Ring-shaped lateral ventricular nodules: an incidental finding on brain magnetic resonance imaging

IntroductionWe have occasionally seen ring-shaped lateral ventricular nodules <1 cm in diameter during routine brain magnetic resonance imaging (MRI). We investigated retrospectively clinical and MRI findings of the nodules.Materials and methodsReview of radiological records was performed for 39,607 patients who underwent brain MRI between January 2001 and April 2008. Nodules were assessed for number, location, shape, and signal intensity, which was determined based on the range of signal intensity from gray to white matter on T1- and T2-weighted imaging. Fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging (DWI), contrast enhancement characteristics, and serial MRI changes of nodules were assessed when available.ResultsNine of 39,607 patients (0.023%) showed the nodules. No symptoms associated with the nodules. Among the nine patients, 11 nodules were identified (one nodule in seven patients (77.8%) and two nodules in two patients (22.2%)). Location was limited to the roof of the body for six nodules (54.5%) and the frontal horn for five patients (45.5%). All nodules (100%) were round and isointense on T1- and T2-weighted imaging. On FLAIR imaging of eight nodules, six (75%) were hyperintense, and two (25%) were isointense. On DWI of seven nodules, all nodules (100%) were isointense. None of seven nodules (0%) examined using postcontrast MRI showed enhancement. None of eight nodules (0%) examined using serial MRI (range, 4–60 months) showed changes in morphology over time.ConclusionThese nodules were incidentally encountered and shared similar MRI features. Although pathological confirmation was lacking in our cases, these nodules may be of nonaggressive nature.

[1]  A J Barkovich,et al.  MR imaging of tuberous sclerosis in neonates and young infants. , 1999, AJNR. American journal of neuroradiology.

[2]  T. Hirai,et al.  Virtual MRI endoscopy of the intracranial cerebrospinal fluid spaces , 1998, Neuroradiology.

[3]  J. Ecklund,et al.  Subependymoma revisited: clinicopathological evaluation of 83 cases , 2007, Journal of Neuro-Oncology.

[4]  M. Shapiro,et al.  Minimal asymmetry of the brain: a normal variant. , 1986, AJR. American journal of roentgenology.

[5]  J. Guichard,et al.  MR manifestations of subependymomas. , 1995, AJNR. American journal of neuroradiology.

[6]  B. Zhang,et al.  Central neurocytoma: a clinicopathological and neuroradiological study , 2004, Neuroradiology.

[7]  D. Tampieri,et al.  Glioependymal Cysts: CT and MR Findings , 1992, Journal of computer assisted tomography.

[8]  E. Gasparetto,et al.  Migrating intraventricular cysticercosis: magnetic resonance imaging findings. , 2008, Arquivos de neuro-psiquiatria.

[9]  D R Fish,et al.  Subependymal heterotopia: a distinct neuronal migration disorder associated with epilepsy. , 1994, Journal of neurology, neurosurgery, and psychiatry.

[10]  B. Brody,et al.  MR imaging of tuberous sclerosis: pathogenesis of this phakomatosis, use of gadopentetate dimeglumine, and literature review. , 1992, Radiology.

[11]  K. Kawamoto,et al.  Glioependymal cyst in the posterior fossa. , 1997, Clinical neuropathology.

[12]  N. Altınörs,et al.  INTRAVENTRICULAR DYSEMBRYOPLASTIC NEUROEPITHELIAL TUMOR: CASE REPORT , 2007, Neurosurgery.

[13]  A. Levy,et al.  From the archives of the AFIP. Benign tumors and tumorlike lesions of the gallbladder and extrahepatic bile ducts: radiologic-pathologic correlation. Armed Forces Institute of Pathology. , 2002, Radiographics : a review publication of the Radiological Society of North America, Inc.

[14]  Anne G. Osborn,et al.  Diagnostic Imaging: Brain , 2004 .

[15]  A. Chacko,et al.  Solitary fibrous tumor of the lateral ventricle: CT appearances and pathologic correlation with follow-up. , 2006, AJNR. American journal of neuroradiology.

[16]  C. Sarkar,et al.  Intraventricular Glioneuronal Hamartoma: Histopathological Correlation with Magnetic Resonance Spectroscopy , 2005, Journal of Neuro-Oncology.

[17]  J. Parisi,et al.  Lateral ventricular neoplasms of the brain: differential diagnosis based on clinical, CT, and MR findings. , 1990, AJR. American journal of roentgenology.

[18]  D P Friedman,et al.  Abnormalities of the deep medullary white matter veins: MR imaging findings. , 1997, AJR. American journal of roentgenology.

[19]  C. Majós,et al.  Intraventricular mass lesions of the brain , 2009, European Radiology.

[20]  C. Glasier,et al.  Cysts of the subependymal germinal matrix: sonographic demonstration with pathologic correlation. , 1983, Radiology.

[21]  L. Vanormelingen,et al.  Accessory intraventricular prominence of the occipital horn of the lateral ventricle. , 2003, Journal of neurosurgery.

[22]  K. Koeller,et al.  From the archives of the AFIP. Cerebral intraventricular neoplasms: radiologic-pathologic correlation. , 2002, Radiographics : a review publication of the Radiological Society of North America, Inc.

[23]  A. Hofman,et al.  Incidental findings on brain MRI in the general population. , 2007, The New England journal of medicine.

[24]  T. Sasaki,et al.  A rare case of hamartoma in the lateral ventricle: case report. , 1997, Surgical neurology.

[25]  A. Matsuno [Neuroglial cyst]. , 2000, Ryōikibetsu shōkōgun shirīzu.