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Broken vertibrea, no Chiari Malformation, decreased T1 and increased T2, Pilocytic astrocytoma, no restricted diffusion

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Practicing since : 2001
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Is this a RARE cyst???
17 year old MRI - active athlete that has broken her vertibrea but no other health issues
Procedure: A combination of FLAIR, T1-, T2-, gradient-echo, diffusion and postgadolinium (10cc) T1-weighted images of the head were obtained in multiple imagine planes. Multiple coronal sequences were performed to evaluate the temporal lobe structures.
FINDINGS: There is no evidence of an acute ischemic event on diffusion imagine, Posterior fossa structures are unremarkable. 4th ventrical is midline and nondilated. No Chiari Malformation.
Supratentorial compartment: There is an area of decreased T1 and increased T2 signal without enhancement in the left parietal lobe. This appears to have a septation within it, it measures 1.5 mm in greatest diameter. There is decreased signal intensity. No other lesions are identified within the brain. Possible etiologies for this lesion include the following:
1. Ganglioglioma: These lesson are oftencystic in appearance and often peripheral within the brain. No definite enhancement which is typical.
2. Pleomorphic xanthoastrocytoma: No enhancement and no enhanced “tail”.
3. Pilocytic astrocytoma: Location uncommon – supratentorial
4. Neurocysticercosis or sequelae of neurocysticcercosis – only one lesion
5. Other posttraumatic: Patient does have a vertebrae break, Neoplastic or infections ethologies: No restricted diffusion on diffusion imaging.
Posted Tue, 22 May 2012 in Brain Tumor
Answered by Dr. Shiva Kumar R 4 hours later

Thanks for the query

From the MRI findings given to me only a differential diagnosis of a non-enhancing cystic lesion can be considered. An extra-axial, supratentorial non enhancing lesion present off midline, other possibilities could be arachnoid cyst and a hydatid cyst.

CT scan of the brain would be an option to look for calcification within the lesion or on the periphery as it could be easily missed on the MRI.

Lastly I would like to know the reasons for doing an MRI of the brain in her for a clinical correlation.

So I personally feel in the presence of clinical symptoms and CT scan of the brain list of possibilities in the differential diagnosis can be reduced. If possible please send me the MRI images including FLAIR, gradient and diffusion and the clinical details.

I thank you again for submitting your question. I hope you find my response to be both helpful and adequate. If you have any additional concerns regarding your question I would be happy to address them.


Dr Shiva Kumar R
Consultant Neurologist & Epileptologist
Above answer was peer-reviewed by
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