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Koch, MD" + - key: "20008105-51da-4bbf-aba6-e8253b2d9c21" + value: "Daniel E. Meltzer, MD" +breadcrumbs: + - + name: "Head and Neck" + slug: "head-and-neck" + treeNodeId: "ed24ed8c-5d57-4629-879b-447b82d2973d" + - + name: "Differential Diagnosis" + slug: "differential-diagnosis" + treeNodeId: "40d68862-8975-4dde-ac2b-ebc43ab0fb5c" + - + name: "CPA-IAC and Posterior Fossa" + slug: "cpa-iac-and-posterior-fossa" + treeNodeId: "c590eedb-4a3b-4158-a04f-ad880564c992" + - + name: "Anatomically Based Differentials" + slug: "anatomically-based-differentials" + treeNodeId: "debfb06c-8656-4f5d-92c1-eaa468185d78" + - + name: "Cisterna Magna Mass" + slug: "cisterna-magna-mass" + treeNodeId: null +category: "Head and Neck" +documentVersionId: "86b48ea6-d9ea-428a-b5cb-32a58aaf84b2" +imageCount: 37 +lastUpdated: "07/16/24" +pageDescription: "Cisterna Magna Mass" +pageKeywords: "Head and Neck, Differential Diagnosis, CPA-IAC and Posterior Fossa, Anatomically Based Differentials, Cisterna Magna Mass" +pageTitle: "Cisterna Magna Mass | STATdx" +enhancedTitle: "Cisterna Magna Mass" +type: "DDX" +references: true +breadcrumbs: + - "Head and Neck" + - "Differential Diagnosis" + - "CPA-IAC and Posterior Fossa" + - "Anatomically Based Differentials" + - "Cisterna Magna Mass" +--- +# ESSENTIAL INFORMATION + +- ## Key Differential Diagnosis Issues + + + - Cisterna magna (CM) between medulla (anterior), occiput (posterior) (a.k.a. cerebellomedullary cistern) + - Below/behind inferior vermis + - Large medullary cistern masses may extend laterally, posteriorly into CM + - Most common adult lesions are tonsillar associated + - Indirect (secondary effect on tonsil) > direct (lesion in tonsil) + - MR and clinical information helps DDx +- ## Helpful Clues for Common Diagnoses + + + - **Herniation Syndromes, Intracranial** + - Tonsillar herniation most often 2° to posterior fossa (PF) mass effect + - Tonsils pushed down into CM + - Peg-like configuration of tonsils + - Tonsil folia usually oriented horizontally → become vertically oriented when herniated + - 4th ventricle may obstruct → obstructive hydrocephalus + - **Chiari 1** + - Pointed cerebellar tonsils ≥ 5 mm below foramen magnum (FM) + - Crowded FM + effaced CSF + - ± brainstem compression + - ± retroflexed odontoid, horizontal clivus, scoliosis + - PF usually normal size + - Syrinx in 30-70% + - Treatment aim = restore normal CSF flow at FM + - **Chiari 2** + - Small PF → contents herniates inferiorly through FM and superiorly through widened incisura + - Cascade of tissue (vermis, not tonsil) herniates downward through FM + - Caudal brainstem herniation with cervicomedullary kink, tectal beaking, falx insufficiency + - ± ventriculomegaly, subependymal gray matter heterotopia, &/or polymicrogyria + - ~ 100% secondary to open spinal dysraphism, most often myelomeningocele + - **Dandy-Walker Continuum** + - Dandy-Walker continuum is broad spectrum of cystic PF malformations + - 2/3 have associated CNS &/or extracranial anomalies + - All may have inner table occipital bone scalloping + - Dandy-Walker malformation classic triad + - Vermian agenesis/hypogenesis + - Cystic dilatation 4th ventricle + - Large PF with lambdoid-torcular inversion + - ± hydrocephalus + - Vermian hypoplasia + - Varying degrees of vermian hypoplasia + - ± rotation of vermis + - No enlargement of PF + - Blake pouch cyst + - Open 4th ventricle + - Elevated tegmentovermian angle + - Normal size and morphology of vermis + - Mega CM + - Enlarged retrocerebellar cistern communicates with normal 4th ventricle + - Normal vermis +- ## Helpful Clues for Less Common Diagnoses + + + - **Arachnoid Cyst** + - Sharply