508 lines
51 KiB
Markdown
508 lines
51 KiB
Markdown
---
|
|
title: "CSF-Like Parenchymal Lesion(s)"
|
|
docid: "24559f7a-ed5a-4ab6-90ba-769f0b5c1197"
|
|
authors:
|
|
- key: "4b6589b0-9b8d-4467-8a90-01a0a59742fc"
|
|
value: "Troy A. Hutchins, MD"
|
|
- key: "5cff4116-3654-4b3a-bb75-5ebe0b8c9850"
|
|
value: "Anne G. Osborn, MD, FACR"
|
|
breadcrumbs:
|
|
-
|
|
name: "Brain"
|
|
slug: "brain"
|
|
treeNodeId: "6d8829f1-14d7-45af-8675-255189aa526a"
|
|
-
|
|
name: "Differential Diagnosis"
|
|
slug: "differential-diagnosis"
|
|
treeNodeId: "a7fdd139-664e-4bb8-8d18-400e4733ff60"
|
|
-
|
|
name: "Brain Parenchyma, General"
|
|
slug: "brain-parenchyma-general"
|
|
treeNodeId: "e79be97b-28c0-4023-be87-334c0579d35d"
|
|
-
|
|
name: "Generic Imaging Patterns"
|
|
slug: "generic-imaging-patterns"
|
|
treeNodeId: "66ab9cf6-74ad-42b7-a40a-4b6224edaa25"
|
|
-
|
|
name: "CSF-Like Parenchymal Lesion(s)"
|
|
slug: "csf-like-parenchymal-lesions"
|
|
treeNodeId: null
|
|
category: "Brain"
|
|
documentVersionId: "5368df09-e002-41e2-8b4e-fbc71286b47d"
|
|
imageCount: 51
|
|
lastUpdated: "01/18/23"
|
|
pageDescription: "CSF-Like Parenchymal Lesion(s)"
|
|
pageKeywords: "Brain, Differential Diagnosis, Brain Parenchyma, General, Generic Imaging Patterns, CSF-Like Parenchymal Lesion(s)"
|
|
pageTitle: "CSF-Like Parenchymal Lesion(s) | STATdx"
|
|
enhancedTitle: "CSF-Like Parenchymal Lesion(s)"
|
|
type: "DDX"
|
|
references: true
|
|
breadcrumbs:
|
|
- "Brain"
|
|
- "Differential Diagnosis"
|
|
- "Brain Parenchyma, General"
|
|
- "Generic Imaging Patterns"
|
|
- "CSF-Like Parenchymal Lesion(s)"
|
|
---
|
|
# ESSENTIAL INFORMATION
|
|
|
|
- ## Key Differential Diagnosis Issues
|
|
|
|
|
|
- Key imaging questions
|
|
- Does lesion follow CSF on all modalities/sequences?
|
|
- Is there any associated mass effect?
|
|
- Does lesion enhance?
|
|
- Included
|
|
- CSF-like cystic mass(es), e.g., enlarged perivascular spaces (PVS), neuroglial cysts
|
|
- Excluded
|
|
- Cystic neoplasms, abscess, resolving hematoma (rarely exactly like CSF)
|
|
- Developmental cysts that do not behave exactly like CSF (e.g., epidermoid, neurenteric cysts)
|
|
- ## Helpful Clues for Common Diagnoses
|
|
|
|
|
|
- **Enlarged Perivascular Spaces**
|
|
- PVS
|
|
- Can be seen at all ages but ↑ with age
|
|
- Filled with interstitial fluid but follow CSF on all sequences
|
|
- Most have no abnormality in surrounding parenchyma on FLAIR
|
|
- ~ 25% have thin, hyperintense rim
|
|
- Bilateral > unilateral
|
|
- Multiple > solitary
|
|
- "Clusters" of variably sized, CSF-like cysts characteristic
|
|
- Can occur anywhere but most common locations = basal ganglia (BG), hemispheric white matter (WM), midbrain, dentate nuclei
|
|
- Variant (mostly in older adults) = "état criblé" ("cribriform state") with multiple tiny cysts in BG
|
|
- Classification
|
|
- Type I: BG
|
|
- Type II: High convexity WM
|
|
- Type III: Midbrain
|
|
- Large PVS cause mass effect, assume bizarre configurations, and can mimic cystic neoplasm
|
|
- **Encephalomalacia**
|
|
- Etiology varies (trauma, infarction, etc.)
