CincyKidsRad

Cincinnati Children's Radiology

Spinal epidermoid

Sagittal T1 and T2 weighted (image 1) and diffusion weighted (image 2) MR images of the spine shows a spinal epidermoid (arrow) at the L4 level. Spinal epidermoids are uncommon but account for approximately 10% of intraspinal tumors in children. They can be associated with segmentation anomalies. They're characterized on imaging with similar signal characteristics to fluid. The intense restricted diffusion is a key feature of the lesion.

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Sagittal T1 with fat saturation (image 1), sagittal T2, axial T1, and sagittal diffusion weighted MRI in a patient with a previously repaired myelomeningocele shows a lipoma (arrow) and dermoid/epidermoid (dashed arrow) leading to a tethered spinal cord (arrowhead). Lipomas can be identified by the presence of signal loss on fat saturated images. Dermoids have restricted diffusion. Spinal dermoids are uncommon but account for a large percentage of intradural tumors in infants. They typically occur in the lumbosacral region.

Axial T2 (image 1), T1 postcontrast (image 2), and diffusion weighted image (image 3) show a small dermoid (arrow) adjacent to the lateral wall of the right orbit. The lesion is bright on the T2-weighted image, has mild peripheral enhancement and restricted diffusion. Dermoids are well demarcated masses with fatty content. They typically have a thin rim of peripheral enhancement and restricted diffusion. Dermoids typically present as a painless mass in the region of the orbit, floor the mouth, anterior neck, or nasoglabellar region. #NeuroWednesday

Axial T2 (image 1), T1 postcontrast (image 2), and FLAIR (image 3) MRI of the brain in an asymptomatic adolescent with an epidermoid cyst shows a cystic lesion involving the right superior frontal gyrus. There is no significant effect on the underlying brain with minimal adjacent edema or mass effect. The mass does not enhance, has mild heterogeneous signal on the FLAIR sequence, and showed restricted diffusion (not shown). Epidermoid cysts most commonly occur at the cerebellar pontine angle or the region of the fourth ventricle. Characteristic features include the heterogeneous signal on FLAIR sequence and restricted diffusion. #NeuroWednesday

Axial diffusion-weighted (image 1) and apparent diffusion coefficient (ADC) map (image 2) show the lesion (arrow) of the left middle cranial fossa restricts diffusion. This is a common location for an arachnoid cyst. However, an arachnoid cyst should follow cerebral spinal fluid on all imaging sequences including diffusion-weighted imaging. Intracranial epidermoid cysts can mimic an arachnoid cyst. They are differentiated from arachnoid cysts by their restricted diffusion. The ADC map helps to confirm that there is true restricted diffusion and not just T2 shine through. #FridayQuizDay #Quiz #FridayQuiz

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