Multiple cerebellar hemangioblastomas

Multiple cerebellar hemangioblastomas on MR, perfusion imaging (ASL). Two small nodular enhancing lesions, with mild accompanying vasogenic edema, are noted within the cerebellum in this patient with von Hippel Lindau syndrome. Arterial spin labeling (ASL) is an alternative technique to first pass perfusion MR, the latter acquired during bolus gadolinium chelate administration typically using echoplanar technique. The advantages of ASL include the lack of intravenous contrast administration and that the exam can be repeated. Disadvantages include low SNR (and thus typically lower spatial resolution) and limited anatomic coverage (and thus long scan times to acquire sufficient slices to cover the entire brain). Also, the technique is limited to acquisition only of CBF, with MTT not assessed. CBF and CBV can be used for improved differential diagnosis of brain tumors, with hemangioblastomas demonstrating the highest rCBV of all common lesions (including glial tumors, metastases, and lymphoma).

Multiple cerebellar hemangioblastomas on MR, perfusion imaging (ASL)2

Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015)