demarcated extraaxial cyst that follows CSF attenuation/signal + - FLAIR suppresses; no diffusion restriction + - Size varies from few millimeters to giant + - Often asymptomatic, found incidentally + - Cerebellopontine angle (CPA) location > CM + - **Ependymoma** + - Anywhere in neuraxis: 2/3 in PF, 1/3 in supratentorial + - 3rd most common malignant pediatric brain tumor arising in PF + - Heterogeneous T1/T2 signal with mild to moderate enhancement + - Soft or "plastic" tumor squeezes out of 4th ventricle foramina into cisterns + - Calcification common (50%) + - ± cysts, hemorrhage + - Sagittal imaging can distinguish origin as floor vs. roof of 4th ventricle + - CSF seeding may occur → image entire neuraxis + - **Meningioma** + - CM rare PF location + - CPA, medullary cisterns more common than CM + - CM meningiomas usually arise from occipital squamosa + - Well-demarcated, lobulated/rounded enhancing mass with dural attachment + - Hyperostosis, tumoral calcifications, ↑ vascular markings + - **Metastasis** + - Linear or nodular meningeal enhancement + - MR CSF flow may be helpful establishing location and degree of CSF obstruction + - Primary tumors include breast, lung, melanoma, prostate + - Lymphoproliferative malignancy = lymphoma and leukemia + - Primary CNS tumor seed basal cisterns (drop metastases) + - **Image entire neuraxis** + - **Intracranial Hypotension** + - Sagittal shows brain descent in 40-50% + - Caudal displacement of cerebellar tonsils in 25-75% + - Diffusely and intensely enhancing dura in 85% + - Bilateral subdural fluid collections in 15% + - Dural venous sinus may be distended (convex margins) + - Enlarged pituitary + - Frequently misdiagnosed syndrome of headache caused by ↓ intracranial CSF pressure from spontaneous spinal CSF leak +- ## Helpful Clues for Rare Diagnoses + + + - **Subependymoma** + - T2-hyperintense lobular, nonenhancing intraventricular mass + - When arises from 4th ventricle floor, may extend posteroinferiorly into CM + - More common in middle-aged, older adults + - 0.7% of intracranial neoplasms + - **Epidermoid Cyst** + - Congenital inclusion cysts + - Lobulated, irregular, CSF-like mass with "fronds" insinuate cistern + - FLAIR usually does not completely null; diffusion yields high-signal restriction + - 0.2-1.8% of all primary intracranial tumors + - CPA cistern (40-50%) > 4th ventricle (17%) > sellar/parasellar (10-15%) + - Rare malignant degeneration into squamous cell carcinoma + - **Dermoid Cyst** + - Fat appearance: Use fat suppression sequence to confirm + - With rupture, fat droplets in cisterns, sulci, and ventricles with extensive MR enhancement possible from chemical meningitis + - Rare: < 0.5% of primary intracranial tumors + - Rupture can cause significant morbidity/mortality + - Rare malignant degeneration into squamous cell carcinoma + - **Hemangioblastoma** + - Intraaxial PF mass with cyst, enhancing mural nodule abutting pia + - Classified as 1 of mesenchymal, nonmeningothelial tumors + - Familial = von Hippel-Lindau + - ≈ 30% of patients with hemangioblastoma have von Hippel-Lindau + - 7-10% of PF tumors + - **Neurenteric Cyst** + - Round/lobulated, nonenhancing, slightly hyperintense to CSF mass + - Most intracranial NECs found in PF + - Benign malformative endodermal CNS cyst + - Part of split spinal cord malformation spectrum; persistent neurenteric canal + - Location + - Thoracic (42%), cervical (32%) + - Others: Lumbar spine, basilar cisterns, brain parenchyma + - Anterior medullary, CPA cisterns > CM + +## References + +# Selected References + +1. [Pindrik J et al: Imaging in Chiari I malformation. Neurosurg Clin N Am. 34(1):67-79, 2023](http://www.ncbi.nlm.nih.gov/pubmed/?term=36424066%5Bpmid%5D) +1. [Paun