Clinical and imaging features in surgically verified patients over 11 years and literature review

Vedula RR, Kummary Y, Gurram SR, Gudipati A, Ponnaganti S, Panigrahi MK

Pdf Page Numbers :- 47-59

Rajanikanth Rao Vedula^1,*, Yadagiri Kummary¹, Sunil Reddy Gurram¹, Anantram Gudipati¹, Sandeep Ponnaganti¹, and Manas Kumar Panigrahi²

¹Department of Radiololgy, Krishna Institute of Medical Sciences, Minister Road, Secunderabad-500003, Telangana, India

²Department of Neurosurgery, Krishna Institute of Medical Sciences, Minister Road, Secunderabad-500003, Telangana, India

*Corresponding author: Rao RK Vedula, MD, DMRD, FRCP (Glasgow), Emeritus Professor, Krishna Institute of Medical Sciences, Minister Road, Secunderabad-500003, Telangana, India. Mobile: +91 9989773473; Email: vedula@gmail.com

Received 25 January 2022; Revised 14 March 2022; Accepted 22 March 2022; Published 30 March 2022

Citation: Vedula RR, Kummary Y, Gurram SR, Gudipati A, Ponnaganti S, Panigrahi MK. Clinical and imaging features in surgically verified patients over 11 years and literature review. J Med Sci Res. 2022; 10(2):47-59. DOI: http://dx.doi.org/10.17727/JMSR.2022/10-11

Copyright: © 2022 Vedula RR et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Background: Controversy continues in the treatment decisions despite advanced imaging techniques. Though specific diagnosis by imaging is not precise. Diffusion weighted imaging is useful in a small proportion of patients. We evaluated the features of magnetic resonance imaging (MRI) with histopathological findings in patients with lesions of the cavernous sinus (CS).

Materials and methods: Retrospective analysis of clinical, imaging and histopathological findings of lesions involving cavernous sinus (CS) in 27 consecutive patients was done.

Results: The average age of the study population was 41.12 ± 14.49 (13-63) years; with 16 (59.2%) males. Visual disturbances were the most common complaints, reported in 62.0% and cranial nerve involvement was observed in 55 % of the patients. Complete excision was done in nine (33.3%) patients. Post-operative histopathology revealed meningiomas and hemangiomas in six (22.2%) patients each. While, five (18.5%) patients had schwannoma; fungal granuloma was observed in three (11.1%). Imaging based diagnosis showed concordance with histopathology in five (85.0%) patients with hemangioma. Among fungal granuloma, schwannoma and meningiomas, the concordance was 66.6%, 40.0% and 33.3% respectively. In the entire study population, concordance was 44.4%.

Conclusions: MR signal intensities are similar in neoplasms, infections, vascular lesions and inflammatory lesions. Cavernous hemangiomas are most often mistaken for other lesions but may be characterized by intense contrast enhancement and absence of restriction of DWI and blooming on GRE sequence. In lesions of cavernous sinus, accuracy of diagnosis on MRI is less than 50%. Diagnosis on MRI is more accurate in hemangiomas and fungal granulomas. Non-invasive diagnosis of granulomatous lesions may help plan appropriate management strategy.

Keywords: cavernous sinus; magnetic resonance imaging; diffusion weighted imaging