Differentiation between pediatric spinal arachnoid and epidermoid-dermoid cysts: is diffusion-weighted MRI useful?
BACKGROUND
Appropriate differentiation between epidermoid-dermoid and arachnoid cysts is important for patient management. MRI has had limitations in differentiating these two types of cysts, especially in the region of the spinal cord.


OBJECTIVE
To evaluate the role of diffusion-weighted (DW) MRI for differentiation between spinal arachnoid and epidermoid-dermoid cysts.


METHODS
Four children underwent conventional and DW MRI. Turbo spin-echo imaging was used to obtain DW images.


RESULTS
On conventional MRI, low T1-W and high T2-W signal was present in all lesions. DW imaging showed restricted diffusion in two patients with epidermoid-dermoid cysts and no water restriction in two patients with arachnoid cysts. Three of four children had extramedullary lesions and one patient had an intramedullary lesion. Three children had surgery, two with epidermoid-dermoid cysts and one with arachnoid cyst. Diagnosis was confirmed by histopathology. One child with a thoracic arachnoid cyst had stable clinical imaging findings during a follow-up of 21 months.


CONCLUSIONS
On conventional MRI, epidermoid-dermoid and arachnoid cysts have similar signal characteristics. Initial experience with spine DW imaging shows promise in differentiating epidermoid-dermoid cysts from arachnoid cysts. Preoperative differentiation is important because it changes management and surgical approach.
Kukreja
Kamlesh
K
Department of Radiology, Miami Children's Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA. kamleshkukreja@gmail.com
Manzano
Glen
G
Ragheb
John
J
Medina
L Santiago
LS
D000293:Adolescent; D016080:Arachnoid Cysts / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D004814:Epidermal Cyst / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000175:diagnosis*