Abstract
This study was designed to assess the feasibility of intrathecal gadolinium-enhanced magnetic resonance cisternography (MRC) for the evaluation of the presence or absence of communication of cranial arachnoid cysts with the cerebrospinal fluid (CSF) pathways of the central nervous system (CNS). This prospective study included 20 patients (12 males and 8 females) with a mean age of 37 years, who had, as a group, 22 intracranial arachnoid cysts identified on prior CT and/or MR examinations. Routine pre-contrast cranial MR imaging was followed by the intrathecal administration of 0.5 cc gadopentetate dimeglumine (GD) (Magnevist, Schering, Germany). Immediate and delayed (24 h) MR cisternography was then carried out. Eleven of 22 arachnoid cysts showed immediate CSF communication by the demonstration GD-contrast enhancement of the cyst fluid on the immediate post-injection scan. Contrast enhancement of the cyst was observed only on delayed MRC in six patients. MR imaging in five patients demonstrated no contrast enhancement of the arachnoid cysts on either immediate or delayed imaging. Six patients had mild transient post-procedure headache that was relieved by oral analgesics within 24 h. No serious immediate or chronic adverse effects or complications relating to the intrathecal contrast administration were observed. This study showed the relative safety, feasibility and reliability of low-dose intrathecal GD MR imaging in the demonstration of the communication or non-communication of intracranial arachnoid cysts with the CSF pathways of the CNS. In the future, this may have bearing on the selection for surgery of patients with intracranial arachnoid cysts presenting with clinical signs and symptoms potentially related to the location and mass effect of the cyst.
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Naidich TP, McLone DG, Radkowski MA (1985–86) Intracranial arachnoid cysts. Pediat Neurosci 12:112–122
Robertson SJ, Wolpert SM, Runge WM (1989) MR imaging of middle cranial fossa arachnoid cysts: temporal lobe agenesis syndrome revisited. AJNR Am J Neuroradiol 10:1007–1010
Eustace S, Toland J, Stack J (1992) CT and MRI of arachnoid cyst with complicating intracystic and subdural hemorrhage. J Comput Assist Tomogr 16:997–999
van Burken MM, Sarioglu AC, O’Donnell HD (1992) Supratentorial arachnoid cyst with intracystic and subdural hematoma. Neurochirurgia 35:199–203
Galassi E, Tognetti F, Gaist G, Fagioli L, Frank F, Frank G (1982) CT scan and metrizamide CT cisternography in arachnoid cysts of the middle cranial fossa: Classification and pathophysiological aspects. Surg Neurol 17:363–369
Dyck P, Gruskin P (1977) Supratentorial arachnoid cysts in adults. A discussion of two cases from a pathophysiologic and surgical perspective. Arch Neurol 34:276–279
Kollias SS, Ball WS Jr, Prenger EC (1993) Cystic malformations of the posterior fossa: differential diagnosis clarified through embryologic analysis. Radiographics 13:1211–1231
Lusins J, Nakagawa H, Sorek M, Goldsmith S (1979) Cisternography and CT scanning with 111In-DTPA in evaluation of posterior fossa arachnoid cysts. Clin Nucl Med 4:161–163
Henkes H, Huber G, Hierholzer J, Cordes M, Kujat C, Piepgras U (1991) Radionuclide cisternography: SPECT- and 3D-technique. Radiologe 31:489–495
Ferreira S, Jhingran SG, Johnson PC (1980) Radionuclide cisternography for the study of arachnoid cysts: a case report. Neuroradiology 19:167–169
Osborn AG (1994) Diagnostic neuroradiology. Mosby–Year Book, St. Louis, Missouri, USA, pp 639–642
Rengachary SS, Watanabe I (1982) Ultrastructure of pathogenesis of intracranial arachnoid cysts. J Neuropathol Exp Neurol 40:61–83
