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DOI: 10.1148/radiol.2393050823
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Intracranial Cysts: Radiologic-Pathologic Correlation and Imaging Approach1

Anne G. Osborn, MD and Michael T. Preece, MD

1 From the Department of Radiology, University of Utah Medical Center, Salt Lake City, Utah. Received May 13, 2005; revision requested June 17; revision received July 25; accepted September 1; final version accepted December 8. Address correspondence to M.T.P., 266 East 4th Ave #501, Salt Lake City, Utah 84103 (e-mail: michael.preece{at}intermountainmail.org).


Figure 1
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  		Figure 1a: (a) Transverse graphic representation shows multiple cystic masses in the choroid plexus glomi (arrows). Most CPCs are actually degenerative xanthogranulomas. (Image courtesy of Amirsys, Salt Lake City, Utah.) (b) Transverse contrast-enhanced T1-weighted MR image in a healthy 52-year-old man shows bilateral CPCs with peripheral and nodular enhancement (arrows).

 

Figure 1
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  		Figure 1b: (a) Transverse graphic representation shows multiple cystic masses in the choroid plexus glomi (arrows). Most CPCs are actually degenerative xanthogranulomas. (Image courtesy of Amirsys, Salt Lake City, Utah.) (b) Transverse contrast-enhanced T1-weighted MR image in a healthy 52-year-old man shows bilateral CPCs with peripheral and nodular enhancement (arrows).

 

Figure 2
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  		Figure 2a: (a) Coronal gross slice of autopsied brain with postmortem gas in bilateral enlarged PVSs. (Image courtesy of E. T. Hedley-Whyte, MD, Massachusetts General Hospital, Boston, Mass.) (b) Transverse contrast-enhanced T1-weighted MR image shows typical nonenhancing enlarged PVSs in right basal ganglia. The cluster of variably sized cysts is a common appearance. (c) Transverse T2-weighted MR image shows multiple bizarre-appearing cysts (arrows) in centrum semiovale and subcortical white matter of both hemispheres. The cysts vary in size and focally expand but otherwise spare the overlying cortex.

 

Figure 2
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  		Figure 2b: (a) Coronal gross slice of autopsied brain with postmortem gas in bilateral enlarged PVSs. (Image courtesy of E. T. Hedley-Whyte, MD, Massachusetts General Hospital, Boston, Mass.) (b) Transverse contrast-enhanced T1-weighted MR image shows typical nonenhancing enlarged PVSs in right basal ganglia. The cluster of variably sized cysts is a common appearance. (c) Transverse T2-weighted MR image shows multiple bizarre-appearing cysts (arrows) in centrum semiovale and subcortical white matter of both hemispheres. The cysts vary in size and focally expand but otherwise spare the overlying cortex.

 

Figure 2
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  		Figure 2c: (a) Coronal gross slice of autopsied brain with postmortem gas in bilateral enlarged PVSs. (Image courtesy of E. T. Hedley-Whyte, MD, Massachusetts General Hospital, Boston, Mass.) (b) Transverse contrast-enhanced T1-weighted MR image shows typical nonenhancing enlarged PVSs in right basal ganglia. The cluster of variably sized cysts is a common appearance. (c) Transverse T2-weighted MR image shows multiple bizarre-appearing cysts (arrows) in centrum semiovale and subcortical white matter of both hemispheres. The cysts vary in size and focally expand but otherwise spare the overlying cortex.

 

Figure 3
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  		Figure 3: Transverse FLAIR MR image shows ependymal cyst within enlarged atrium of the left lateral ventricle (open arrow). Signal intensity was isointense to CSF at all pulse sequences. Note lateral displacement of choroid plexus (solid arrow).

 

Figure 4
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  		Figure 4a: (a) Transverse FLAIR MR image shows typical neuroglial cyst (straight arrow) adjacent to left temporal horn. The cyst appears well demarcated without surrounding gliosis and has the same appearance as CSF at all sequences. This cyst does not communicate with the ventricle (curved arrow). (b) Transverse FLAIR MR image demonstrates neuroglial cyst in the choroid fissure (arrow).

