Neuroepithelial cyst
Neuroglial cysts (also known as glioependymal cysts and neuroepithelial cysts) are rare, benign epithelial-lined cystic lesions that can potentially occur anywhere in the neuraxis. On imaging, they are characterized as CSF-like parenchymal cysts with smooth, rounded borders and minimal-to-no surrounding signal intensity abnormality.
Epidemiology
They are rare and represent <1% of the intracranial cysts .
Pathology
Neuroglial cysts are congenital lesions that develop a sequestration of neural tube embryonic elements that develop into a fluid-filled cavity, lined by glial cell and located within the white matter .
Location
They can be intra- or extra-parenchymal with the former being more common. The frontal lobe is thought to be the most typical location .
Radiographic features
CT
Typically seen as a well defined, non-enhancing, hypodense (CSF density) unilocular cystic lesion with no surrounding edema. They do not calcify.
MRI
Neuroglial cysts usually follow CSF signal. Hence they are hypointense on T1 and hyperintense on T2. They do not enhance with gadolinium. They are usually suppressed on T2 FLAIR sequences.
Differential diagnosis
General imaging differential considerations include:
- porencephalic cyst
- communicates with the lateral ventricle
- usually shows surrounding gliosis
- arachnoid cyst
- typically extra-axial
- enlarged perivascular space
- typically multiple
- cluster around the basal ganglia
- neurocysticercosis
- usually <1 cm
- partially enhance
- cerebral hydatid cyst
- usually spherical
- may be indistinguishable
- ependymal cyst
- periventricular
- may be indistinguishable
- epidermoid cyst
- usually, do not follow CSF signal in all sequences
- restricted diffusion
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