L et al: Foramen magnum meningiomas: a systematic review and meta-analysis. Neurosurg Rev. 44(5):2583-96, 2021](http://www.ncbi.nlm.nih.gov/pubmed/?term=33507444%5Bpmid%5D) +1. [Menezes AH et al: Neurenteric cysts at foramen magnum in children: presentation, imaging characteristics, and surgical management-case series and literature review. Childs Nerv Syst. 36(7):1379-84, 2020](http://www.ncbi.nlm.nih.gov/pubmed/?term=32322975%5Bpmid%5D) +1. [Abdel Razek AA et al: Magnetic resonance imaging of malformations of midbrain-hindbrain. J Comput Assist Tomogr. 40(1):14-25, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=26599961%5Bpmid%5D) +1. [Dorfer C et al: Ependymoma: a heterogeneous tumor of uncertain origin and limited therapeutic options. Handb Clin Neurol. 134:417-31, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=26948369%5Bpmid%5D) +1. [Louis DN et al: The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 131(6):803-20, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=27157931%5Bpmid%5D) +1. [Tao C et al: Prognostic factors affecting the surgical outcome of anterolateral benign tumors in the foramen magnum region. Int J Surg. 33 Pt A:172-6, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=27528437%5Bpmid%5D) +1. [Tian W et al: A quantitative study of intracranial hypotensive syndrome by magnetic resonance. Clin Neurol Neurosurg. 141:71-6, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=26745515%5Bpmid%5D) +1. [Yamahata H et al: Exploitation of simple classification and space created by the tumor for the treatment of foramen magnum meningiomas. World Neurosurg. 87:1-7, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=26409077%5Bpmid%5D) +1. [Cesmebasi A et al: The Chiari malformations: a review with emphasis on anatomical traits. Clin Anat. 28(2):184-94, 2015](http://www.ncbi.nlm.nih.gov/pubmed/?term=25065525%5Bpmid%5D) +1. [Liao CC et al: Clinical features and surgical outcomes of sporadic cerebellar hemangioblastomas. Clin Neurol Neurosurg. 125:160-5, 2014](http://www.ncbi.nlm.nih.gov/pubmed/?term=25156409%5Bpmid%5D) + + +## Images + + +### Selected Images + +![Sagittal T1 C+ MR shows a cystic mass with an enhancing nodule , consistent with hemangioblastoma, pushing the tonsils inferiorly through the foramen magnum . Note effaced 4th ventricle , enlarged foramen of Monro , and enlarged 3rd and lateral ventricles, consistent with obstructive hydrocephalus.](images/app.statdx.com_image_thumbnail_d93e03ab-ee6a-4de8-b332-8660df2448e1_annotated_true_size_900_quality_90_11e9ec7f.jpg) +**Herniation Syndromes, Intracranial** +*Sagittal T1 C+ MR shows a cystic mass with an enhancing nodule , consistent with hemangioblastoma, pushing the tonsils inferiorly through the foramen magnum . Note effaced 4th ventricle , enlarged foramen of Monro , and enlarged 3rd and lateral ventricles, consistent with obstructive hydrocephalus.* + +![Sagittal T1 C+ MR shows a cystic mass with an enhancing nodule , consistent with hemangioblastoma, pushing the tonsils inferiorly through the foramen magnum . Note effaced 4th ventricle , enlarged foramen of Monro , and enlarged 3rd and lateral ventricles, consistent with obstructive hydrocephalus.](images/app.statdx.com_image_thumbnail_d93e03ab-ee6a-4de8-b332-8660df2448e1_size_174_quality_85_c6e99252.jpg) +**Herniation Syndromes, Intracranial** +*Sagittal T1 C+ MR shows a cystic mass with an enhancing nodule , consistent with hemangioblastoma, pushing the tonsils inferiorly through the foramen magnum . Note effaced 4th ventricle , enlarged foramen of Monro , and enlarged 3rd and lateral ventricles, consistent with obstructive hydrocephalus.