|
|
- Can be solitary, multifocal, multicystic
|
|
- CSF-like ± adjacent FLAIR hyperintensity
|
|
- **Lacunar Infarction**
|
|
- Solitary or multiple
|
|
- Typically along single long, unpaired penetrating arteries &/or vascular watershed zones
|
|
- BG, thalamus, WM common
|
|
- Multifocal BG infarcts + surrounding gliosis = "état lacunaire" or "lacunar state"
|
|
- **Neurocysticercosis**
|
|
- Most neurocysticercosis (NCC) cysts are actually in sulci
|
|
- Cysts in vesicular stage smooth, thin walled, with scolex generally visible as "dot" within cyst
|
|
- Multiple lesions in mixed stages common
|
|
- Some enhance, some do not
|
|
- Ca⁺⁺ (multiple = starry-sky pattern)
|
|
- ## Helpful Clues for Less Common Diagnoses
|
|
|
|
|
|
- **Porencephalic Cyst**
|
|
- CSF-filled parenchymal cavity
|
|
- Communicates with ventricle &/or pial surface
|
|
- Lined by reactive gliosis/astrocytic proliferation
|
|
- Does not enhance
|
|
- Etiology varies (trauma, infarction, etc.)
|
|
- **Multiple Sclerosis**
|
|
- Chronic "burned-out" lesions
|
|
- Appear as CSF foci with hyperintense rinds on FLAIR
|
|
- Look for faint T1 hyperintensity surrounding lesions ("lesion within lesion")
|
|
- Obtain sagittal FLAIR to look for other lesions along callososeptal interface
|
|
- **Hippocampal Sulcus Remnants**
|
|
- "String of beads" cysts medial to temporal horns of lateral ventricles
|
|
- Developmental variant, incidental
|
|
- Remnants of vestigial primary embryonic hippocampal sulcus
|
|
- Imaging
|
|
- Between hippocampus, dentate gyrus
|
|
- Follow CSF on all sequences
|
|
- No surrounding gliosis
|
|
- **Connatal Cysts**
|
|
- Single or multiple
|
|
- Location
|
|
- Intra- or periventricular (may actually be cysts of anterior choroid plexus)
|
|
- Small cyst adjacent to tip of frontal horn may be normal anatomic variant
|
|
- Lined with ependyma
|
|
- Present at birth
|
|
- Usually transient
|
|
- Occasionally seen in older patients
|
|
- No septations, no hemosiderin
|
|
- Generally isolated without associated abnormalities
|
|
- ## Helpful Clues for Rare Diagnoses
|
|
|
|
|
|
- **Neuroglial Cyst**
|
|
- Benign, glial-lined, nonenhancing CSF-like cyst
|
|
- No surrounding signal abnormality
|
|
- Does not communicate with ventricle
|
|
- Subcortical WM, choroidal fissure common sites
|
|
- Does not restrict on DWI
|
|
- No enhancement
|
|
- **Cryptococcosis**
|
|
- Opportunistic fungal infection
|
|
- Nonenhancing, gelatinous pseudocysts in PVS
|
|
- BG, thalamus, brainstem, cerebellum, dentate nucleus, periventricular WM
|
|
- Multifocal > > solitary lesions
|
|
- Most patients have HIV/AIDS
|
|
- **Parasites, Miscellaneous**
|
|
- Other than NCC, parasitic brain cysts uncommon
|
|
- Hydatid cyst
|
|
- Unilocular cyst, isointense to CSF
|
|
- T2-hypointense rim, no enhancement
|
|
- **Mucopolysaccharidoses**
|
|
- Group of lysosomal storage disorders
|
|
- PVS dilated by accumulated glycosaminoglycans
|
|
- Corpus callosum, peritrigonal WM
|
|
- Multiple, bilateral
|
|
- Dilated PVS in deep periventricular WM
|
|
- FLAIR-hyperintense rim surrounding dilated PVS
|
|
- **Germinolytic Cysts**
|
|
- Periventricular/subependymal cysts
|
|
- Cyst(s) along caudothalamic groove probably resulting from germinolysis
|
|
- Glial (not ependymal)-lined cysts/pseudocysts
|
|
- Distinguish from "connatal" cysts (intraventricular anterior choroid plexus cysts)
|
|
- Many etiologies, including inherited metabolic disorders (e.g., Zellweger, infantile Refsum), congenital infections (CMV)
|
|
- CSF-like; ± septations, hemosiderin; do not enhance
|
|
- Look for associated abnormalities
|
|
- Leukoencephalopathy
|
|
- Delayed myelination
|
|
- Polymicrogyria, pachygyria, heterotopias
|
|
- **Miscellaneous Congenital Malformations**
|
|
