Capillary telangiectasia

• Cluster of enlarged, dilated capillaries interspersed with normal brain parenchyma
• More common in pons, cerebellum, and spinal cord
• Imaging
  • CT - usually normal
  • MR
    • T1 - usually normal
    • T2 - 50/50 normal vs faint stippled foci of hyperintensity
    • Large ones may show ill-defined FLAIR hyperintensity
    • SWI profoundly hypointense; SWI more sensitive than standard T2* GRE
    • T1 C+ shows faint stippled or speckled brush-like enhancement
      • May have a enlarged central draining vein with prominent linear enhancement
• Usually clinically benign and quiescent
• Often mixed with other vascular malformations (cavernous, DVAs)
• Association with HHT (hereditary hemorrhagic telangiectasia)
• Not treated
• Faintly enhancing pontine lesion that becomes moderately hypointense on T2* is usually BCT