* + +![Sagittal T2 MR in a patient with occipital headaches shows a significantly pointed configuration of a low-lying cerebellar tonsil to the level of the midposterior ring of C2. Notice also the dorsally tilted dens , effacement of CSF at the foramen magnum, and associated cervicothoracic syrinx .](images/app.statdx.com_image_thumbnail_f32667fd-ebff-4c5c-bd14-80a9c76d4c17_annotated_true_size_900_quality_90_0d739782.jpg) +**Chiari 1** +*Sagittal T2 MR in a patient with occipital headaches shows a significantly pointed configuration of a low-lying cerebellar tonsil to the level of the midposterior ring of C2. Notice also the dorsally tilted dens , effacement of CSF at the foramen magnum, and associated cervicothoracic syrinx .* + +![Sagittal T2 MR shows a small posterior fossa with extension of the cerebellar peg through the foramen magnum to the level of C6. The cervicomedullary junction and 4th ventricle are low-lying and there is mild tectal beaking and moderate prominence of the massa intermedia .](images/app.statdx.com_image_thumbnail_3c1182ce-603f-414b-9ecd-728488f8ea13_annotated_true_size_900_quality_90_73ce0e43.jpg) +**Chiari 2** +*Sagittal T2 MR shows a small posterior fossa with extension of the cerebellar peg through the foramen magnum to the level of C6. The cervicomedullary junction and 4th ventricle are low-lying and there is mild tectal beaking and moderate prominence of the massa intermedia .* + +![Sagittal T2 MR demonstrates a markedly enlarged posterior fossa with cystic dilatation of the 4th ventricle , upward rotation of severely hypoplastic vermis , markedly enlarged posterior fossa, and elevated torcula.](images/app.statdx.com_image_thumbnail_0c6467dd-b795-4546-9afd-1680b2372865_annotated_true_size_900_quality_90_45a0b4c2.jpg) +**Dandy-Walker Continuum** +*Sagittal T2 MR demonstrates a markedly enlarged posterior fossa with cystic dilatation of the 4th ventricle , upward rotation of severely hypoplastic vermis , markedly enlarged posterior fossa, and elevated torcula.* + +![Sagittal T1WI MR shows a CSF isointense arachnoid cyst filling the lower posterior fossa, effacing the cisterna magna, flattening the cervicomedullary junction , and extending caudally into the upper cervical canal.](images/app.statdx.com_image_thumbnail_9358bfe0-0e81-45e5-a915-382de4ca45a8_annotated_true_size_900_quality_90_5ee2bea0.jpg) +**Arachnoid Cyst** +*Sagittal T1WI MR shows a CSF isointense arachnoid cyst filling the lower posterior fossa, effacing the cisterna magna, flattening the cervicomedullary junction , and extending caudally into the upper cervical canal.* + +![Sagittal T1WI C+ MR shows enhancing tissue extruding through the foramen of Magendie, filling the cisterna magna . Resultant obstruction has caused enlargement of the cerebral aqueduct and dilated 3rd ventricle .](images/app.statdx.com_image_thumbnail_dcf88032-90a4-4cdc-837d-0db68076ba0d_annotated_true_size_900_quality_90_8996372c.jpg) +**Ependymoma** +*Sagittal T1WI C+ MR shows enhancing tissue extruding through the foramen of Magendie, filling the cisterna magna . Resultant obstruction has caused enlargement of the cerebral aqueduct and dilated 3rd ventricle .* + +![Sagittal T1WI MR demonstrates dural-based tumor with significant mass effect compressing and displacing the cerebellum. Note the trapped CSF clefts . The tumor encroaches on the cisterna magna.](images/app.statdx.com_image_thumbnail_552dcc86-9bc3-45d4-a79b-5f70d7aee358_annotated_true_size_900_quality_90_b1b07faa.jpg) +**Meningioma** +*Sagittal T1WI MR demonstrates dural-based tumor with significant mass effect compressing and displacing the cerebellum. Note the trapped CSF clefts . The tumor encroaches on the cisterna magna.