E1003. Causes of Perivascular Enhancement in the Brain: A Case-Based Review
  1. Daniel Welch; University of Nebraska Medical Center
  2. Sean Kelly; University of Nebraska Medical Center
  3. Justin Cramer; Mayo Clinic - Phoenix; University of Nebraska Medical Center
  4. Mark Keiper; University of Nebraska Medical Center
  5. Harvey Sekhon; University of Nebraska Medical Center
Intraparenchymal perivascular enhancement is an uncommon though important pattern of pathologic enhancement within the brain. There are several neoplastic and non-neoplastic causes of perivascular enhancement, some of which have only recently been recognized and described. A familiarity with the various causes and clinical presentations of perivascular enhancement will aid the radiologist in guiding clinicians toward the correct diagnosis when possible. This educational exhibit will review the various etiologies of perivascular enhancement, their clinical presentation, workup, and imaging appearances in the brain utilizing a case-based review format.

Educational Goals / Teaching Points
Educational goals of the exhibit include increasing the viewer’s familiarity with and ability to recognize perivascular enhancement patterns within the brain, highlighting several cases encountered in our large academic medical center, and reviewing important differential diagnostic considerations in a concise and organized exhibit.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Imaging modalities will include multi-sequence MR imaging of the brain, MR perfusion as well as MR angiography/venography and black-blood sequences where available. Imaging results will be correlated with a discussion of the relevant histopathology where available. Post-treatment clinical course and follow-up imaging will be presented. Some case examples include angiocentric CNS lymphoma, primary CNS angiitis, primary CNS hemophagocytic lymphohistiocytosis, myelin oligodendrocyte glycoprotein antibody-associated disease, multiple sclerosis, autoimmune GFAP astrocytopathy, and inflammatory amyloid angiopathy.

Pattern recognition and accurate, concise interpretation of brain imaging is arguably the most critical role for a radiologist because any pathologic sampling carries significant morbidity for the patient. Radiologists do a fantastic job at recognizing common imaging patterns, but when faced with unusual and uncommon imaging patterns it can lead to a sense of dread, fear, and uncertainty. It is our hope that by viewing this exhibit, the radiologist will be prepared and equipped with knowledge of perivascular enhancement patterns enabling the interpreting radiologist to provide treating clinicians with appropriate and accurate differential considerations, thus expediting effective patient care, decreasing patient morbidity, and further instilling confidence from referring clinicians.