Arachnoid cyst MRI

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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

  • 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.[1][2]
  • 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).
  • CSF signal is seen within the cyst;
  • Eventually, arachnoid cysts may contain proteinaceous fluid or blood, which can cause diagnostic confusion.[3]

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)


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.

==MRI Examples of Arachnoid Cysts

(Images courtesy of RadsWiki)

Patient #1: Left middle cranial fossa arachnoid cyst

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