뇌척수 신경장관 낭종: 다양한 자기공명영상소견

Craniospinal Neurenteric Cysts: Various MR Imaging Features

  • 전세정 (서울대학교병원 영상의학과) ;
  • 손철호 (서울대학교병원 영상의학과) ;
  • 김은희 (서울대학교병원 영상의학과) ;
  • 손규리 (서울대학교병원 영상의학과) ;
  • 박성혜 (서울대학교병원 해부병리학과) ;
  • 장기현 (서울대학교병원 영상의학과)
  • Jeon, Se-Jeong (Departments of Radiology, Seoul National University Hospital) ;
  • Sohn, Chul-Ho (Departments of Radiology, Seoul National University Hospital) ;
  • Kim, Eun-Hee (Departments of Radiology, Seoul National University Hospital) ;
  • Son, Kyu-Ri (Departments of Radiology, Seoul National University Hospital) ;
  • Park, Sung-Hye (Departments of Pathology, Seoul National University Hospital) ;
  • Chang, Kee-Hyun (Departments of Radiology, Seoul National University Hospital)
  • 발행 : 2009.06.30

초록

목적: 신경장관 낭종은 중추신경계에 발생하는 비 종양성, 발생학적 낭종으로 다양한 자기공명 영상 소견을 보인다. 이 연구의 목적은 저자들이 경험한 두개내와 척수내의 신경장관 낭종의 다양한 자기공명 영상 소견을 보이고 설명하고자 한다. 대상과 방법: 저자들의 병원에서 경험한 여섯 명의 신경장관 낭종환자를 대상으로 하였으며, 이 환자들의 자기공명 영상에서 병변의 해부학적 위치, 병변의 신호강도, 병변의 크기 및 조영증강형태에 대해 후향적으로 분석하였다. 결과: 두 개의 두개강 내 병변은 소뇌교각과 사구체조 부위에 축 외 낭종으로 보였다. 세개의 척추 부위 병변은 경막내-척수외 낭종으로, 척수의 배측부위 위치하였고, 한 개의 흉추 병변은 척수 내 낭종이었다. 두 개의 두개강내 낭종과 한개의 경추부 낭종의 신호강도는 T1 강조영상에서 고 신호강도이고, T2 강조영상에서 뇌척수액과 같은 저 신호강도로 보였으며, 두개강내 병변은 모두 중등도 이상의 확산제한을 보였다. 다른 3개의 척수 병변의 신호강도는 T1과 T2강조 영상 모두에서 뇌척수액과 같은 신호강도였다. 조영증강 검사에서, 두개강 내 병변은 모두 작은 결절상 조영증강을 보였고, 한 개의 흉추부 병변은 가장자리에 환상의 조영증강을 보였다. 결론: 신경장관 낭종은 다양한 위치에서 발생할 수 있고 부분적인 결절상 또는 환상의 조영증강을 보일 수 있다. 그러므로, 비전형적인 자기공명영상소견을 보일 경우, 다른 비종양성, 종양성 낭종과의 감별진단에 포함 될 수 있다.

Purpose : Craniospinal neurenteric (NE) cysts are rare developmental non-neoplastic cysts of the central nervous system with diverse MR imaging findings. The purpose of this study was to evaluate various MR imaging findings of intracranial and intraspinal NE cysts. Materials and Methods : We retrospectively reviewed the MR imaging findings of six NE cysts that were confirmed by pathology. We evaluated anatomic location, signal intensity, size and enhancement pattern of NE cysts. Results : Two intracranial lesions were located extra-axially in the cerebellopontine angle and quadrigeminal cisterns. Three spinal lesions were intraduralextramedullary cysts, located ventral to the spinal cord, but one thoracic lesion was an intramedullary cyst. The signal intensity of the cysts was hyperintense on T1-weighted images as compared with the cerebrospinal fluid (CSF) for two intracranial lesions and one cervical lesion. In addition, all intracranial lesions showed diffusion restriction. For the remaining three spinal lesions, the signal intensity was nearly the same as the signal intensity of the CSF as seen on both T1- and T2-weighted images. On contrast-enhanced studies, two intracranial cysts showed a small nodular enhancement and one thoracic spinal lesion showed rim enhancement. Conclusion : NE cysts have various locations, signal intensities, and possible focal nodular or rim enhancement. Therefore, NE cysts can be included in the differential diagnosis of various craniospinal cystic or tumorous cystic lesions.