- Several have parenchymal CSF-like cysts as part of syndrome
|
|
- van der Knaap leukoencephalopathies (megaloencephalic leukoencephalopathy with subcortical cysts, anterior temporal lobe cavitations)
|
|
- Congenital muscular dystrophy (cerebellar cysts common, may represent dilated PVS)
|
|
- Dorsal interhemispheric CSF cyst
|
|
- Corpus callosal dysgenesis
|
|
- Holoprosencephaly
|
|
- ## Alternative Differential Approaches
|
|
|
|
|
|
- **Based on location**
|
|
- Deep gray nuclei
|
|
- Enlarged PVS
|
|
- Lacunar infarction
|
|
- Cryptococcosis
|
|
- Periventricular WM
|
|
- Multiple sclerosis
|
|
- Connatal cysts
|
|
- Germinolytic cysts
|
|
- Lobar
|
|
- Encephalomalacia
|
|
- NCC
|
|
- Porencephalic cyst
|
|
- Neuroglial cyst
|
|
- Hydatid cyst
|
|
|
|
## References
|
|
|
|
# Selected References
|
|
|
|
1. [Filippi M et al: Present and future of the diagnostic work-up of multiple sclerosis: the imaging perspective. J Neurol. ePub, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=36427168%5Bpmid%5D)
|
|
1. [Gyanwali B et al: Arterial spin-labeling parameters and their associations with risk factors, cerebral small-vessel disease, and etiologic subtypes of cognitive impairment and dementia. AJNR Am J Neuroradiol. 43(10):1418-23, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=36562454%5Bpmid%5D)
|
|
1. [Kim HG et al: MRI-visible dilated perivascular space in the brain by age: the human connectome project. Radiology. 213254, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=36378031%5Bpmid%5D)
|
|
1. [Loh DDL et al: Tumefactive perivascular spaces causing obstructive hydrocephalus. Radiology. 221724, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=36472539%5Bpmid%5D)
|
|
1. [Roosendaal SD et al: Imaging patterns characterizing mitochondrial leukodystrophies. AJNR Am J Neuroradiol. 42(7):1334-40, 2021](http://www.ncbi.nlm.nih.gov/pubmed/?term=34255734%5Bpmid%5D)
|
|
1. [Ajtai B et al: Imaging of intracranial cysts. Continuum (Minneap Minn). 22(5, Neuroimaging):1553-73, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=27740988%5Bpmid%5D)
|
|
1. [Taillibert S et al: Intracranial cystic lesions: a review. Curr Neurol Neurosci Rep. 14(9):481, 2014](http://www.ncbi.nlm.nih.gov/pubmed/?term=25106500%5Bpmid%5D)
|
|
1. [Osborn AG, Preece MT. Intracranial cysts: radiologic-pathologic correlation and imaging approach. Radiology. 239(3):650-64, 2006](http://www.ncbi.nlm.nih.gov/pubmed/?term=16714456%5Bpmid%5D)
|
|
1. [Salzman KL et al: Giant tumefactive perivascular spaces. AJNR Am J Neuroradiol. 26:298-305, 2005](http://www.ncbi.nlm.nih.gov/pubmed/?term=15709127%5Bpmid%5D)
|
|
|
|
|
|
## Images
|
|
|
|
|
|
### Selected Images
|
|
|
|
|
|
**Enlarged Perivascular Spaces**
|
|
*Axial T2 MR shows a cluster of CSF-like cysts in the inferior left basal ganglia <img src='img/arrows/CS.png'/>, a common location for enlarged perivascular spaces. They are often seen at the level of the anterior commissure.*
|
|
|
|
|
|
**Enlarged Perivascular Spaces**
|
|
*Axial T2 MR shows a cluster of CSF-like cysts in the inferior left basal ganglia <img src='img/arrows/CS.png'/>, a common location for enlarged perivascular spaces. They are often seen at the level of the anterior commissure.*
|
|
|
|
|
|
**Enlarged Perivascular Spaces**
|
|
*Axial T2 MR shows a cluster of CSF-like cysts in the inferior left basal ganglia <img src='img/arrows/CS.png'/>, a common location for enlarged perivascular spaces. They are often seen at the level of the anterior commissure.*
|
|
|
|
|
|
**Enlarged Perivascular Spaces**
|
|
*Axial T2 MR shows a cluster of CSF-like cysts in the inferior left basal ganglia <img src='img/arrows/CS.png'/>, a common location for enlarged perivascular spaces. They are often seen at the level of the anterior commissure.*
|
|
