BRAIN CAPILLARY TELANGIECTASIA - MR-IMAGING APPEARANCE AND CLINICOHISTOPATHOLOGIC FINDINGS

PURPOSE: To demonstrate the clinical and magnetic resonance (MR) imagi ng findings of brain capillary telangiectasia and compare them with po stmortem specimens. MATERIALS AND METHODS: MR images obtained in and c linical histories of 18 adult patients with a presumed diagnosis of ca pillary telangiectasia examined within 3 years were retrospectively re viewed. All patients had undergone MR imaging with conventional T1- an d T2-weighted spin-echo sequences and gadolinium-enhanced T1-weighted and susceptibility-sensitive gradient-echo (GRE) sequences. No biopsie s had been performed. Fourteen patients had undergone clinical and MR imaging follow-up (median, II months). Postmortem tissues from three c ases of histopathologically confirmed capillary telangiectasia were im aged, RESULTS: All lesions were small, homogeneously enhancing, and hy po-to isointense on T1-weighted images and iso-to slightly hyperintens e on proton-density-and T2-weighted images. None was hypointense on pr oton-density-or T2-weighted images. All lesions showed marked GRE sign al loss. None had changed at follow-up. Two patients had multiple clas sic cerebral cavernous angiomas. The three specimens showed no abnorma l susceptibility and contained no hemosiderin at tissue analysis. CONC LUSION: Capillary telangiectasia has mild contrast material enhancemen t but is otherwise undetectable on conventional MR images. It lacks th e ''hemosiderin rim'' of cavernous angioma and demonstrates increased susceptibility only on GRE images, likely owing to blood oxygen-level- dependent contrast. GRE is essential in diagnosing brain capillary tel angiectasia, which could otherwise be misdiagnosed as neoplasia, subac ute infarction, or demyelination.