 10 pages. NGC:003285
ACR Appropriateness Criteria® cerebrovascular disease. American College of Radiology - Medical Specialty Society. 1996 (revised 2006). 20 pages. NGC:005545
ACR Appropriateness Criteria® headache - child. American College of Radiology - Medical Specialty Society. 1999 (revised 2005). 6 pages. [NGC Update Pending] NGC:004790
Clinical trials
Influence of MMP on Brain AVM Hemorrhage
Tetracycline-Derivatives for Treatment of Cerebral Arteriovenous Malformations and Aneurysms
Comparison of Abnormal Cortical Development in Brain Malformations on Postmortem Imaging With Autopsy
Genetic Analysis of the Chiari I Malformation
Duragen Versus Duraguard in Chiari Surgery
Keywords
capillary telangiectasia, brain capillary telangiectasia, capillary angioma, CTSs, abnormally dilated capillaries, brain vascular malformation, occult cerebrovascular malformations, OCVMs, cavernous angiomas, cavernomas, venous angiomas