|
|
|
|
**Enlarged Perivascular Spaces**
|
|
*Axial T2 MR shows a cluster of CSF-like cysts in the inferior left basal ganglia <img src='img/arrows/CS.png'/>, a common location for enlarged perivascular spaces. They are often seen at the level of the anterior commissure.*
|
|
|
|
|
|
**Enlarged Perivascular Spaces**
|
|
*Axial T2 MR shows a cluster of CSF-like cysts in the inferior left basal ganglia <img src='img/arrows/CS.png'/>, a common location for enlarged perivascular spaces. They are often seen at the level of the anterior commissure.*
|
|
|
|
|
|
**Enlarged Perivascular Spaces**
|
|
*Axial FLAIR MR in the same patient demonstrates complete suppression of central T2 signal <img src='img/arrows/CS.png'/>. While most enlarged perivascular spaces have normal signal in the adjacent parenchyma, 25% have thin, FLAIR-hyperintense rim. These lesions are typically incidental but may be enlarged in certain conditions.*
|
|
|
|
|
|
**Enlarged Perivascular Spaces**
|
|
*Coronal T1 C+ MR shows a nonenhancing, multiloculated cystic structure <img src='img/arrows/CO.png'/> in left midbrain, thalamus, and medial temporal lobe, which followed CSF signal on all pulse sequences, consistent with giant tumefactive perivascular space. Mass effect results in hydrocephalus <img src='img/arrows/CC.png'/>.*
|
|
|
|
|
|
**Encephalomalacia**
|
|
*Axial FLAIR MR in a newborn shows large, fairly symmetric cystic areas of encephalomalacia <img src='img/arrows/CC.png'/> in both cerebral hemispheres with associated volume loss. Cystic encephalomalacia was a result of hypoxic-ischemic encephalopathy at birth.*
|
|
|
|
|
|
**Encephalomalacia**
|
|
*Axial FLAIR MR in a newborn shows large, fairly symmetric cystic areas of encephalomalacia <img src='img/arrows/CC.png'/> in both cerebral hemispheres with associated volume loss. Cystic encephalomalacia was a result of hypoxic-ischemic encephalopathy at birth.*
|
|
|
|
|
|
**Encephalomalacia**
|
|
*Axial FLAIR MR in a newborn shows large, fairly symmetric cystic areas of encephalomalacia <img src='img/arrows/CC.png'/> in both cerebral hemispheres with associated volume loss. Cystic encephalomalacia was a result of hypoxic-ischemic encephalopathy at birth.*
|
|
|
|
|
|
**Encephalomalacia**
|
|
*Axial T2 3D SPACE MR demonstrates subtotal right middle cerebral artery <img src='img/arrows/CO.png'/> and left posterior cerebral artery <img src='img/arrows/CC.png'/> encephalomalacia from chronic central embolic infarcts in this patient with atrial fibrillation.*
|
|
|
|
|
|
**Lacunar Infarction**
|
|
*Axial T2 MR shows multiple T2-hyperintense lesions in the periventricular white matter <img src='img/arrows/CC.png'/> and thalami <img src='img/arrows/CS.png'/> due to remote lacunar infarcts. Lacunar infarcts in the deep gray nuclei are classically seen in patients with vascular dementia.*
|
|
|
|
|
|
**Lacunar Infarction**
|
|
*Axial T2 MR shows multiple T2-hyperintense lesions in the periventricular white matter <img src='img/arrows/CC.png'/> and thalami <img src='img/arrows/CS.png'/> due to remote lacunar infarcts. Lacunar infarcts in the deep gray nuclei are classically seen in patients with vascular dementia.*
|
|
|
|
|
|
**Lacunar Infarction**
|
|
*Axial T2 MR shows multiple T2-hyperintense lesions in the periventricular white matter <img src='img/arrows/CC.png'/> and thalami <img src='img/arrows/CS.png'/> due to remote lacunar infarcts. Lacunar infarcts in the deep gray nuclei are classically seen in patients with vascular dementia.*
|
|
|
|
|
|
**Neurocysticercosis**
|
|
*Axial FLAIR MR shows cystic lesions <img src='img/arrows/CS.png'/> in the right frontal and left parietal lobes. An eccentric nodule (scolex) <img src='img/arrows/CC.png'/> seen in the right frontal lesion on this image helps make the diagnosis of neurocysticercosis.*
