Magnetic Resonance Images of Hemangioblastomas in the Central Nervous System

Detailed findings on magnetic resonance (MR) images of 18 histologically proven hemangioblastomas of the central nervous system in 8 patients are reported here. Five morphological types of the tumors were identified a small mural nodule in a large cyst; multiple mural nodules in a large cyst; a solid tumor; a solid tumor with a small peripheral cyst and a solid tumor with internal and peripheral cysts. There were fifteen tumors found located at the cerebellar hemispheres, two found at the medulla and one found at the upper cervical cord. Upper cervical syringes were found in two cases. Four patients had multiple tumors, and two of them were patients with von Hippel-Lindau disease. The cystic portions were generally hypointense on T1-weighted image (T1WI) and hyperintense on T2-weighted image (T2WI) and proton-density-weighted image (PDWI). The solid portions were slightly hypointense or isointense in contrast to adjacent brain structures on T1WI but marked hyperintense on T2WI and PDWI. Intense homogeneous enhancement of all solid portions was seen after intravenous administration of gadolinium-DTPA (Gd-DTPA). It is of paramount importance to recognize and remove the fine mural nodule in the cystic part of hemangioblastoma in order to prevent recurrence. Thus, magnetic resonance imaging (MRI) with intravenous Gd-DTPA enhancement should be performed for complete evaluation of all cases of hemangioblastomas of the central nervous system prior to surgical intervention.