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Capillary Telangiectasia


KEY FACTS

Terminology

  • Brain capillary telangiectasia (BCT)

  • Cluster of enlarged, dilated capillaries interspersed with normal brain parenchyma

Imaging

  • General features

    • Common sites: Pons, cerebellum, spinal cord

    • Usually < 1 cm

  • CT

    • Usually normal

  • MR

    • T1WI usually normal

    • T2WI

      • –

        50% normal on T2WI

      • –

        50% show faint stippled foci of hyperintensity

    • Large BCTs may show ill-defined FLAIR hyperintensity

    • Moderately hypointense on GRE; profoundly hypointense on SWI

    • T1 C+ shows faint stippled or speckled brush-like enhancement

    • Large BCTs typically contain prominent linear draining vein(s)

Top Differential Diagnoses

  • Developmental venous anomaly

  • Metastasis

  • Cavernous malformation

  • Capillary hemangioma

Clinical Issues

  • BCTs represent 15-20% of all intracranial vascular malformations

  • Usually found incidentally at autopsy or imaging

  • Rare: Headache, vertigo, tinnitus

  • Clinically benign, quiescent

    • Unless histologically mixed (usually with capillary malformation)

Axial gross pathology shows a large capillary telangiectasia of the pons. The dusky color
is caused by deoxygenated blood, not frank hemorrhage. Note undisturbed transverse pontine tracts
crossing the telangiectasia.

Axial T2WI in a neurologically normal patient with headaches shows very faint “stippled” hyperintensities in the central pons
.

Axial T2* GRE in the same patient shows faint hypointensity in the central pons
.

Axial T1 C+ MR in the same patient shows faint brush-like enhancement
in the central pons, characteristic of a large capillary telangiectasia.

(Courtesy P. Rodriguez, MD.)

TERMINOLOGY

Abbreviations

  • Brain capillary telangiectasia (BCT)

  • Cerebrovascular malformation (CVM)

Synonyms

  • Capillary malformation

  • Not capillary “hemangioma”

    • Hemangiomas are true benign vasoformative neoplasms

    • Usually in face, scalp, back, chest, orbit

    • Less common: Dura, venous sinuses

    • Exceptionally rare in brain parenchyma

Definitions

  • Cluster of enlarged, thin-walled capillaries surrounded and separated by normal brain (usually WM)

IMAGING

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