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Pediatric Radiology

Published in:

01-12-2013 | Original Article

Incidental pineal cysts in children who undergo 3-T MRI

Authors: Matthew T. Whitehead, Christopher C. Oh, Asim F. Choudhri

Published in: Pediatric Radiology | Issue 12/2013

Abstract

Background

Pineal cysts, both simple and complex, are commonly encountered in children. More cysts are being detected with MR technology; however, nearly all pineal cysts are benign and require no follow-up.

Objective

To discover the prevalence of pineal cysts in children at our institution who have undergone high-resolution 3-T MRI.

Materials and methods

We retrospectively reviewed 100 consecutive 3-T brain MRIs in children ages 1 month to 17 years (mean 6.8 ± 5.1 years). We evaluated 3-D volumetric T1-W imaging, axial T2-W imaging, axial T2-W FLAIR (fluid attenuated inversion recovery) and coronal STIR (short tau inversion recovery) sequences. Pineal parenchymal and cyst volumes were measured in three planes. Cysts were analyzed for the presence and degree of complexity.

Results

Pineal cysts were present in 57% of children, with a mean maximum linear dimension of 4.2 mm (range 1.5–16 mm). Of these cysts, 24.6% showed thin septations or fluid levels reflecting complexity. None of the cysts demonstrated complete T2/FLAIR signal suppression. No cyst wall thickening or nodularity was present. There was no significant difference between the ages of children with and without cysts. Cysts were more commonly encountered in girls than boys (67% vs. 52%; P = 0.043). There was a slight trend toward increasing pineal gland volume with age.

Conclusion

Pineal cysts are often present in children and can be incidentally detected by 3-T MRI. Characteristic-appearing pineal cysts in children are benign, incidental findings, for which follow-up is not required if there are no referable symptoms or excessive size.

Al-Holou WN, Hugh JL, Muraszko KM et al (2009) Prevalence of pineal cysts in children and young adults. J Neurosurg Pediatr 4:230–236PubMedCrossRef

Bumb JM, Brockmann MA, Groden C et al (2012) TrueFISP of the pediatric pineal gland. Clin Neuroradiol 22:69–77PubMedCrossRef

Di Costanzo A, Tedeschi G, Di Salle F et al (1993) Pineal cysts: an incidental MRI finding? J Neurol Neurosurg Psychiatry 56:207–208PubMedCrossRef

Lacroix-Boudhrioua VL, Linglart A, Ancel PY et al (2011) Pineal cysts in children. Insights Imaging 2:671–678PubMedCrossRef

Zajac A, Skowrokek-Bala B, Wesolowska E et al (2010) The pineal cyst in children with different central nervous system diseases. Przegl Lek 67:1136–1139PubMed

Fleege MA, Miller GM, Fletcher GP et al (1994) Benign glial cysts of the pineal gland: unusual imaging characteristics with histologic correlation. AJNR Am J Neuroradiol 15:161–166PubMed

Engel U, Gottschalk S, Niehaus L et al (2000) Cystic lesions of the pineal region—MRI and pathology. Neuroradiology 42:399–402PubMedCrossRef

Mandera M, Wieslaw M, Bierzynska-Macyszyn G et al (2003) Pineal cysts in childhood. Childs Nerv Syst 19:750–755PubMedCrossRef

Fakhran S, Escott EJ (2008) Pineocytoma mimicking a pineal cyst on imaging: true diagnostic dilemma or a case of incomplete imaging? AJNR Am J Neuroradiol 29:159–163PubMedCrossRef

10.

Rosset A, Spadola L, Ratib O (2004) OsiriX: an open-source software for navigating in multidimensional DICOM images. J Digit Imaging 17:205–216PubMedCrossRef

11.

Silman RE, Leone RM, Hooper RJ et al (1979) Melatonin, the pineal gland and human puberty. Nature 282:301–303PubMedCrossRef

12.

Gillis FH, Nelson MD (2012) The developing human brain: Growth and adversities (clinics in developmental medicine), 1st edn. MacKeith Press, London, pp 36–38

13.

Carr JL (1994) Cystic hydrops of the pineal gland. J Nerv Ment Dis 99:552–572CrossRef

14.

Al-Holou WN, Maher CO, Muraszkio KM et al (2010) The natural history of pineal cysts in children and young adults. Neurosurg Pediatr 5:162–166CrossRef

15.

Fain JS, Tomlinson FH, Scheithauer BW et al (1994) Symptomatic glial cysts of the pineal gland. J Neurosurg 80:454–460PubMedCrossRef

16.

Hasegawa A, Ohtsubo K, Mori W (1987) Pineal gland in old age; quantitative and qualitative morphological study of 168 human autopsy cases. Brain Res 409:343–349PubMedCrossRef

17.

Sun B, Wang D, Tang Y et al (2009) The pineal volume: a three-dimensional volumetric study in healthy young adults using 3.0 T MR data. Int J Dev Neurosci 27:655–660PubMedCrossRef

18.

Pu Y, Mahankali S, Hou J et al (2007) High prevalence of pineal cysts in healthy adults demonstrated by high-resolution, noncontrast brain MR imaging. AJNR Am J Neuroradiol 28:1706–1709PubMedCrossRef

19.

Pastel DA, Mamourian AC, Duhaime AC (2009) Internal structure in pineal cysts on high-resolution magnetic resonance imaging: not a sign of malignancy. J Neurosurg Pediatr 4:81–84PubMedCrossRef

20.

Cauley KA, Linnell GJ, Braff SP et al (2009) Serial follow-up MRI of indeterminate cystic lesions of the pineal region: experience at a rural tertiary care referral center. AJR Am J Roentgenol 193:533–537PubMedCrossRef

21.

Barboriak DP, Lee L, Provenzale JM (2000) Serial MR imaging of pineal cysts: implications for natural history and follow-up. AJR Am J Roentgenol 176:737–743CrossRef

22.

Hayashida Y, Hirai T, Korogi Y et al (2004) Pineal cystic germinoma with syncytiotrophoblastic giant cells mimicking MR imaging findings of a pineal cyst. AJNR Am J Neuroradiol 25:1538–1540PubMed

23.

Kluczewska E, Giec-Lorenz A, Bazowski P et al (1999) Pineal cyst in MRI: clinical symptoms and analysis. Neurol Neurochir Pol 33:1033–1044PubMed

24.

Engel U, Gottschalk S, Niehaus L et al (1994) Symptomatic glial cysts of the pineal gland. J Neurosurg 80:454–460CrossRef

25.

Wisoff JH, Epstein F (1992) Surgical management of symptomatic pineal cysts. J Neurosurg 77:896–900PubMedCrossRef

26.

Al-Holou WN, Terman SW, Kilburg C et al (2011) Prevalence and natural history of pineal cysts in adults. J Neurosurg 115:1106–1114PubMedCrossRef

27.

Mena H, Armonda RA, Ribas JL et al (1997) Nonneoplastic pineal cysts: a clinicopathologic study of twenty-one cases. Ann Diagn Pathol 1:11–18PubMedCrossRef

Title: Incidental pineal cysts in children who undergo 3-T MRI
Authors: Matthew T. Whitehead
Christopher C. Oh
Asim F. Choudhri
Publication date: 01-12-2013
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Radiology / Issue 12/2013
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-013-2742-x

At a glance: The STEP trials

Springer Medicine

Incidental pineal cysts in children who undergo 3-T MRI

Abstract

Background

Objective

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objective

Materials and methods

Results

Conclusion

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