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Differential Diagnosis of Intracranial Cystic Lesions at Head US: Correlation with CT and MR Imaging¹

¹ From the Department of Diagnostic Imaging, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. Recipient of a Certificate of Merit award for an education exhibit at the 2004 RSNA Annual Meeting. Received March 2, 2005; revision requested April 26; final revision received and accepted July 6. All authors have no financial relationships to disclose.

View larger version (41K): [in a new window]   Figure 1a.  Diagram shows the midline cavities and their positions in the sagittal plane (top) and coronal plane (bottom). The shaded areas represent the fluid-filled spaces, which include the cavum septi pellucidi (CSP) (a), cavum vergae (CV) (b), and cavum veli interpositi (CVI) (c).

 

View larger version (45K): [in a new window]   Figure 1b.  Diagram shows the midline cavities and their positions in the sagittal plane (top) and coronal plane (bottom). The shaded areas represent the fluid-filled spaces, which include the cavum septi pellucidi (CSP) (a), cavum vergae (CV) (b), and cavum veli interpositi (CVI) (c).

 

View larger version (43K): [in a new window]   Figure 1c.  Diagram shows the midline cavities and their positions in the sagittal plane (top) and coronal plane (bottom). The shaded areas represent the fluid-filled spaces, which include the cavum septi pellucidi (CSP) (a), cavum vergae (CV) (b), and cavum veli interpositi (CVI) (c).

 

View larger version (178K): [in a new window]   Figure 2a.  Cavum septi pellucidi and cavum vergae in a 28-week gestation neonate. (a) Midline sagittal US scan shows a cavum septi pellucidi (CSP) and cavum vergae (CV). (b) Coronal US scan obtained at the level of the frontal horns shows the cavum septi pellucidi (CSP). (c) Coronal US scan, obtained at the level of the bodies of the lateral ventricles, shows the cavum vergae (CV).

 

View larger version (130K): [in a new window]   Figure 2b.  Cavum septi pellucidi and cavum vergae in a 28-week gestation neonate. (a) Midline sagittal US scan shows a cavum septi pellucidi (CSP) and cavum vergae (CV). (b) Coronal US scan obtained at the level of the frontal horns shows the cavum septi pellucidi (CSP). (c) Coronal US scan, obtained at the level of the bodies of the lateral ventricles, shows the cavum vergae (CV).

 

View larger version (174K): [in a new window]   Figure 2c.  Cavum septi pellucidi and cavum vergae in a 28-week gestation neonate. (a) Midline sagittal US scan shows a cavum septi pellucidi (CSP) and cavum vergae (CV). (b) Coronal US scan obtained at the level of the frontal horns shows the cavum septi pellucidi (CSP). (c) Coronal US scan, obtained at the level of the bodies of the lateral ventricles, shows the cavum vergae (CV).

 

View larger version (160K): [in a new window]   Figure 3a.  Cavum veli interpositi. (a) Sagittal fetal MR image, obtained at 33 weeks of gestation due to an "inter-hemispheric cyst" seen at fetal US, shows a large cavum veli interpositi (CVI). No other abnormalities were identified. (b) Magnified midline sagittal US scan obtained with a linear-array transducer shows the cavum veli interpositi (arrows). This image was obtained during the first week of life. (c) Coronal US scan, obtained at the level of the bodies of the lateral ventricles, shows the cavum veli interpositi (arrows). (d) Sagittal postnatal MR image obtained at 8 months of age shows the large cavum veli interpositi (arrows).

 

View larger version (103K): [in a new window]   Figure 3b.  Cavum veli interpositi. (a) Sagittal fetal MR image, obtained at 33 weeks of gestation due to an "inter-hemispheric cyst" seen at fetal US, shows a large cavum veli interpositi (CVI). No other abnormalities were identified. (b) Magnified midline sagittal US scan obtained with a linear-array transducer shows the cavum veli interpositi (arrows). This image was obtained during the first week of life. (c) Coronal US scan, obtained at the level of the bodies of the lateral ventricles, shows the cavum veli interpositi (arrows). (d) Sagittal postnatal MR image obtained at 8 months of age shows the large cavum veli interpositi (arrows).