* + +![Axial T1WI C+ MR shows a typical case of primary CNS lymphoma with subependymal tumor spread. Note a posterior fossa mass near the foramen of Luschka as well as a 2nd dural-based mass .](images/app.statdx.com_image_thumbnail_78b4e7b9-3149-4afa-8312-4f8ac2681b52_annotated_true_size_900_quality_90_f84a81af.jpg) +**Metastasis** +*Axial T1WI C+ MR shows a typical case of primary CNS lymphoma with subependymal tumor spread. Note a posterior fossa mass near the foramen of Luschka as well as a 2nd dural-based mass .* + +![Sagittal T1WI C+ MR shows obliteration of the suprasellar cistern , sagging/fat midbrain with closed angle between the peduncles and the pons , dural enhancement , and tonsillar descent with effacement of the cisterna magna.](images/app.statdx.com_image_thumbnail_43f42495-6e64-47ac-8abd-7ca9ca2ff540_annotated_true_size_900_quality_90_a13877a5.jpg) +**Intracranial Hypotension** +*Sagittal T1WI C+ MR shows obliteration of the suprasellar cistern , sagging/fat midbrain with closed angle between the peduncles and the pons , dural enhancement , and tonsillar descent with effacement of the cisterna magna.* + +![Sagittal T1WI C+ MR in 40-year-old man shows an enhancing mass at the bottom of the 4th ventricle filling the cisterna magna.](images/app.statdx.com_image_thumbnail_7a028d65-ddd4-458e-9bb8-cd91406e17cc_annotated_true_size_900_quality_90_a4e2aff3.jpg) +**Subependymoma** +*Sagittal T1WI C+ MR in 40-year-old man shows an enhancing mass at the bottom of the 4th ventricle filling the cisterna magna.* + +![Sagittal T1WI MR shows a typical case of a large 4th ventricular epidermoid cyst , which follows CSF intensity but is often slightly brighter and mildly heterogeneous in signal.](images/app.statdx.com_image_thumbnail_ae931e3a-ee28-4c7d-854c-665d58b34439_annotated_true_size_900_quality_90_8f1340e9.jpg) +**Epidermoid Cyst** +*Sagittal T1WI MR shows a typical case of a large 4th ventricular epidermoid cyst , which follows CSF intensity but is often slightly brighter and mildly heterogeneous in signal.* + +![Axial T2WI MR demonstrates a T2- hyperintense mass encroaching laterally upon the ventral CSF at the foramen magnum. There was evidence of rupture (not shown) causing recurrent meningitis.](images/app.statdx.com_image_thumbnail_fc461ab0-6909-4db8-b585-ee6b0495e584_annotated_true_size_900_quality_90_ab4bf44b.jpg) +**Dermoid Cyst** +*Axial T2WI MR demonstrates a T2- hyperintense mass encroaching laterally upon the ventral CSF at the foramen magnum. There was evidence of rupture (not shown) causing recurrent meningitis.* + +![Sagittal T1WI C+ MR shows an enhancing vermian mass protruding through the foramen magnum . An associated cyst is deforming the 4th ventricle .](images/app.statdx.com_image_thumbnail_b01e6fff-9cce-4843-8749-c18dfa0f8c59_annotated_true_size_900_quality_90_36cd9838.jpg) +**Hemangioblastoma** +*Sagittal T1WI C+ MR shows an enhancing vermian mass protruding through the foramen magnum . An associated cyst is deforming the 4th ventricle .* + +![Axial T1WI C+ MR shows a neurenteric cyst encroaching upon the prepontine cistern. Although most often these are located anteriorly, they may arise posteriorly at the cisterna magnum.](images/app.statdx.com_image_thumbnail_baa88901-5c32-4263-95c8-65e0655116f4_annotated_true_size_900_quality_90_4bc83322.jpg) +**Neurenteric Cyst** +*Axial T1WI C+ MR shows a neurenteric cyst encroaching upon the prepontine cistern. Although most often these are located anteriorly, they may arise posteriorly at the cisterna magnum.