|
|
|
|
|
|
**Neurocysticercosis**
|
|
*Axial FLAIR MR shows cystic lesions <img src='img/arrows/CS.png'/> in the right frontal and left parietal lobes. An eccentric nodule (scolex) <img src='img/arrows/CC.png'/> seen in the right frontal lesion on this image helps make the diagnosis of neurocysticercosis.*
|
|
|
|
|
|
**Neurocysticercosis**
|
|
*Axial FLAIR MR shows cystic lesions <img src='img/arrows/CS.png'/> in the right frontal and left parietal lobes. An eccentric nodule (scolex) <img src='img/arrows/CC.png'/> seen in the right frontal lesion on this image helps make the diagnosis of neurocysticercosis.*
|
|
|
|
|
|
**Neurocysticercosis**
|
|
*Axial T2 MR reveals multiple cystic lesions in the right inferior frontal region <img src='img/arrows/CC.png'/> and the left sylvian fissure <img src='img/arrows/CS.png'/> due to racemose neurocysticercosis.*
|
|
|
|
|
|
**Porencephalic Cyst**
|
|
*Axial FLAIR MR shows a porencephalic cyst <img src='img/arrows/CO.png'/> in the right frontal lobe communicating with the right frontal horn.*
|
|
|
|
|
|
**Porencephalic Cyst**
|
|
*Axial FLAIR MR shows a porencephalic cyst <img src='img/arrows/CO.png'/> in the right frontal lobe communicating with the right frontal horn.*
|
|
|
|
|
|
**Porencephalic Cyst**
|
|
*Axial FLAIR MR shows a porencephalic cyst <img src='img/arrows/CO.png'/> in the right frontal lobe communicating with the right frontal horn.*
|
|
|
|
|
|
**Porencephalic Cyst**
|
|
*Axial T2 MR demonstrates a classic porencephalic cyst <img src='img/arrows/CC.png'/> in the right parietal lobe communicating with the posterior horn of the right lateral ventricle. Porencephalic cysts have CSF signal on all sequences and communicate with the ventricle &/or the pial surface.*
|
|
|
|
|
|
**Multiple Sclerosis**
|
|
*Axial T1 MR in a 34-year-old patient with longstanding, severe multiple sclerosis reveals multiple hypointense foci that are low signal and almost, but not quite, CSF-like. Note the faint, hyperintense rims <img src='img/arrows/CS.png'/> that surround some of the MS plaques. The T1 hypointensity correlates with axonal destruction.*
|
|
|
|
|
|
**Multiple Sclerosis**
|
|
*Axial T1 MR in a 34-year-old patient with longstanding, severe multiple sclerosis reveals multiple hypointense foci that are low signal and almost, but not quite, CSF-like. Note the faint, hyperintense rims <img src='img/arrows/CS.png'/> that surround some of the MS plaques. The T1 hypointensity correlates with axonal destruction.*
|
|
|
|
|
|
**Multiple Sclerosis**
|
|
*Axial T1 MR in a 34-year-old patient with longstanding, severe multiple sclerosis reveals multiple hypointense foci that are low signal and almost, but not quite, CSF-like. Note the faint, hyperintense rims <img src='img/arrows/CS.png'/> that surround some of the MS plaques. The T1 hypointensity correlates with axonal destruction.*
|
|
|
|
|
|
**Multiple Sclerosis**
|
|
*Axial T2 MR in the same patient shows that some lesions have CSF signal intensity <img src='img/arrows/CO.png'/>. Several others are hyperintense to brain parenchyma <img src='img/arrows/CC.png'/> but clearly do not resemble CSF in the lateral ventricles.*
|
|
|
|
|
|
**Hippocampal Sulcus Remnants**
|
|
*Axial T2 MR shows multiple CSF-like cysts in both hippocampi <img src='img/arrows/CS.png'/> just medial to the temporal horns of the lateral ventricles.*
|
|
|
|
|
|
**Hippocampal Sulcus Remnants**
|
|
*Axial T2 MR shows multiple CSF-like cysts in both hippocampi <img src='img/arrows/CS.png'/> just medial to the temporal horns of the lateral ventricles.*
|
|
|
|
|
|
**Hippocampal Sulcus Remnants**
|
|
*Axial T2 MR shows multiple CSF-like cysts in both hippocampi <img src='img/arrows/CS.png'/> just medial to the temporal horns of the lateral ventricles.*
