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==Overview==
==Overview==
On brain/spine MRI, arachnoid cysts are characterized by cystic images with similar density to CSF and non-enhancing borders, mostly found in the middle cranial fossa while they only rarely occur in the spinal cord. MRIs are more adequate than CT scans for evaluating arachnoid cysts.   
On [[brain]]/[[spine]] MRI, [[arachnoid cysts]] are characterized by cystic images with similar density to [[CSF]] and non-enhancing borders, mostly found in the [[middle cranial fossa]] while they only rarely occur in the [[spinal cord]]. [[Magnetic resonance imaging|MRIs]] are more adequate than [[CT scans]] for evaluating [[Arachnoid cyst|arachnoid cysts]].   


==MRI==
==MRI==


* MRIs are better to diagnose and evaluate the extent of the arachnoid cyst than the CT Scan;
*[[Magnetic resonance imaging|MRIs]] are better to diagnose and evaluate the extent of the [[arachnoid cyst]] than the [[CT Scan]];
*Most cysts (50-60%) are found in the floor of the middle cranial fossa, while 1/4 to 1/3 of occur in the posterior fossa, particularly in the retrocerebellar, cerebellopontine, and quadrigeminal plate cisterns. Rarely, they may be found in the spinal cord.<ref>Robertson, S. J., S. M. Wolpert, and V. M. Runge. "MR imaging of middle cranial fossa arachnoid cysts: temporal lobe agenesis syndrome revisited." ''American journal of neuroradiology'' 10.5 (1989): 1007-1010.</ref><ref>{{Cite web|url=https://emedicine.medscape.com/article/336489-overview|title=Arachnoid Cysts - Imaging|last=|first=|date=06/26/2020|website=Medscape|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*Most cysts (50-60%) are found in the floor of the [[middle cranial fossa]], while 1/4 to 1/3 of occur in the [[Posterior cranial fossa|posterior foss]]<nowiki/>a, particularly in the [[retrocerebellar]], [[cerebellopontine]], and [[quadrigeminal plate]] [[cisterns]]. Rarely, they may be found in the [[spinal cord]].<ref>Robertson, S. J., S. M. Wolpert, and V. M. Runge. "MR imaging of middle cranial fossa arachnoid cysts: temporal lobe agenesis syndrome revisited." ''American journal of neuroradiology'' 10.5 (1989): 1007-1010.</ref><ref>{{Cite web|url=https://emedicine.medscape.com/article/336489-overview|title=Arachnoid Cysts - Imaging|last=|first=|date=06/26/2020|website=Medscape|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
* Demonstrate the exact location, extent, and relationship of the cyst;
* Demonstrate the exact location, extent, and relationship of the cyst;
* Can differentiate arachnoid from epidermoid cysts (arachnoid cysts are identical to CSF, while epidermoid present a higher signal with FLAIR and reduced diffusion with DWI, making them appear brighter than CSF).  
* Can differentiate arachnoid from [[epidermoid cysts]] (arachnoid cysts are identical to [[CSF]], while epidermoid present a higher signal with [[FLAIR]] and reduced diffusion with [[DWI]], making them appear brighter than [[CSF]]).
* CSF signal is seen within the cyst;
*[[CSF]] signal is seen within the cyst;
* Eventually, arachnoid cysts may contain proteinaceous fluid or blood, which can cause diagnostic confusion.<ref>{{Cite web|url=https://medpix.nlm.nih.gov/case?id=9c946ba2-4e56-458a-a20b-bd3092a4704e|title=Arachnoid Cysts|last=|first=|date=06/26/2020|website=MedPix|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
* Eventually, arachnoid cysts may contain [[proteinaceous]] fluid or blood, which can cause diagnostic confusion.<ref>{{Cite web|url=https://medpix.nlm.nih.gov/case?id=9c946ba2-4e56-458a-a20b-bd3092a4704e|title=Arachnoid Cysts|last=|first=|date=06/26/2020|website=MedPix|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
=== Differential Diagnosis ===
=== Differential Diagnosis ===
{| class="wikitable"
{| class="wikitable"
|+Arachnoid cysts differential diagnosis<ref>Cincu, Rafael, Amit Agrawal, and Jose Eiras. "Intracranial arachnoid cysts: current concepts and treatment alternatives." ''Clinical neurology and neurosurgery'' 109.10 (2007): 837-843.</ref>
|+Arachnoid cysts differential diagnosis<ref>Cincu, Rafael, Amit Agrawal, and Jose Eiras. "Intracranial arachnoid cysts: current concepts and treatment alternatives." ''Clinical neurology and neurosurgery'' 109.10 (2007): 837-843.</ref>
|'''Intraventricularly:'''
|'''Intraventricularly:'''
|Colloid cysts
|[[Colloid cysts]]
|-
|-
|'''Intraparenchymally:'''
|'''Intraparenchymally:'''
|Parasitic infections, cystic metastases
|[[Parasitic infections]], [[cystic metastases]]
|-
|-
|Porencephalic cysts
|[[Porencephalic cysts]]
|
|
|-
|-
|Craniopharyngiomas
|[[Craniopharyngiomas]]
|
|
|-
|-
|Holoprosencephalies
|[[Holoprosencephaly|Holoprosencephalies]]
|
|
|-
|-
|Agenesis of corpus callosum
|[[Agenesis of the corpus callosum|Agenesis of corpus callosum]]
|
|
|-
|-
Line 38: Line 38:
|
|
|-
|-
|Dandy-Walker complex (posterior fossa cysts)
|[[Dandy-Walker complex]] (posterior fossa cysts)
|
|}
|}
* As differential diagnosis, the following hypothesis must be considered:
As differential diagnosis, the following hypothesis must be considered:
enlarged CSF space (e.g. mega cisterna magna)
 