 

Figure 4
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  		Figure 4b: (a) Transverse FLAIR MR image shows typical neuroglial cyst (straight arrow) adjacent to left temporal horn. The cyst appears well demarcated without surrounding gliosis and has the same appearance as CSF at all sequences. This cyst does not communicate with the ventricle (curved arrow). (b) Transverse FLAIR MR image demonstrates neuroglial cyst in the choroid fissure (arrow).

 

Figure 5
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  		Figure 5a: (a) Sagittal gross postmortem slice demonstrates cystic pineal gland (arrow) with thin cyst wall. (Image courtesy of E. Tessa Hedley-Whyte, MD, Massachusetts General Hospital, Boston, Mass.) (b) Sagittal contrast-enhanced T1-weighted MR image shows classic benign pineal cyst (straight arrows) with rim enhancement and mild mass effect (note slight compression, displacement of tectal plate [curved arrow]). (Image courtesy of L. Rudolf, MD, Barrett Memorial Hospital, Dillon, Mont.)

 

Figure 5
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  		Figure 5b: (a) Sagittal gross postmortem slice demonstrates cystic pineal gland (arrow) with thin cyst wall. (Image courtesy of E. Tessa Hedley-Whyte, MD, Massachusetts General Hospital, Boston, Mass.) (b) Sagittal contrast-enhanced T1-weighted MR image shows classic benign pineal cyst (straight arrows) with rim enhancement and mild mass effect (note slight compression, displacement of tectal plate [curved arrow]). (Image courtesy of L. Rudolf, MD, Barrett Memorial Hospital, Dillon, Mont.)

 

Figure 6
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  		Figure 6a: (a) Submentovertex view of autopsied brain with large middle fossa arachnoid cyst, which is contained within split layers of arachnoid. (Image courtesy of J. Townsend, MD, University of Utah School of Medicine.) (b) Transverse T2-weighted MR image shows extraaxial CSF-like arachnoid cyst in anterior middle cranial fossa (straight arrow). The temporal lobe is hypoplastic with posteriorly displaced temporal horn (curved arrow). (c) Transverse diffusion-weighted MR image shows no restriction (an epidermoid cyst would not suppress completely on FLAIR image and would restrict on diffusion-weighted image) and a classic arachnoid cyst (arrows).

 

Figure 6
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  		Figure 6b: (a) Submentovertex view of autopsied brain with large middle fossa arachnoid cyst, which is contained within split layers of arachnoid. (Image courtesy of J. Townsend, MD, University of Utah School of Medicine.) (b) Transverse T2-weighted MR image shows extraaxial CSF-like arachnoid cyst in anterior middle cranial fossa (straight arrow). The temporal lobe is hypoplastic with posteriorly displaced temporal horn (curved arrow). (c) Transverse diffusion-weighted MR image shows no restriction (an epidermoid cyst would not suppress completely on FLAIR image and would restrict on diffusion-weighted image) and a classic arachnoid cyst (arrows).

 

Figure 6
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  		Figure 6c: (a) Submentovertex view of autopsied brain with large middle fossa arachnoid cyst, which is contained within split layers of arachnoid. (Image courtesy of J. Townsend, MD, University of Utah School of Medicine.) (b) Transverse T2-weighted MR image shows extraaxial CSF-like arachnoid cyst in anterior middle cranial fossa (straight arrow). The temporal lobe is hypoplastic with posteriorly displaced temporal horn (curved arrow). (c) Transverse diffusion-weighted MR image shows no restriction (an epidermoid cyst would not suppress completely on FLAIR image and would restrict on diffusion-weighted image) and a classic arachnoid cyst (arrows).

 

Figure 7
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  		Figure 7a: (a) Coronal gross specimen shows colloid cyst at the foramen of Monro. Note displacement of septum pellucidum and fornices (white arrow) around the cyst (black arrow). Moderate hydrocephalus is present. (Image courtesy of J. Townsend, MD, University of Utah School of Medicine.) (b) Transverse nonenhanced CT scan shows classic hyperattenuated colloid cyst at foramen of Monro (arrow).

