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Perivascular Spaces: Normal and Giant

Published online by Cambridge University Press:  02 December 2014

Randy Fanous  and
Mehran Midia
Randy Fanous
Affiliation:
Department of Radiology, McMaster University, Hamilton, Ontario, Canada
Mehran Midia
Affiliation:
Department of Radiology, McMaster University, Hamilton, Ontario, Canada
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Abstract

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The purpose of this paper is to discuss both normal perivascular spaces (PVSs) and pathological giant perivascular spaces (GPVSs). The anatomy and physiology of normal PVSs, including important immunological and lymphatic roles, are described. Special attention is given to the Magnetic Resonance Imaging (MRI) findings of both normal and GPVSs. Furthermore, the clinical features and pathogenesis of GPVSs are explored, with special emphasis on the pathological implications of these lesions, and their relevance. It is important that symptomatic GPVSs not be mistaken for more devastating disease processes. When the lesions in question occur in a characteristic location along the path of a penetrating vessel, are isointense with cerebrospinal fluid on all MRI sequences, do not enhance with contrast material, are not calcified, and have normal adjacent brain parenchyma, their appearance is pathognomonic of GPVSs. The clinician should realize that an extensive differential diagnosis is superfluous and that biopsy is unnecessary in these patients. Instead, the clinical focus should be aimed at neurosurgical intervention, as dictated by the symptoms of mass effect.

Résumé:

RÉSUMÉ:

Le but de cet article est de discuter des espaces périvasculaires normaux (EPVNs) et des espaces périvasculaires géants (EPVGs). Nous décrivons l'anatomie et la physiologie des EPVNs ainsi que leur fonction immunologique et lymphatique qui sont des fonctions importantes. Nous portons une attention spéciale aux caractéristiques des EPVNs et des EPVGs à l'imagerie par résonance magnétique (IRM). De plus, nous examinons les manifestations cliniques et la pathogenèse des EPVGs, en soulignant les implications pathologiques de ces lésions et leur pertinence. Il est important de ne pas confondre des EPVGs symptomatiques avec des processus morbides plus dévastateurs. Quand les lésions en question surviennent à un endroit caractéristique le long du trajet d'un vaisseau pénétrant, sont isointenses par rapport au LCR sur toutes les séquences de l'IRM, ne sont pas rehaussées par la substance de contraste, ne sont pas calcifiées et que le parenchyme cérébral adjacent est normal, leur aspect est pathognomonique d'EPVGs. Le clinicien devrait réaliser qu'il est superflu d'envisager un diagnostic différentiel exhaustif et qu'une biopsie n'est pas nécessaire chez ces patients. Au point de vue clinique, l'attention devrait au contraire se porter sur l‘intervention neurochirurgicale, si le patient présente des symptômes d'effet de masse.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue 1 , February 2007 , pp. 5 - 10
Copyright
Copyright © The Canadian Journal of Neurological 2007

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