* + + +### Additional Images + +![Sagittal T1WI MR shows a small posterior fossa with extension of the cerebellar peg through the foramen magnum to the level of C3. The cervicomedullary junction and 4th ventricle are low-lying, and there is tectal beaking .](images/app.statdx.com_image_thumbnail_f0e743d3-48ed-4542-b207-11bb55f9d934_annotated_true_size_900_quality_90_a2144ce8.jpg) +**Chiari 2** +*Sagittal T1WI MR shows a small posterior fossa with extension of the cerebellar peg through the foramen magnum to the level of C3. The cervicomedullary junction and 4th ventricle are low-lying, and there is tectal beaking .* + +![Sagittal T1WI MR demonstrates a markedly enlarged posterior fossa with cystic dilatation of the 4th ventricle , upwardly rotated hypoplastic vermis , and low-lying torcular Herophili .](images/app.statdx.com_image_thumbnail_597739b9-7ca6-42c3-9220-6e8459aded8e_annotated_true_size_900_quality_90_271d003d.jpg) +**Dandy-Walker Continuum** +*Sagittal T1WI MR demonstrates a markedly enlarged posterior fossa with cystic dilatation of the 4th ventricle , upwardly rotated hypoplastic vermis , and low-lying torcular Herophili .* + +![Sagittal T2 MR in a patient with occipital headaches shows a significantly pointed configuration of a low-lying cerebellar tonsil to the level of the midposterior ring of C2. Notice also the dorsally tilted dens and effacement of CSF at the foramen magnum.](images/app.statdx.com_image_thumbnail_dac4c49b-c2b5-416f-a085-f7b7e6de8e51_annotated_true_size_900_quality_90_60d55480.jpg) +**Chiari 1** +*Sagittal T2 MR in a patient with occipital headaches shows a significantly pointed configuration of a low-lying cerebellar tonsil to the level of the midposterior ring of C2. Notice also the dorsally tilted dens and effacement of CSF at the foramen magnum.* + +![Sagittal T1WI MR shows inferior extension of the peg-like cerebellar tonsils well below the level of the foramen magnum , consistent with Chiari 1.](images/app.statdx.com_image_thumbnail_bf765af5-15a4-473e-8df5-a11a991e90bc_annotated_true_size_900_quality_90_1e09c50d.jpg) +**Chiari 1** +*Sagittal T1WI MR shows inferior extension of the peg-like cerebellar tonsils well below the level of the foramen magnum , consistent with Chiari 1.* + +![Axial T2WI MR at the level of the foramen magnum demonstrates downward tonsillar herniation secondary to mass affect from brain death.](images/app.statdx.com_image_thumbnail_4ec0f703-c702-49e8-a1ed-adb06f9da9c5_annotated_true_size_900_quality_90_813870b0.jpg) +**Herniation Syndromes, Intracranial** +*Axial T2WI MR at the level of the foramen magnum demonstrates downward tonsillar herniation secondary to mass affect from brain death.* + +![Sagittal T1WI MR shows cerebellar tonsillar herniation from a large left posterior fossa mass. Note compression of 4th ventricle . Supratentorial ventricles are enlarged .](images/app.statdx.com_image_thumbnail_8aaa21ec-1c19-4e6c-8181-592b3df7869d_annotated_true_size_900_quality_90_60eba5bd.jpg) +**Herniation Syndromes, Intracranial** +*Sagittal T1WI MR shows cerebellar tonsillar herniation from a large left posterior fossa mass. Note compression of 4th ventricle . Supratentorial ventricles are enlarged .* + +![Sagittal CINE phase-contrast CSF flow - diastolic shows diminished posterior CSF flow compared to anterior CSF flow at the site of tonsillar impaction.](images/app.statdx.com_image_thumbnail_bbdce702-8985-4ec6-a3e4-cad6dea34ada_annotated_true_size_900_quality_90_9fd2b7f0.jpg) +**Chiari 1** +*Sagittal CINE phase-contrast CSF flow - diastolic shows diminished posterior CSF flow compared to anterior CSF flow at the site of tonsillar impaction.* + +![Sagittal T2WI MR shows a classic case of Chiari 1 with pointed cerebellar tonsils protruding through the foramen magnum and effacing the cisterna magna.](images/app.statdx.com_image_thumbnail_6840be04-8ddf-44dd-90f5-533d79cc1e88_annotated_true_size_900_quality_90_19b200f9.jpg) +**Chiari 1** +*Sagittal T2WI MR shows a classic case of Chiari 1 with pointed cerebellar tonsils protruding through the foramen magnum and effacing the cisterna magna.