 

Figure 7
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  		Figure 7b: (a) Coronal gross specimen shows colloid cyst at the foramen of Monro. Note displacement of septum pellucidum and fornices (white arrow) around the cyst (black arrow). Moderate hydrocephalus is present. (Image courtesy of J. Townsend, MD, University of Utah School of Medicine.) (b) Transverse nonenhanced CT scan shows classic hyperattenuated colloid cyst at foramen of Monro (arrow).

 

Figure 8
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  		Figure 8a: (a) Sagittal graphic representation shows posterior fossa epidermoid cyst (arrow) wrapping around basilar artery and displacing the brainstem posteriorly. (Image courtesy of Amirsys, Salt Lake City, Utah.) (b) Transverse nonenhanced CT scan shows slightly lobulated low-attenuation mass in posterior fossa (arrows). (c) Transverse diffusion-weighted image shows markedly restricted diffusion (arrows). Epidermoid cyst was confirmed at surgery.

 

Figure 8
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  		Figure 8b: (a) Sagittal graphic representation shows posterior fossa epidermoid cyst (arrow) wrapping around basilar artery and displacing the brainstem posteriorly. (Image courtesy of Amirsys, Salt Lake City, Utah.) (b) Transverse nonenhanced CT scan shows slightly lobulated low-attenuation mass in posterior fossa (arrows). (c) Transverse diffusion-weighted image shows markedly restricted diffusion (arrows). Epidermoid cyst was confirmed at surgery.

 

Figure 8
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  		Figure 8c: (a) Sagittal graphic representation shows posterior fossa epidermoid cyst (arrow) wrapping around basilar artery and displacing the brainstem posteriorly. (Image courtesy of Amirsys, Salt Lake City, Utah.) (b) Transverse nonenhanced CT scan shows slightly lobulated low-attenuation mass in posterior fossa (arrows). (c) Transverse diffusion-weighted image shows markedly restricted diffusion (arrows). Epidermoid cyst was confirmed at surgery.

 

Figure 9
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  		Figure 9: Sagittal T1-weighted MR image shows mixed-signal-intensity lesion in the pineal region (straight arrow) with multiple hyperintense droplets scattered through the subarachnoid space (curved arrows). Moderate hydrocephalus is present. Ruptured dermoid cyst was confirmed at surgery.

 

Figure 10
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  		Figure 10: Sagittal T1-weighted MR image shows small well-delineated ovoid mass in front of pontomedullary junction (arrow). Mass is hyperintense compared to CSF. Location and configuration are typical for a neurenteric cyst, confirmed at surgery.

 

Figure 11
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  		Figure 11: Sagittal postcontrast T1-weighted MR image shows rounded mass (solid arrow) separate from and just above the pituitary gland (open arrow). This cyst has moderately high protein content and is isointense with brain, not CSF. Location is typical for a Rathke cleft cyst, confirmed at surgery. (Image courtesy of J. Rees, MD, MedTell International, McLean, Va.)

 

Figure 12
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  		Figure 12a: (a) Close-up of autopsy brain specimen shows large acquired porencephalic cyst in the temporal lobe that communicates with temporal horn of the lateral ventricle (arrows). (Image courtesy of E. Ross, MD, Loyola University School of Medicine, Chicago, Ill.) (b) Coronal T1-weighted MR image in another case shows enlarged left temporal horn (black arrow) that communicates with peripherally located porencephalic cyst (white arrows). Cyst extends to the brain surface.

 

Figure 12
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  		Figure 12b: (a) Close-up of autopsy brain specimen shows large acquired porencephalic cyst in the temporal lobe that communicates with temporal horn of the lateral ventricle (arrows). (Image courtesy of E. Ross, MD, Loyola University School of Medicine, Chicago, Ill.) (b) Coronal T1-weighted MR image in another case shows enlarged left temporal horn (black arrow) that communicates with peripherally located porencephalic cyst (white arrows). Cyst extends to the brain surface.