|
|
|
|
|
|
**Hippocampal Sulcus Remnants**
|
|
*Coronal T2 MR reveals tiny cysts <img src='img/arrows/CC.png'/> in the hippocampi bilaterally, classic for hippocampal sulcus remnant cysts, which are incidental findings.*
|
|
|
|
|
|
**Connatal Cysts**
|
|
*Coronal ultrasound in a 1-day-old premature infant shows a CSF-like intra- or periventricular cyst <img src='img/arrows/CS.png'/> with a tiny strand of tissue <img src='img/arrows/CO.png'/> that connects the walls of anterior horn.*
|
|
|
|
|
|
**Connatal Cysts**
|
|
*Coronal ultrasound in a 1-day-old premature infant shows a CSF-like intra- or periventricular cyst <img src='img/arrows/CS.png'/> with a tiny strand of tissue <img src='img/arrows/CO.png'/> that connects the walls of anterior horn.*
|
|
|
|
|
|
**Connatal Cysts**
|
|
*Coronal ultrasound in a 1-day-old premature infant shows a CSF-like intra- or periventricular cyst <img src='img/arrows/CS.png'/> with a tiny strand of tissue <img src='img/arrows/CO.png'/> that connects the walls of anterior horn.*
|
|
|
|
|
|
**Connatal Cysts**
|
|
*Axial T2 MR demonstrates connatal cysts surrounded by mild hyperintensity <img src='img/arrows/CO.png'/>. Whether these are connatal/germinolytic cysts persisting into adulthood or neuroglial cyst is uncertain. Regardless of etiology, such asymptomatic cysts are benign and typically nonprogressive.*
|
|
|
|
|
|
**Neuroglial Cyst**
|
|
*Axial T2 MR shows a large, well-defined cyst <img src='img/arrows/CO.png'/> in the left posterior frontal region. The cyst showed CSF signal on all sequences, which is typical for a neuroglial cyst.*
|
|
|
|
|
|
**Neuroglial Cyst**
|
|
*Axial T2 MR shows a large, well-defined cyst <img src='img/arrows/CO.png'/> in the left posterior frontal region. The cyst showed CSF signal on all sequences, which is typical for a neuroglial cyst.*
|
|
|
|
|
|
**Neuroglial Cyst**
|
|
*Axial T1 MR demonstrates a well-defined cyst <img src='img/arrows/CC.png'/> in the left choroidal fissure, a typical location for a neuroglial cyst/choroidal fissure cyst.*
|
|
|
|
|
|
**Cryptococcosis**
|
|
*Axial T2 MR in a patient with HIV/AIDS shows several hyperintense cystic areas representing dilated perivascular spaces <img src='img/arrows/CO.png'/> from cryptococcosis. Fungi and gelatinous material collect within the spaces. There is typically little to no enhancement following contrast administration.*
|
|
|
|
|
|
**Cryptococcosis**
|
|
*Axial T2 MR in a patient with HIV/AIDS shows several hyperintense cystic areas representing dilated perivascular spaces <img src='img/arrows/CO.png'/> from cryptococcosis. Fungi and gelatinous material collect within the spaces. There is typically little to no enhancement following contrast administration.*
|
|
|
|
|
|
**Parasites, Miscellaneous**
|
|
*Axial CECT reveals a unilocular cyst <img src='img/arrows/CS.png'/> in the right cerebral hemisphere with no surrounding edema or enhancement, typical of echinococcus (hydatid disease).*
|
|
|
|
|
|
**Parasites, Miscellaneous**
|
|
*Axial CECT reveals a unilocular cyst <img src='img/arrows/CS.png'/> in the right cerebral hemisphere with no surrounding edema or enhancement, typical of echinococcus (hydatid disease).*
|
|
|
|
|
|
**Mucopolysaccharidoses**
|
|
*Axial T1 MR shows multiple enlarged perivascular spaces <img src='img/arrows/CC.png'/> in this young child with mucopolysaccharidoses 1H and minimal neurological symptoms. Note severe peritrigonal, callosal involvement.*
|
|
|
|
|
|
**Mucopolysaccharidoses**
|
|
*Axial FLAIR MR demonstrates 3 findings typical of mucopolysaccharidosis: CSF-like dilated perivascular spaces filled with mucopolysaccharides <img src='img/arrows/WS.png'/>, hyperintense white matter, and global atrophy.*
|
|
|
|
|
|
**Germinolytic Cysts**
|
