Hemangioblastoma

Fig 1: Axial MR image (T2) of a 57-year-old man presenting with headache shows a large T2 hyperintense mass in the left cerebellar hemisphere. The mass compresses the adjacent fourth ventricle.
Fig 2: Sagittal MR image (T1 with gadolinium) shows a focus of nodular enhancement at the wall of the mass, which is predominantly T1 hypointense. There is hydrocephalus.

Facts:

• Rare, benign neoplasm of endothelial origin
• Most are sporadic. Between 4 and 20% of patients with hemangioblastomas of the cerebellum or spinal cord have von Hippel-Lindau disease.
• Usually in cerebellum (hemisphere > vermis > medulla near area postrema)
• Most often have a firm mural nodule (near pial surface) associated with a glial-lined cyst. The cyst contains clear yellow fluid but hemorrhage can occur innto the cyst.

Imaging Appearance:

• Peripherally located cerebellar mass with central cystic region with peripheral enhancing nodule.
• Cystic portion of the hemangioma may be brighter than that of cerebral spinal fluid.
• In some cases, hemangioblastomas can be solid, mixed solid/cystic.
  

Reference:
Lee SR, Sanches J, Mark AS, et al. Posterior fossa hemangioblastomas: MR imaging. Radiology 1989; 171:463-468.