title: Large anterior temporal Virchow-Robin spaces: unique MR imaging features.
abstract: BACKGROUND
  Large Virchow-Robin (VR) spaces may mimic cystic tumor. The anterior temporal subcortical white matter is a recently described preferential location, with only 18 reported cases. Our aim was to identify unique MR features that could increase prospective diagnostic confidence.
  
  
  METHODS
  Thirty-nine cases were identified between November 2003 and February 2014. Demographic, clinical data and the initial radiological report were retrospectively reviewed. Two neuroradiologists reviewed all MR imaging; a neuropathologist reviewed histological data.
  
  
  RESULTS
  Median age was 58 years (range 24-86 years); the majority (69 %) was female. There were no clinical symptoms that could be directly referable to the lesion. Two thirds were considered to be VR spaces on the initial radiological report. Mean maximal size was 9 mm (range 5-17 mm); majority (79 %) had perilesional T2 or fluid-attenuated inversion recovery (FLAIR) hyperintensity. The following were identified as potential unique MR features: focal cortical distortion by an adjacent branch of the middle cerebral artery (92 %), smaller adjacent VR spaces (26 %), and a contiguous cerebrospinal fluid (CSF) intensity tract (21 %). Surgery was performed in three asymptomatic patients; histopathology confirmed VR spaces. Unique MR features were retrospectively identified in all three patients.
  
  
  CONCLUSIONS
  Large anterior temporal lobe VR spaces commonly demonstrate perilesional T2 or FLAIR signal and can be misdiagnosed as cystic tumor. Potential unique MR features that could increase prospective diagnostic confidence include focal cortical distortion by an adjacent branch of the middle cerebral artery, smaller adjacent VR spaces, and a contiguous CSF intensity tract.
authors.affiliation: Neuroradiology Service, Monash Imaging, Monash Health, Monash University, 246 Clayton Road, Melbourne, Victoria, 3168, Australia.
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Lim
authors.forename: Ronil V
authors.initials: RV
authors.lastname: Chandra
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Trost
authors.forename: Penelope A
authors.initials: PA
authors.lastname: McKelvie
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Stuckey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013346:Subarachnoid Space / Q000473:pathology*; D013702:Temporal Lobe / Q000473:pathology*; D055815:Young Adult