 

View larger version (145K): [in a new window]   Figure 3c.  Cavum veli interpositi. (a) Sagittal fetal MR image, obtained at 33 weeks of gestation due to an "inter-hemispheric cyst" seen at fetal US, shows a large cavum veli interpositi (CVI). No other abnormalities were identified. (b) Magnified midline sagittal US scan obtained with a linear-array transducer shows the cavum veli interpositi (arrows). This image was obtained during the first week of life. (c) Coronal US scan, obtained at the level of the bodies of the lateral ventricles, shows the cavum veli interpositi (arrows). (d) Sagittal postnatal MR image obtained at 8 months of age shows the large cavum veli interpositi (arrows).

 

View larger version (124K): [in a new window]   Figure 3d.  Cavum veli interpositi. (a) Sagittal fetal MR image, obtained at 33 weeks of gestation due to an "inter-hemispheric cyst" seen at fetal US, shows a large cavum veli interpositi (CVI). No other abnormalities were identified. (b) Magnified midline sagittal US scan obtained with a linear-array transducer shows the cavum veli interpositi (arrows). This image was obtained during the first week of life. (c) Coronal US scan, obtained at the level of the bodies of the lateral ventricles, shows the cavum veli interpositi (arrows). (d) Sagittal postnatal MR image obtained at 8 months of age shows the large cavum veli interpositi (arrows).

 

View larger version (132K): [in a new window]   Figure 4a.  Isolated mega cisterna magna in a patient with trisomy 21. (a) Sagittal US scan shows a retrocerebellar collection of CSF (arrows). (b) Transmastoid US scan of the posterior fossa shows an area of linear echogenicity consistent with a dural fold (arrow) and demonstrates the presence of a cerebellar vermis (arrowheads), which is critical for differential diagnosis from Dandy-Walker malformation. (c) US scan obtained with a linear-array transducer shows the findings in b more clearly. Arrow = dural fold, arrowhead = cerebellar vermis. (d) Unenhanced CT image shows the dural fold (arrow) and a normal cerebellum.

 

View larger version (113K): [in a new window]   Figure 4b.  Isolated mega cisterna magna in a patient with trisomy 21. (a) Sagittal US scan shows a retrocerebellar collection of CSF (arrows). (b) Transmastoid US scan of the posterior fossa shows an area of linear echogenicity consistent with a dural fold (arrow) and demonstrates the presence of a cerebellar vermis (arrowheads), which is critical for differential diagnosis from Dandy-Walker malformation. (c) US scan obtained with a linear-array transducer shows the findings in b more clearly. Arrow = dural fold, arrowhead = cerebellar vermis. (d) Unenhanced CT image shows the dural fold (arrow) and a normal cerebellum.

 

View larger version (79K): [in a new window]   Figure 4c.  Isolated mega cisterna magna in a patient with trisomy 21. (a) Sagittal US scan shows a retrocerebellar collection of CSF (arrows). (b) Transmastoid US scan of the posterior fossa shows an area of linear echogenicity consistent with a dural fold (arrow) and demonstrates the presence of a cerebellar vermis (arrowheads), which is critical for differential diagnosis from Dandy-Walker malformation. (c) US scan obtained with a linear-array transducer shows the findings in b more clearly. Arrow = dural fold, arrowhead = cerebellar vermis. (d) Unenhanced CT image shows the dural fold (arrow) and a normal cerebellum.

 

View larger version (112K): [in a new window]   Figure 4d.  Isolated mega cisterna magna in a patient with trisomy 21. (a) Sagittal US scan shows a retrocerebellar collection of CSF (arrows). (b) Transmastoid US scan of the posterior fossa shows an area of linear echogenicity consistent with a dural fold (arrow) and demonstrates the presence of a cerebellar vermis (arrowheads), which is critical for differential diagnosis from Dandy-Walker malformation. (c) US scan obtained with a linear-array transducer shows the findings in b more clearly. Arrow = dural fold, arrowhead = cerebellar vermis. (d) Unenhanced CT image shows the dural fold (arrow) and a normal cerebellum.