Becker T, Wagner M, Hofmann E (1991) Do arachnoid cysts grow? A retrospective CT volumetric study. Neuroradiology 33:341–345
Wolpert SM, Scott RM (1981) The value of metrizamide CT cisternography in the management of cerebral arachnoid cysts. AJNR Am J Neuroradiol 2:29–35
Koga H, Mukawa J, Miyagi K, Kinjo T, Okuyama K (1995) Symptomatic intraventricular arachnoid cyst in an elderly man. Acta Neurochir (Wien) 137:113–117
Hayashi T, Anegawa S, Honda E, Kuramoto S, Mori K, Murata T, Miwa S, Handa H (1979) Clinical analysis of arachnoid cysts in the middle fossa. Neurochirurgia (Stuttg) 22:201–210
Fujita K, Sato H, Tamaki N, Matsumoto S (1984) Arachnoid cyst of the quadrigeminal cistern. No Shinkei Geka 12:1315–1322
Suganuma Y, Okada K, Ohata M, Hiratsuka H, Oie K, Inaba Y, Matsushima Y, Tanigawa K (1978) Radioisotope cisternographic study on intracranial arachnoid cyst. No To Shinkei 30:515–524
Tsuyumu M, Fujiwara K, Yamaguchi T, Hiratsuka H, Inaba Y (1979) Metrizamide CT cisternography in skull base tumors. No Shinkei Geka 7:49–54
Eguchi T, Taoka T, Nikaido Y, Shiomi K, Fujimoto T, Otsuka H, Takeuchi H (1996) Cine-magnetic resonance imaging evaluation of communication between middle cranial fossa arachnoid cysts and cisterns. Neurol Med Chir (Tokyo) 36:353–357
Di Chiro G, Knop RH, Girton MR et al (1985) MR cisternography and myelography with GD-DTPA in monkeys. Radiology 157:373–377
Zeng Q, Xiong L, Jinkins JR, Fan Z, Liu Z (1999) Intrathecal gadolinium-enhanced MR myelography and cisternography. AJR Am J Roentgenol 173:1109–1115
Skalpe IO, Tang GJ (1997) MRI contrast media in the subarachnoid space. A comparison between gadodiamide injection and gadopentetate dimeglumine in an experimental study in pigs. Invest Radiol 32:140–148
Siebner HR, Grafin von Einsiedel H, Conrad B (1997) MR ventriculography with gadolinium DTPA: report of two cases. Neuroradiology 39:418–422
Di Chiro G, Girton ME, Frank JA, Dietz MJ, Gansow OA, Wright DC, Dwyer AJ (1986) Cerebrospinal fluid rhinorrhea: depiction with MR cisternography in dogs. Radiology 160:221–222
Toney GM, Chavez HA, Ibarra R, Jinkins RA (2001) Acute and subacute physiological and histological studies of the central nervous system after intrathecal gadolinium injection in the anesthetized rat. Invest Radiol 36:33–40
Ray DE, Cavanagh JB, Nolan CC, Williams SC (1996) Neurotoxic effects of gadopentetate dimeglumine: behavioral disturbance and morphology after intracerebroventricular injection in rats. AJNR Am J Neuroradiol 17:365–373
Jinkins JR, Williams RF, Xiong L (1999) Evaluation of gadopentetate dimeglumine magnetic resonance cisternography in an animal model: preliminary report. Invest Radiol 34:156–159
Yamakawa H, Ohkuma A, Hattori T, Niikawa S, Kobayashi H (1991) Primary intracranial arachnoid cyst in the elderly: a survey on 39 cases. Acta Neurochir (Wien) 113:42–47
Ruscalleda J, Guardia E, dos Santos FM, Carvajal A (1980) Dynamic study of arachnoid cysts with metrizamide. Neuroradiology 20:185–189
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This study was presented at RSNA 2000
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Tali, E.T., Ercan, N., Kaymaz, M. et al. Intrathecal gadolinium (gadopentetate dimeglumine)—enhanced MR cisternography used to determine potential communication between the cerebrospinal fluid pathways and intracranial arachnoid cysts. Neuroradiology 46, 744–754 (2004). https://doi.org/10.1007/s00234-004-1240-0
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DOI: https://doi.org/10.1007/s00234-004-1240-0