Cisternography of arachnoid cysts

Abstract

Conventional magnetic resonance (MR) sequences are useful for the diagnosis of arachnoid cysts (ACs), but they are not sufficient to show the communication between ACs and adjacent cerebrospinal fluid (CSF)-containing areas. Contrast material-enhanced computed tomography (CT) and MR cisternography play a crucial role in demonstrating this relationship. These tests create a contrast difference in the CSF in the ventricular system and in the cisternal spaces. Compared with radionuclide cisternography and CT cisternography (CTC), the main advantages of contrast material-enhanced MR cisternography (CE-MRC) are its high contrast-noise ratio, multiplanar analysis capacity, images with thin section thickness, and not causing radiation exposure. ACs that were filled with intrathecal contrast on early-phase postcontrast (after intrathecal administration) images were included in the full communicating group that did not fill at the 24th hour later or showed minimal filling was included in the noncommunication group. In addition, 3D-SPACE with variant flip-angle mode (VFAM) and PC-MRI techniques have special capabilities for evaluating CSF flow. It was successful in showing the communication between ACs and the adjacent CSF-containing areas. In cases with suspicious findings on phase-contrast MRI images, the final decision can be made with CE-MRC. CE-MRC is considered the gold standard in demonstrating the relationship between ACs and CSF-containing spaces. Isotope cisternography has obvious disadvantages, and it is no longer used today. In conclusion, demonstrating the relationship of ACs with adjacent CSF-filled structures is important in making surgical decisions.