키워드

참고문헌

  1. de Oliveira RS, Cinalli G, Roujeau T, Sainte-Rose C, Pierre-Kahn A, Zerah M. Neurenteric cysts in children: 16 consecutive cases and review of the literature. J Neurosurg 2005; 103:512-523
  2. Preece MT, Osborn AG, Chin SS, Smirniotopoulos JG. Intracranial neurenteric cysts: Imaging and pathology spectrum. AJNR Am J Neuroradiol 2006; 27:1211-1216
  3. Brooks BS, Duvall ER, el Gammal T, Garcia JH, Gupta KL, Kapila A. Neuroimaging features of neurenteric cysts: Analysis of nine cases and review of the literature. AJNR 1993; 14:735-746
  4. Menezes AH, Traynelis VC. Spinal neurenteric cysts in the magnetic resonance imaging era. Neurosurgery 2006; 58:97-105 https://doi.org/10.1227/01.NEU.0000192160.79897.25
  5. Shenoy SN, Raja A. Spinal neurenteric cyst. Report of 4 cases and review of the literature. Pediatr Neurosurg 2004; 40:284-292 https://doi.org/10.1159/000083741
  6. Kantrowitz LR, Pais MJ, Burnett K, Choi B, Pritz MB. Intraspinal neurenteric cyst containing gastric mucosa: Ct and mri findings. Pediatr Radiol 1986; 16:324-327 https://doi.org/10.1007/BF02386874
  7. Prasad VS, Reddy DR, Murty JM. Cervico-thoracic neurenteric cyst: Clinicoradiological correlation with embryogenesis. Childs Nerv Syst 1996; 12:48-51 https://doi.org/10.1007/BF00573856
  8. Suri VS, Tatke M, Sinha S. Intracranial neurenteric cysts: A report of two cases. Br J Neurosurg 2002; 16:185-188 https://doi.org/10.1080/026886902317384544
  9. Lin J, Feng H, Li F, Chen Z, Wu G. Ventral brainstem enterogenous cyst: An unusual location. Acta Neurochir 2004; 146:419-420 https://doi.org/10.1007/s00701-004-0227-2
  10. Jamjoom A, Jamjoom ZA, Griffiths D, Moss T, Coakham H. Cerebellopontine angle epithelial cyst. A case report. Neurosurg Rev 1993; 16:67-70 https://doi.org/10.1007/BF00308617
  11. Oyama H, Ikeda A, Inoue S, Nakamura S, Nishimura Y, Shibuya M. Multiple neurenteric cysts in the posterior fossa and cervical spinal canal—case report. Neurol Med Chir 2004; 44:146-149 https://doi.org/10.2176/nmc.44.146
  12. Singhal BS, Parekh HN, Ursekar M, Deopujari CE, Manghani DK. Intramedullary neurenteric cyst in mid thoracic spine in an adult: A case report. Neurol India 2001; 49:302-304
  13. Shakudo M, Inoue Y, Ohata K, Tanaka S. Neurenteric cyst with alteration of signal intensity on follow-up mr images. AJNR 2001; 22:496-498
  14. Pang D, Dias MS, Ahab-Barmada M. Split cord malformation: Part i: A unified theory of embryogenesis for double spinal cord malformations. Neurosurgery 1992; 31:451-480 https://doi.org/10.1227/00006123-199209000-00010
  15. Kulkarni V, Daniel RT, Haran RP. Extradural endodermal cyst of posterior fossa: Case report, review of the literature, and embryogenesis. Neurosurgery 2000; 47:764-767 https://doi.org/10.1097/00006123-200009000-00048
  16. Graziani N, Dufour H, Figarella-Branger D, Donnet A, Bouillot P, Grisoli F. Do the suprasellar neurenteric cyst, the rathke cleft cyst and the colloid cyst constitute a same entity- Acta Neurochir 1995; 133:174-180 https://doi.org/10.1007/BF01420070
  17. Osborn AG. Diagnostic neuroradiology. St. Louis: Mosby 1994; 639-649
  18. Chaynes P, Bousquet P, Sol JC, Delisle MB, Richaud J, Lagarrigue J. Recurrent intracranial neurenteric cysts. Acta Neurochir 1998; 140:905-911 https://doi.org/10.1007/s007010050192
  19. Sahara Y, Nagasaka T, Takayasu M, Takagi T, Hata N, Yoshida J. Recurrence of a neurenteric cyst with malignant transformation in the foramen magnum after total resection. Case report. J Neurosurg 2001; 95:341-345 https://doi.org/10.3171/jns.2001.95.2.0341
  20. Eynon-Lewis NJ, Kitchen N, Scaravilli F, Brookes GB. Neurenteric cyst of the cerebellopontine angle: Case report. Neurosurgery 1998; 42:655-658 https://doi.org/10.1097/00006123-199803000-00040
  21. Shin JH, Byun BJ, Kim DW, Choi DL. Neurenteric cyst in the cerebellopontine angle with xanthogranulomatous changes: Serial MR findings with pathologic correlation. AJNR 2002; 23:663-665
  22. Tan GS, Hortobagyi T, Al-Sarraj S, Connor SE. Intracranial laterally based supratentorial neurenteric cyst. Br J Radiol 2004; 77:963-9 https://doi.org/10.1259/bjr/77185587
  23. Kim CY, Wang KC, Choe G, Kim HJ, Jung HW, Kim IO, Chi JG, Cho BK. Neurenteric cyst: Its various presentations. Childs Nerv Syst 1999; 15:333-341 https://doi.org/10.1007/s003810050406
  24. Perry A, Scheithauer BW, Zaias BW, Minassian HV. Aggressive enterogenous cyst with extensive craniospinal spread: Case report. Neurosurgery 1999; 44:401-404 https://doi.org/10.1097/00006123-199902000-00098
  25. Hicdonmez T, Steinbok P. Spontaneous hemorrhage into spinal neurenteric cyst. Childs Nerv Syst 2004; 20:438-442 https://doi.org/10.1007/s00381-003-0886-y
  26. Ochi M, Hayashi K, Hayashi T, Morikawa M, Ogino A, Hashmi R, et al. Unusual CT and MR appearance of an epidermoid tumor of the cerebellopontine angle. AJNR Am J Neuroradiol 1998; 19:1113-1115
  27. Tsuruda JS, Chew WM, Moseley ME, Norman D. Diffusion-weighted mr imaging of the brain: Value of differentiating between extraaxial cysts and epidermoid tumors. AJR Am J Roentgenol 1990; 155:1059-1065 https://doi.org/10.2214/ajr.155.5.2120936
  28. Inoue T, Matsushima T, Fukui M, Iwaki T, Takeshita I, Kuromatsu C. Immunohistochemical study of intracranial cysts. Neurosurgery 1988; 23:576-581 https://doi.org/10.1227/00006123-198811000-00006