 

Figure 13
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  		Figure 13a: (a) Multiple neurocysticercosis cysts of various sizes. Some contain visible scolices (arrows). (Image courtesy of E. Ross, MD, Loyola University School of Medicine, Chicago, Ill.) (b) Transverse T1-weighted MR image shows innumerable tiny low-signal-intensity neurocyticercosis cysts in brain parenchyma and subarachnoid spaces. Most contain small "dot" that represents the scolex (arrows).

 

Figure 13
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  		Figure 13b: (a) Multiple neurocysticercosis cysts of various sizes. Some contain visible scolices (arrows). (Image courtesy of E. Ross, MD, Loyola University School of Medicine, Chicago, Ill.) (b) Transverse T1-weighted MR image shows innumerable tiny low-signal-intensity neurocyticercosis cysts in brain parenchyma and subarachnoid spaces. Most contain small "dot" that represents the scolex (arrows).

 

Figure 14
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  		Figure 14: Hydatid cyst. Transverse contrast-enhanced CT scan in a 5-year-old child shows a very large nonenhancing cystic mass without surrounding edema (arrows). (Image courtesy of R. Ramakantan, MD, King Edward Memorial Hospital, Bombay, India.)

 

Figure 15
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  		Figure 15a: (a) Sagittal precontrast T1-weighted MR image in a patient presenting to the emergency room with seizure shows partially cystic mixed-signal-intensity subcortical mass (arrow). (b) Transverse postcontrast T1-weighted MR image demonstrates some enhancement around complex cystic mass (arrow). Surgery disclosed multiloculated amebic abscess. (Image courtesy of R. Hewlett, MD, Stellenbosch University School of Medicine, Cape Town, South Africa.)

 

Figure 15
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  		Figure 15b: (a) Sagittal precontrast T1-weighted MR image in a patient presenting to the emergency room with seizure shows partially cystic mixed-signal-intensity subcortical mass (arrow). (b) Transverse postcontrast T1-weighted MR image demonstrates some enhancement around complex cystic mass (arrow). Surgery disclosed multiloculated amebic abscess. (Image courtesy of R. Hewlett, MD, Stellenbosch University School of Medicine, Cape Town, South Africa.)

 

Figure 16
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  		Figure 16a: (a) Transverse postcontrast T1-weighted MR image shows facial schwannoma associated with large arachnoid cyst (open arrow). Note enhancing cerebellopontine angle cistern–internal auditory canal portion of the mass as it extends into labyrinthine segment of facial nerve canal (curved arrow). Incidentally noted is a filling defect in the left transverse sinus, which was a large arachnoid granulation (black arrow). (b) Coronal postcontrast T1-weighted MR image in another case shows large pituitary macroadenoma with multiple cysts (arrows) surrounding the suprasellar component. Cysts appear slightly hyperintense to CSF. Fluid in enlarged trapped PVSs was confirmed at surgery.

 

Figure 16
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  		Figure 16b: (a) Transverse postcontrast T1-weighted MR image shows facial schwannoma associated with large arachnoid cyst (open arrow). Note enhancing cerebellopontine angle cistern–internal auditory canal portion of the mass as it extends into labyrinthine segment of facial nerve canal (curved arrow). Incidentally noted is a filling defect in the left transverse sinus, which was a large arachnoid granulation (black arrow). (b) Coronal postcontrast T1-weighted MR image in another case shows large pituitary macroadenoma with multiple cysts (arrows) surrounding the suprasellar component. Cysts appear slightly hyperintense to CSF. Fluid in enlarged trapped PVSs was confirmed at surgery.

 

Figure 17
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  		Figure 17: Diagnostic algorithm for intracranial cyst with common location: Rathke cleft cyst (RCC), suprasellar arachnoid cyst (SSAC), arachnoid cyst (AC), neurocysticercosis (NCC), neurenteric cyst (NE), and enlarged PVSs.

 




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