|
*Axial T2 MR in an infant with congenital CMV infection shows multiple periventricular germinolytic cysts <img src='img/arrows/CS.png'/>.*
|
|
|
|
|
|
**Germinolytic Cysts**
|
|
*Coronal FLAIR MR in a patient with infantile Refsum disease reveals bilateral periventricular germinolytic cysts <img src='img/arrows/CC.png'/> mimicking Zellweger syndrome. Germinolytic cysts are subependymal along a caudothalamic groove, probably resulting from germinolysis.*
|
|
|
|
|
|
**Miscellaneous Congenital Malformations**
|
|
*Axial T2 MR in a child with congenital muscular dystrophy shows multiple small, cystic lesions in the dysplastic cerebellum <img src='img/arrows/CS.png'/>. The pons is hypoplastic with dorsal clefting <img src='img/arrows/CC.png'/>. Hypomyelination of the temporal lobes <img src='img/arrows/CO.png'/> is present.*
|
|
|
|
|
|
**Miscellaneous Congenital Malformations**
|
|
*Coronal FLAIR MR in an 18-month-old infant with van der Knaap leukoencephalopathy shows cystic changes in both temporal lobes <img src='img/arrows/CS.png'/>, characteristic of this condition.*
|
|
|
|
|
|
### Additional Images
|
|
|
|
|
|
**Enlarged Perivascular Spaces**
|
|
*Axial T2 MR shows a cluster of CSF-like cysts <img src='img/arrows/CC.png'/> in the right frontal subcortical white matter.*
|
|
|
|
|
|
**Enlarged Perivascular Spaces**
|
|
*Axial FLAIR MR in the same patient shows suppression of the signal <img src='img/arrows/CS.png'/> within the cysts. Note subtle FLAIR hyperintensity <img src='img/arrows/CO.png'/> surrounding the cysts. Large perivascular spaces can assume a bizarre configuration and mimic a cystic neoplasm.*
|
|
|
|
|
|
**Enlarged Perivascular Spaces**
|
|
*Coronal T2 MR shows a cluster of variable-sized CSF-like cysts in left parietal subcortical white matter <img src='img/arrows/WS.png'/>. Lesions did not enhance. Follow-up scan 5 years later showed no change.*
|
|
|
|
|
|
**Encephalomalacia**
|
|
*Axial T1 MR in a patient with old left internal artery occlusion shows multicystic encephalomalacia. FLAIR, T2-weighted scans showed extensive hyperintensity in the residual parenchyma secondary to gliosis and spongiosis.*
|
|
|
|
|
|
**Encephalomalacia**
|
|
*Axial FLAIR MR demonstrates cystic encephalomalacia <img src='img/arrows/CC.png'/> in the right frontal lobe due to an old infarct. Note associated volume loss with prominence of the adjacent sulcal spaces.*
|
|
|
|
|
|
**Lacunar Infarction**
|
|
*Axial T2 MR shows a cystic lesion <img src='img/arrows/CO.png'/> in the left caudate nucleus due to an old lacunar infarct. Lacunar infarcts are small, deep cerebral infarcts located in basal ganglia and thalamus, pons, or cerebral white matter, which are ≤ 15 mm in size.*
|
|
|
|
|
|
**Lacunar Infarction**
|
|
*Coronal T1 MR in an older adult patient with bilateral subacute subdural hematomas <img src='img/arrows/BO.png'/> shows multiple lacunar infarcts <img src='img/arrows/BS.png'/> in white matter and basal ganglia.*
|
|
|
|
|
|
**Neurocysticercosis**
|
|
*Axial T1 C+ MR shows several nonenhancing CSF-like cysts <img src='img/arrows/BS.png'/> of variable sizes in a patient with neurocysticercosis. Several may be cisternal, invaginating into brain. (Courtesy E. Bravo, MD.)*
|
|
|
|
|
|
**Neurocysticercosis**
|
|
*Axial FLAIR MR shows a cystic lesion <img src='img/arrows/CC.png'/> in the left parietal region with an eccentric nodule <img src='img/arrows/CS.png'/> and mild perilesional edema <img src='img/arrows/CO.png'/> typical of the colloid vesicular stage of neurocysticercosis.*
|
|
|
|
|
|
**Neurocysticercosis**
|
|
*Sagittal T1 MR shows a variant case of neurocysticercosis with multiple large, well-delineated parenchymal cysts.*
|
|
|
|
|
|
**Hippocampal Sulcus Remnants**
|
|
