CEREBRAL VENOUS INFARCTIONS PRESENTING AS ENHANCING SPACE-OCCUPYING LESIONS - MRI FINDINGS

Cerebral venous thrombosis is an unusual form of cerebrovascular disea se that may cause cerebral venous infarction (CVI). Magnetic resonance imaging (MRI) of the brain may improve the often elusive diagnosis of CVI. However, the sensitivity, specificity, and full spectrum of such MRI findings are poorly understood. The authors present the cases of three patients with CVI whose MRI scans showed abnormally enhancing tu mor-like brain lesions. Two of the CVIs were hemorrhagic and exerted m ass effect. One patient showed increasingly nodular and heterogeneous ring-like enhancement progressing from the single-dose to the triple-d ose gadolinium contrast images. The CVI of a second patient also showe d ring-like enhancement. Biopsy was performed on one of these patients and was strongly considered for the other two patients to exclude neo plastic disease. Careful examination of the MRI appearance of venous s tructures and the use of specialized MRI techniques improved the recog nition of CVI for two patients and prevented biopsy. This represents t he first description of abnormal triple-dose MRI contrast enhancement in CVI. Consideration of CVI in the care of patients with enhancing tu mor-like masses may lead to earlier diagnosis and treatment, preventin g unnecessary invasive diagnostic procedures. CVI should be added to t he differential diagnosis of supratentorial ring-enhancing masses.