* + +![Sagittal T2WI MR shows a small posterior fossa with caudal descent of cerebellar tonsillar tissue , elongation of the 4th ventricle , and cervical cord syrinx .](images/app.statdx.com_image_thumbnail_e8e875a9-dab9-4138-acad-70e88f4e90d9_annotated_true_size_900_quality_90_95de6bef.jpg) +**Chiari 2** +*Sagittal T2WI MR shows a small posterior fossa with caudal descent of cerebellar tonsillar tissue , elongation of the 4th ventricle , and cervical cord syrinx .* + +![Axial FSPGR image demonstrates caudally displaced cerebellar tissue wrapping around the brainstem. This is sometimes referred to as a "creeping cerebellum" due to a small posterior fossa.](images/app.statdx.com_image_thumbnail_2881fed2-4a1d-4e08-8032-ccc2e2135a6c_annotated_true_size_900_quality_90_b9efe583.jpg) +**Chiari 2** +*Axial FSPGR image demonstrates caudally displaced cerebellar tissue wrapping around the brainstem. This is sometimes referred to as a "creeping cerebellum" due to a small posterior fossa.* + +![Sagittal T1WI MR shows caudal descent of cerebellar vermian tissue and elongated 4th ventricle as well as callosal dysgenesis and a small posterior fossa.](images/app.statdx.com_image_thumbnail_5a4e9906-ab96-4d21-9cab-e237c76a221e_annotated_true_size_900_quality_90_77c3db2e.jpg) +**Chiari 2** +*Sagittal T1WI MR shows caudal descent of cerebellar vermian tissue and elongated 4th ventricle as well as callosal dysgenesis and a small posterior fossa.* + +![Sagittal T1 C+ MR shows a small posterior fossa with extension of the vermis through the foramen magnum to the level of C1/2 . The 4th ventricle is small , and there is tectal beaking .](images/app.statdx.com_image_thumbnail_fc43bc05-4fc8-45c2-8329-13bc355cf93c_annotated_true_size_900_quality_90_7e196aa3.jpg) +**Chiari 2** +*Sagittal T1 C+ MR shows a small posterior fossa with extension of the vermis through the foramen magnum to the level of C1/2 . The 4th ventricle is small , and there is tectal beaking .* + +![Axial T2WI MR shows a normal 4th ventricle and vermis; however, there is a prominent retrocerebellar CSF space , which does not cause compression but does remodel endosteum, leading to mega cisterna magna.](images/app.statdx.com_image_thumbnail_c3afc83f-66c2-4438-9441-88dc439e4880_annotated_true_size_900_quality_90_bae05a32.jpg) +**Dandy-Walker Continuum** +*Axial T2WI MR shows a normal 4th ventricle and vermis; however, there is a prominent retrocerebellar CSF space , which does not cause compression but does remodel endosteum, leading to mega cisterna magna.* + +![Sagittal T1WI MR demonstrates a CSF-intensity arachnoid cyst remodeling the endosteum and filling the cisterna magna .](images/app.statdx.com_image_thumbnail_91da2980-fb4a-4a4e-b638-7747bec7db0c_annotated_true_size_900_quality_90_eae82879.jpg) +**Arachnoid Cyst** +*Sagittal T1WI MR demonstrates a CSF-intensity arachnoid cyst remodeling the endosteum and filling the cisterna magna .* + +![Sagittal T2WI MR shows heterogeneous features of an ependymoma. Focal hyperintense regions correspond to focal necrosis and hypointense regions correlate to calcification .](images/app.statdx.com_image_thumbnail_f38e8e00-56df-4d69-b748-773ed89d905f_annotated_true_size_900_quality_90_69f8cdb4.jpg) +**Ependymoma** +*Sagittal T2WI MR shows heterogeneous features of an ependymoma. Focal hyperintense regions correspond to focal necrosis and hypointense regions correlate to calcification .