*Coronal FLAIR MR shows tiny cysts <img src='img/arrows/CC.png'/> in the hippocampi bilaterally, classic for hippocampal sulcus remnant cysts.*
|
|
|
|
|
|
**Porencephalic Cyst**
|
|
*Axial FLAIR MR shows a classic porencephalic cyst <img src='img/arrows/WS.png'/> that suppresses completely on FLAIR. Some gliosis is present, seen here as a faint area of increased signal intensity <img src='img/arrows/WO.png'/>.*
|
|
|
|
|
|
**Porencephalic Cyst**
|
|
*Axial T1 MR shows fluid replacing a portion of the anteromedial left temporal lobe <img src='img/arrows/WS.png'/>. The cystic space communicates with the lateral ventricle <img src='img/arrows/BO.png'/> and the pial surface of the brain <img src='img/arrows/WO.png'/>.*
|
|
|
|
|
|
**Hippocampal Sulcus Remnants**
|
|
*Axial T2 MR shows an array of several tiny round and ovoid CSF-like cysts in both hippocampi <img src='img/arrows/BS.png'/>, just medial to the temporal horns of lateral ventricles. FLAIR scan (not shown) demonstrated that the cysts suppressed completely.*
|
|
|
|
|
|
**Neuroglial Cyst**
|
|
*Coronal T2 MR shows a well-defined cyst <img src='img/arrows/CC.png'/> in the right choroidal fissure, a typical location for a neuroglial cyst.*
|
|
|
|
|
|
**Connatal Cysts**
|
|
*Axial T1 MR in an asymptomatic patient shows a CSF-like cyst <img src='img/arrows/CS.png'/> adjacent to, but separated from, the left frontal horn. A smaller cyst present posteriorly <img src='img/arrows/CO.png'/>.*
|
|
|
|
|
|
**Connatal Cysts**
|
|
*Sagittal T2 MR in the same infant shows that the cyst <img src='img/arrows/CC.png'/> is definitely CSF-like.*
|
|
|
|
|
|
**Neuroglial Cyst**
|
|
*Sagittal T2 MR shows a variant case of neuroglial cyst <img src='img/arrows/BS.png'/> that appears to arise from the tectum, which appears stretched <img src='img/arrows/BO.png'/> around the cyst.*
|
|
|
|
|
|
**Neuroglial Cyst**
|
|
*Axial FLAIR MR shows a large, cystic mass <img src='img/arrows/WS.png'/> that suppresses completely but neither enhanced nor restricted. At surgery, the cyst wall was composed of benign glial cells.*
|
|
|
|
|
|
**Neuroglial Cyst**
|
|
*Axial FLAIR MR shows a small, subcortical cyst <img src='img/arrows/BS.png'/> in the left frontal lobe. The cyst suppresses completely and shows no surrounding gliosis.*
|
|
|
|
|
|
**Germinolytic Cysts**
|
|
*Coronal T2 MR in a child with infantile Refsum disease shows patchy hyperintensity in cerebellar <img src='img/arrows/WC.png'/> and periventricular white matter <img src='img/arrows/WO.png'/> as well as the dentate nuclei <img src='img/arrows/CS.png'/>.*
|
|
|
|
|
|
**Germinolytic Cysts**
|
|
*Coronal T2 MR in an infant with Zellweger syndrome shows hypomyelination, multiple small germinolytic cysts <img src='img/arrows/WS.png'/>, and polymicrogyria <img src='img/arrows/WO.png'/>.*
|
|
|
|
|
|
**Germinolytic Cysts**
|
|
*Axial T2 MR in an infant with congenital CMV shows hyperintense germinolytic cysts <img src='img/arrows/BO.png'/> and extensive perisylvian cortical dysplasia <img src='img/arrows/WC.png'/>. Unexplained periventricular T2 hyperintensity <img src='img/arrows/BS.png'/>, periventricular cysts, and neuronal migration and organization abnormalities should suggest congenital CMV infection.*
|
|
|
|
|
|
**Multiple Sclerosis**
|
|
*Axial T2 MR in the same patient shows that some lesions show CSF signal intensity <img src='img/arrows/CO.png'/>. Several others are "bright" <img src='img/arrows/CC.png'/> but clearly do not resemble the other lesions or CSF in the lateral ventricles.*
|
|
|
|
|
|
**Multiple Sclerosis**
|
|
*Axial T1 MR in a patient with longstanding multiple sclerosis reveals multiple hypointense foci that are almost (but not quite) CSF-like. Note the faint hyperintense rims <img src='img/arrows/CS.png'/> that surround plaques.*
|
|
|