Work

Venous infarction mimicking brain tumour: recognition of the sulcal tram-track appearance and gyriform diffusion restriction, a retrospective study

Year: 2026

Type: article

Abstract: Purpose Venous infarctions can present with varied imaging appearances and, in certain cases, may mimic intracranial tumours or space-occupying lesions. This resemblance can lead to diagnostic confusion and potentially unnecessary invasive procedures. The purpose of this study was to describe the neuroimaging features of venous infarction presenting as tumour-like cortical lesions and to characterize a recurrent sulcal imaging pattern, termed the sulcal tram-track appearance, as a potential diagnostic clue. Methods A retrospective review was conducted of patients with venous infarction presenting with imaging features that mimicked a space-occupying lesion or demonstrated a tumour-like appearance. Imaging features were analysed using conventional MRI sequences, diffusion-weighted imaging (DWI), and susceptibility-weighted imaging (SWI). Particular attention was paid to lesion morphology, relationship to cortical sulci, diffusion characteristics, susceptibility findings, and enhancement patterns. Results Eleven patients were identified with venous infarction, where the lesions were predominantly cortically based and mimicked space-occupying lesions. T2-weighted/FLAIR imaging demonstrated paired linear hyperintensities along opposing banks of the affected sulcus in all 11 cases (100%), producing a tram-track appearance. Gyriform cortical diffusion restriction was present in 10 of 11 patients (91%), typically with relative preservation or facilitated diffusion in the underlying white matter. On susceptibility-weighted imaging, a cord sign corresponding to thrombosed cortical veins was observed in most cases. Contrast enhancement was absent or minimal in 10 patients; one patient imaged in the subacute phase demonstrated gyriform cortical enhancement without nodular or mass-like enhancement . However, presence or absence of enhancement was considered variable and dependent on the temporal stage of the lesion. Conclusion Venous infarction due to cortical vein thrombosis may mimic intracranial tumours on MRI. Recognition of the sulcal tram-track appearance, along with associated diffusion restriction and susceptibility changes, can facilitate early diagnosis and help avoid unnecessary invasive interventions. Additionally, enhancement is a time-dependent finding and is not a defining imaging feature; therefore, its absence does not exclude cortical venous infarction. We propose a practical diagnostic imaging algorithm integrating these complementary MRI findings to improve recognition of venous infarction presenting as tumour-like cortical lesions.

Source: The Egyptian Journal of Radiology and Nuclear Medicine

DOI: 10.1186/s43055-026-01909-7