* + +![Axial T1 C+ MR demonstrates a heterogeneously enhancing ependymoma containing cystic elements .](images/app.statdx.com_image_thumbnail_8c0d32d7-f882-4d35-b39d-0cebc442af46_annotated_true_size_900_quality_90_21ba0570.jpg) +**Ependymoma** +*Axial T1 C+ MR demonstrates a heterogeneously enhancing ependymoma containing cystic elements .* + +![Sagittal T1 C+ MR shows an enhancing mass expanding the 4th ventricle . The mass is also distending the obex and protruding through the foramen of Magendie into the cisterna magna .](images/app.statdx.com_image_thumbnail_5fc91f03-53aa-4f1a-b923-2461c8433360_annotated_true_size_900_quality_90_de5dd820.jpg) +**Ependymoma** +*Sagittal T1 C+ MR shows an enhancing mass expanding the 4th ventricle . The mass is also distending the obex and protruding through the foramen of Magendie into the cisterna magna .* + +![Axial T2WI MR demonstrates a posterior fossa meningioma with significant mass effect upon the cerebellum with interposed trapped CSF clefts and vessels .](images/app.statdx.com_image_thumbnail_d1c5e3a5-bf64-4a37-a40b-bb3a99f607ef_annotated_true_size_900_quality_90_329c2b60.jpg) +**Meningioma** +*Axial T2WI MR demonstrates a posterior fossa meningioma with significant mass effect upon the cerebellum with interposed trapped CSF clefts and vessels .* + +![Axial T1 C+ MR of a meningioma shows an avidly enhancing, dural-based mass splaying the cerebellar hemispheres, flattening the 4th ventricle , with dural tail .](images/app.statdx.com_image_thumbnail_c7247000-384b-463a-ac68-4cfddc8bc020_annotated_true_size_900_quality_90_c30a12c4.jpg) +**Meningioma** +*Axial T1 C+ MR of a meningioma shows an avidly enhancing, dural-based mass splaying the cerebellar hemispheres, flattening the 4th ventricle , with dural tail .* + +![Coronal T1 C+ MR demonstrates the diffuse enhancement of meningeal carcinomatosis from metastatic xanthoastrocytoma spread throughout the posterior fossa, folia, and also more cephalad.](images/app.statdx.com_image_thumbnail_1cdce1bc-69d9-42bf-b62f-e5bb173bebec_annotated_true_size_900_quality_90_eb210c6e.jpg) +**Metastasis** +*Coronal T1 C+ MR demonstrates the diffuse enhancement of meningeal carcinomatosis from metastatic xanthoastrocytoma spread throughout the posterior fossa, folia, and also more cephalad.* + +![Sagittal T1WI MR shows tonsillar descent and dural thickening secondary to intracranial hypotension.](images/app.statdx.com_image_thumbnail_275e1525-c39f-4a67-a0c6-85527fff9775_annotated_true_size_900_quality_90_2634400b.jpg) +**Intracranial Hypotension** +*Sagittal T1WI MR shows tonsillar descent and dural thickening secondary to intracranial hypotension.* + +![Axial DWI MR shows a hyperintense mass in the midline posterior fossa.](images/app.statdx.com_image_thumbnail_34b283f3-4ea9-4e5a-9cb3-881ab4f80a29_annotated_true_size_900_quality_90_5cf04a76.jpg) +**Epidermoid Cyst** +*Axial DWI MR shows a hyperintense mass in the midline posterior fossa.* + +![Sagittal T1 C+ MR demonstrates a mostly solid hemangioblastoma involving the cerebellar tonsils and effacing the cisterna magna.](images/app.statdx.com_image_thumbnail_1be0b435-f039-412e-b180-4268d6bd5c32_annotated_true_size_900_quality_90_9f29c937.jpg) +**Hemangioblastoma** +*Sagittal T1 C+ MR demonstrates a mostly solid hemangioblastoma involving the cerebellar tonsils and effacing the cisterna magna.* + diff --git a/docs_md/articles/images/app.statdx.com_image_thumbnail_0c6467dd-b795-4546-9afd-1680b2372865_annotated_true_size_900_quality_90_45a0b4c2.jpg b/docs_md/articles/images/app.statdx.com_image_thumbnail_0c6467dd-b795-4546-9afd-1680b2372865_annotated_true_size_900_quality_90_45a0b4c2.jpg new file mode 100644 index 0000000..5b19871 Binary files 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