The Variable Appearance of Third Ventricular Colloid Cysts: Correlation with Histopathology and the Risk of Obstructive Ventriculomegaly

Abstract

BACKGROUND AND PURPOSE: While third ventricular colloid cysts may present as an incidental finding, they also harbor the potential to cause ventricular obstruction and sudden death. Herein we analyze the relationship between imaging appearance and the risk of obstructive ventriculomegaly.MATERIALS AND METHODS: This is a retrospective review of the MR imaging appearance of 64 patients with colloid cysts, 46 of whom also had a CT scan, obtained by a tertiary hospital imaging report data base search over a 10-year period. Cysts were categorized by appearance on T2-FLAIR and correlated with patient age, cyst size, and the risk of obstructive ventriculomegaly. Histopathologic correlation was available for 28 cases.

Intraventricular sizeable colloid cyst with atypical radiological features: A case report and evidence-based review

“…Therefore, colloid cysts with a hypodense signal on CT, an isointensity on T1WI, and hyperintense signals on T2WI and FLAIR sequences, as demonstrated in our case, are not typical for these cysts and are rarely reported, making them easy to miss on routine imaging studies. However, it is prudent to be aware of such atypical findings, especially with the currently available data that suggest that colloid cysts with hyperintensity on T2WI and FLAIR are associated with relatively larger sizes and younger patient age, and hence risk factors for obstructive hydrocephalus [ [18] , [19] , [20] ].…”

Acute hydrocephalus caused by colloid cyst of third ventricle: A case report

“…CCs of the third ventricle are the most common neuroepithelial cysts [1] . They are congenital lesions of endodermal origin [ 3 , 4 ]. CCs are seen in approximately 3 individuals per million per year [ 1 , 2 ].…”

“…Contents of these kinds of cysts are viscous and aspiration cannot be done [ 1 , 6 ]. Fifty percent of CCs show high signals in T1-weighted images [ 1 , 3 ]. Signals in T2 and FLAIR are more variable [3] .…”

“…Small CCs remain asymptomatic. However, if they obstruct Cerebrospinal fluid (CSF) flow, acute complications are seen [ 2 , 3 ]. Management of CCs is challenging due to their deep location.…”

Rate of Missed Intracranial Colloid Cysts on MRI and CT

“…According to Czervionk et al, colloid cysts are derived from neuroepithelium [ 1 ], while Ho and Garcia provide evidence for an endodermal origin of colloid cysts [ 2 ]. Colloid cysts have a prevalence rate of 0.1% to 1% of all intracranial tumors [ 3 ]. Grossly, colloid cysts have a gelatinous texture.…”