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Serial MR Imaging of Pineal Cysts

Implications for Natural History and Follow-Up

Daniel P. Barboriak1, Lisa Lee and James M. Provenzale

1 All Authors: Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.



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  		Fig. 1A. —7-year-old girl with neurofibromatosis and pilocytic astrocytoma of right inferior thalamus. Initial axial enhanced T1-weighted MR image of brain shows pineal cyst (arrow) with maximal dimension of 10.6 mm.

 


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  		Fig. 1B. —7-year-old girl with neurofibromatosis and pilocytic astrocytoma of right inferior thalamus. Sagittal enhanced T1-weighted MR image obtained 5 months after A shows no change in maximal dimension of cyst (arrow).

 


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  		Fig. 1C. —7-year-old girl with neurofibromatosis and pilocytic astrocytoma of right inferior thalamus. Sagittal enhanced T1-weighted MR image obtained 3 years after A shows no change in maximal dimension of cyst. Internal cyst enhancement is present, possibly because of delayed enhanced imaging.

 


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  		Fig. 1D. —7-year-old girl with neurofibromatosis and pilocytic astrocytoma of right inferior thalamus. Sagittal enhanced T1-weighted MR image obtained 4.5 years after A shows decrease in size of pineal cyst. Maximal cyst dimension is 8.6 mm.

 


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  		Fig. 1E. —7-year-old girl with neurofibromatosis and pilocytic astrocytoma of right inferior thalamus. Sagittal enhanced T1-weighted MR image obtained 5.1 years after A shows decrease in size of pineal cyst to 6.3 mm in maximal dimension.

 


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  		Fig. 1F. —7-year-old girl with neurofibromatosis and pilocytic astrocytoma of right inferior thalamus. Final axial enhanced T1-weighted MR image obtained 6.2 years after A shows no significant pineal cyst remaining. Minimally enhancing material in pineal recess may represent debris from collapsed cyst.

 


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  		Fig. 2A. —2-year-old boy with ependymoma. Axial enhanced T1-weighted MR image of brain shows small pineal cyst (arrow). Maximal cyst dimension was 5.8 mm.

 


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  		Fig. 2B. —2-year-old boy with ependymoma. Axial enhanced T1-weighted image obtained 6.1 years after A shows slight increase in size of pineal cyst (arrow). Maximal cyst dimension was 8.3 mm. No complaints of headache or findings of gaze paresis were noted.

 


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  		Fig. 3A. —4-year-old boy with disseminated medulloblastoma. Sagittal enhanced T1-weighted MR image of brain shows diffuse leptomeningeal enhancement along basilar cisterns. No pineal cyst is visible.

 


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  		Fig. 3B. —4-year-old boy with disseminated medulloblastoma. Sagittal enhanced image obtained 4.1 years after A shows interval development of pineal cyst (arrow), which measured 11.6 mm in maximal dimension. Amount of leptomeningeal enhancement has decreased. Patient presented with syndrome of inappropriate antidiuretic hormone secretion and seizure but had no symptoms of headache or findings of gaze paresis.

 


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  		Fig. 3C. —4-year-old boy with disseminated medulloblastoma. Axial T2-weighted image obtained at the same time as B shows homogeneous signal intensity centrally in pineal cyst (arrow), along with hypointense cyst wall, which measures less than 2 mm thick.

 

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