12/1/13

Brain Imaging in Colloid Cyst

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Brain Imaging in Colloid Cyst

Author: Andrew L Wagner; Chief Editor: L Gill Naul, MD more... Updated: Aug 28, 2013

Overview
Colloid cysts are benign, congenital epithelium-lined cysts that almost always arise in the anterior third ventricle. However, rare reports describe cysts in other locations. The cysts are believed to derive from either primitive neuroepithelium of the tela choroidea or from endoderm.[1] See the images of colloid cysts below.

Sagittal nonenhanced T1-w eighted magnetic resonance image. This image demonstrates a round area of increased signal intensity in the anterosuperior portion of the third ventricle (arrow ).

Axial fluid-attenuated inversion recovery magnetic resonance image. This image show s a bright mass.

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Brain Imaging in Colloid Cyst

Axial contrast-enhanced T1-w eighted magnetic resonance image. This image demonstrates a small amount of peripheral enhancement but no discernible central enhancement. Note the location of the colloid cyst near the foramina of Monro.

Computed tomography scan in a 65-year-old man w ho had acute onset of headache. This image demonstrates a round area of increased attenuation at the foramina of Monro, w ith hydrocephalus. The image is degraded because of motion artifact, as the patient w as in severe pain at the time of imaging.

Axial computed tomography scan in a 50-year-old man w ho w as transported to the emergency department after falling dow n w hile lifting w eights; he later had cardiopulmonary arrest. This image demonstrates a hyperattenuating colloid cyst at the foramina of Monro, w ith marked hydrocephalus.

The diagnosis is usually made by assessing the typical location and appearance of the cyst. Colloid cysts account for approximately 1% of all intracranial tumors and are the most common type of the neuroepithelial cysts, as well as the most common tumor in the third ventricle. Typically, patients are asymptomatic, although colloid cysts may cause symptoms by obstructing the foramen of Monro, which results in sudden death in rare cases.[2, 3] Shapiro et al described the long-term results of an interhemispheric, transcallosal, subchoroidal, fornix-sparing approach to gross-total resection of colloid cysts. In 57 colloid cysts, total removal was achieved via a 3 x 3-in paramedian craniotomy flap and a microscopic interhemispheric, transcallosal, subchoroidal approach sparing the ipsilateral fornix. According to the investigators, at 1 year after surgery, computed tomography (CT) scanning or magnetic resonance imaging (MRI) confirmed gross-total resection, with no infection, hemiparesis, seizures, or disconnection syndrome. There were no deaths or recurrences. The authors noted that the results were superior to those seen with endoscopy.[4]
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Brain Imaging in Colloid Cyst

Preferred examination
Either CT scanning or MRI may help in diagnosing a colloid cyst, although MRI has a few advantages.[5, 6] The multiplanar capabilities of MRI optimally demonstrate the location of the cyst, and typical signal intensities in the cyst help to confirm the diagnosis. T2-weighted MRI sequences may be useful to assess the nature of the intracystic contents and to predict the difficulty of aspiration during endoscopic or stereotactic procedures.[7, 8, 9,
10]

Typically, colloid cysts are clinically silent and are found incidentally when patients are imaged for other reasons. When patients are symptomatic, they typically experience chronic headaches, which may be intermittent and positional because of transient CSF obstruction. On rare occasions, a colloid cyst may completely and irreversibly obstruct the foramen of Monro, resulting in sudden loss of consciousness and, if patients are not treated, in coma and death.[2, 3] Pollock et al reviewed 155 cases of colloid cyst and found 4 factors that were associated with colloid cyst-related clinical symptoms [11] : (1) younger patient age, (2) increased cyst size (average of 13 mm in symptomatic patients vs 8 mm in asymptomatic patients), (3) ventricular dilatation (although 31% of asymptomatic patients had this finding), and (4) increased signal intensity on T2-weighted MRIs. These findings suggest that slowly growing colloid cysts may allow for compensation by the brain, thus avoiding symptoms. In addition, findings of high T2 signals in symptomatic patients suggest that the more-serous colloid cysts enlarge the fastest. The appearance of colloid cysts on CT and MRI scans is important in planning treatment, because the success rate after percutaneous aspiration is lower in colloid cysts that have high attenuation on CT scans and decreased MRI T2-signal intensity than in the cysts that have fluid characteristics.[12] Interestingly, the cysts with high T2signal intensity are easier to treat with minimally invasive surgical techniques; however, these cysts are also the ones that are most likely to cause clinical symptoms.

Preferred examination
Although MRI has the advantage of multiplanar imaging, CT scanning is usually adequate for the diagnosis of a colloid cyst.

Limitations of techniques
Intraventricular hemorrhage occasionally mimics a colloid cyst on CT scans and MRI. Subependymomas, central neurocytomas, and subependymal astrocytomas may occur in the same area as a colloid cyst on imaging studies, but these entities can be distinguished by their shape, contrast enhancement, and signal intensity.

Contributor Information and Disclosures

Author Andrew L Wagner MD, Department of Radiology, Rockingham Memorial Hospital Andrew L Wagner is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Neuroradiology, and Radiological Society of North America Disclosure: Nothing to disclose. Specialty Editor Board Lucien M Levy, MD, PhD Director of Neuroradiology, Professor of Radiology, Department of Radiology, George Washington University Medical Center Lucien M Levy, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Radiology, American Heart Association, American Medical Association, American Roentgen Ray Society, American Society of Neuroradiology, and Radiological Society of North America Disclosure: Nothing to disclose. Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
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Brain Imaging in Colloid Cyst

Disclosure: Nothing to disclose. Robert M Krasny, MD Resolution Imaging Medical Corporation Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America Disclosure: Nothing to disclose. Chief Editor L Gill Naul, MD Professor and Head, Department of Radiology, Texas A&M University College of Medicine; Chair, Department of Radiology, Chief, Section of Magnetic Resonance Imaging, Scott and White Memorial Hospital and Clinic L Gill Naul, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Roentgen Ray Society, Radiological Society of North America, and Texas Medical Association Disclosure: webmd Honoraria Other

References
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Brain Imaging in Colloid Cyst

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