Intracranial isolated varix mimicking a meningioma: the relevance of modern MRI techniques for reliable diagnosis

Variz intracraniana isolada mimetizando um meningioma: a relevância de técnicas modernas de RM para um diagnóstico confiável

A 37-year-old man presented with headache. Brain vessel wall magnetic resonance imaging revealed a left temporal vascular ectasia with heterogeneous flow (Figure 1). Four-dimensional time-resolved magnetic resonance angiography (4DMRA) showed the lesion being progressively filled by contrast during the venous phase, with no arterial feeders (Figure 2).

Figure 1.
Isolated intracranial varix. Ectasia of a left temporal cortical venous vessel, well identified in the axial 3-D T1 dark-blood image, for intracranial vessel wall MRI, pre- (A) and postintravenous contrast injection (B), with heterogeneous filling by the contrast agent. Note the flow-void inside the lesion and its well-demarcated and smooth contours, marking the vascular nature of the lesion.

Figure 2.
Isolated intracranial varix. 4D time-resolved MR angiography showed no arterial abnormalities (A) and progressive filling of the intracranial varix during the venous phase (B, C and D), with no arterial feeders or signs of arteriovenous malformation.

Isolated intracranial varix is a focal dilatation of a vein, without neural tissue or other vessels anomalies¹. Its main differential diagnoses are meningioma and arteriovenous fistula². Vessel wall imaging and 4DMRA can appropriately show the internal flow, absence of arterial components and progressive filling, during the venous phase, confirming the diagnosis and avoiding unnecessary surgery.

References

• ¹ Hoell T, Hohaus C, Beier A, Holzhausen HJ, Meisel HJ. Cortical venous aneurysm isolated cerebral varix. Interv Neuroradiol. 2004 Jun;10(2):161-5. https://doi.org/10.1177/159101990401000210
  » https://doi.org/10.1177/159101990401000210
• ² Tan ZG, Zhou Q, Cui Y, Yi L, Ouyang Y, Jiang Y. Extra-axial isolated cerebral varix misdiagnosed as convexity meningioma: a case report and review of literatures. Medicine (Baltimore). 2016 Jun;95(26):e4047. https://doi.org/10.1097/MD.0000000000004047
  » https://doi.org/10.1097/MD.0000000000004047

• ERRATUM
  https://doi.org/10.1590/0004-282x2020783erratum In the manuscript “Intracranial isolated varix mimicking a meningioma: the relevance of modern MRI techniques for reliable diagnosis”, DOI: 10.1590/0004-282X20190125, published in the Arq Neuropsiquiatr 2020;78(2):124-5. Epub Jan 20, 2020, on page 125, Figure 2 Where it shows:
  

  
  
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Publication Dates

• Publication in this collection
  20 Jan 2020
• Date of issue
  Feb 2020

History

• Reviewed
  29 Jan 2019
• Received
  30 Mar 2019
• Accepted
  19 May 2019