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

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