epidermoid cyst
#Enlarged [[CSF]] space;
often shows a heterogeneous/dirty signal on FLAIR
#[[Epidermoid cyst]];
restricted diffusion
#[[Subdural hygroma]]/[[Subdural hematoma|chronic subdural hemorrhage]];
more lobulated
#Cystic tumors;
tend to engulf adjacent arteries and cranial nerves
#[[Pilocytic astrocytoma]];
subdural hygroma/chronic subdural hemorrhage
#[[Hemangioblastoma]];
do not typically show CSF signal intensity on MRI
#[[Neurenteric cyst]];
can have an enhancing membrane
#[[Neuroglial cyst]];
cystic tumors: often will have a solid/enhancing component and be intra-axial
#[[Porencephalic cyst]];
pilocytic astrocytoma
#[[Neurocysticercosis]].<ref>{{Cite web|url=https://radiopaedia.org/articles/arachnoid-cyst?lang=us|title=Arachnoid Cysts - Radiopaedia|last=|first=|date=06/26/2020|website=Radiopaedia|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
hemangioblastoma
non-neoplastic cysts
neurenteric cyst
neuroglial cyst
porencephalic cyst
often follow a history of trauma or stroke
surrounded by gliotic brain
neurocysticercosis
small cyst
usually multiple when in the subarachnoid space


==References==
==References==

Latest revision as of 02:19, 30 June 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2]

Overview

On brain/spine MRI, arachnoid cysts are characterized by cystic images with similar density to CSF and non-enhancing borders, mostly found in the middle cranial fossa while they only rarely occur in the spinal cord. MRIs are more adequate than CT scans for evaluating arachnoid cysts.

MRI

Differential Diagnosis

Arachnoid cysts differential diagnosis[4]
Intraventricularly: Colloid cysts
Intraparenchymally: Parasitic infections, cystic metastases
Porencephalic cysts
Craniopharyngiomas
Holoprosencephalies
Agenesis of corpus callosum
Defect in the hemispheral cleavage
Dandy-Walker complex (posterior fossa cysts)

As differential diagnosis, the following hypothesis must be considered:

  1. Enlarged CSF space;
  2. Epidermoid cyst;
  3. Subdural hygroma/chronic subdural hemorrhage;
  4. Cystic tumors;
  5. Pilocytic astrocytoma;
  6. Hemangioblastoma;
  7. Neurenteric cyst;
  8. Neuroglial cyst;
  9. Porencephalic cyst;
  10. Neurocysticercosis.[5]

References

  1. ↑ Robertson, S. J., S. M. Wolpert, and V. M. Runge. "MR imaging of middle cranial fossa arachnoid cysts: temporal lobe agenesis syndrome revisited." American journal of neuroradiology 10.5 (1989): 1007-1010.
  2. ↑ "Arachnoid Cysts - Imaging". Medscape. 06/26/2020. Check date values in: |date= (help)
  3. ↑ "Arachnoid Cysts". MedPix. 06/26/2020. Check date values in: |date= (help)
  4. ↑ Cincu, Rafael, Amit Agrawal, and Jose Eiras. "Intracranial arachnoid cysts: current concepts and treatment alternatives." Clinical neurology and neurosurgery 109.10 (2007): 837-843.
  5. ↑ "Arachnoid Cysts - Radiopaedia". Radiopaedia. 06/26/2020. Check date values in: |date= (help)

MRI Examples of Arachnoid Cysts

(Images courtesy of RadsWiki)

Patient #1: Left middle cranial fossa arachnoid cyst

  • Cor T2

    Cor T2

  • Sag T1

    Sag T1

  • Axial T1 FLAIR

    Axial T1 FLAIR

  • Axial T2

    Axial T2

Patient #2: CT and MR images demonstrate a hemorrhagic arachnoid cyst

  • CT

    CT

  • Sag T1

    Sag T1

  • Ax T1

    Ax T1

  • Ax FLAIR

    Ax FLAIR

  • Ax T2

    Ax T2

  • Ax T1 with GAD

    Ax T1 with GAD

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