 

View larger version (157K): [in a new window]   Figure 5a.  Dandy-Walker malformation in a full-term 1-day-old neonate. (a) Midline sagittal US scan shows a retrocerebellar collection of CSF (arrowheads). (b) Coronal US scan shows vermian agenesis and a wide communication with a "keyhole" appearance (arrowheads) between the cyst posteriorly and the fourth ventricle (4) anteriorly. The cerebellar hemispheres (C) are hypoplastic. (c) Magnified transmastoid US scan shows the findings in b more clearly. C = cerebellar hemisphere, arrowheads = communication between the cyst and fourth ventricle. (d, e) Coronal T2-weighted (d) and sagittal T1-weighted (e) MR images show the Dandy-Walker malformation.

 

View larger version (146K): [in a new window]   Figure 5b.  Dandy-Walker malformation in a full-term 1-day-old neonate. (a) Midline sagittal US scan shows a retrocerebellar collection of CSF (arrowheads). (b) Coronal US scan shows vermian agenesis and a wide communication with a "keyhole" appearance (arrowheads) between the cyst posteriorly and the fourth ventricle (4) anteriorly. The cerebellar hemispheres (C) are hypoplastic. (c) Magnified transmastoid US scan shows the findings in b more clearly. C = cerebellar hemisphere, arrowheads = communication between the cyst and fourth ventricle. (d, e) Coronal T2-weighted (d) and sagittal T1-weighted (e) MR images show the Dandy-Walker malformation.

 

View larger version (83K): [in a new window]   Figure 5c.  Dandy-Walker malformation in a full-term 1-day-old neonate. (a) Midline sagittal US scan shows a retrocerebellar collection of CSF (arrowheads). (b) Coronal US scan shows vermian agenesis and a wide communication with a "keyhole" appearance (arrowheads) between the cyst posteriorly and the fourth ventricle (4) anteriorly. The cerebellar hemispheres (C) are hypoplastic. (c) Magnified transmastoid US scan shows the findings in b more clearly. C = cerebellar hemisphere, arrowheads = communication between the cyst and fourth ventricle. (d, e) Coronal T2-weighted (d) and sagittal T1-weighted (e) MR images show the Dandy-Walker malformation.

 

View larger version (126K): [in a new window]   Figure 5d.  Dandy-Walker malformation in a full-term 1-day-old neonate. (a) Midline sagittal US scan shows a retrocerebellar collection of CSF (arrowheads). (b) Coronal US scan shows vermian agenesis and a wide communication with a "keyhole" appearance (arrowheads) between the cyst posteriorly and the fourth ventricle (4) anteriorly. The cerebellar hemispheres (C) are hypoplastic. (c) Magnified transmastoid US scan shows the findings in b more clearly. C = cerebellar hemisphere, arrowheads = communication between the cyst and fourth ventricle. (d, e) Coronal T2-weighted (d) and sagittal T1-weighted (e) MR images show the Dandy-Walker malformation.

 

View larger version (160K): [in a new window]   Figure 5e.  Dandy-Walker malformation in a full-term 1-day-old neonate. (a) Midline sagittal US scan shows a retrocerebellar collection of CSF (arrowheads). (b) Coronal US scan shows vermian agenesis and a wide communication with a "keyhole" appearance (arrowheads) between the cyst posteriorly and the fourth ventricle (4) anteriorly. The cerebellar hemispheres (C) are hypoplastic. (c) Magnified transmastoid US scan shows the findings in b more clearly. C = cerebellar hemisphere, arrowheads = communication between the cyst and fourth ventricle. (d, e) Coronal T2-weighted (d) and sagittal T1-weighted (e) MR images show the Dandy-Walker malformation.

 

View larger version (143K): [in a new window]   Figure 6a.  Arachnoid cyst and complex posterior fossa malformations in a full-term 1-day-old neonate. (a) Left parasagittal US scan shows a CSF collection (arrowheads) anterior to the cerebellum in the cerebellopontine angle region. (b) Axial transmastoid US scan demonstrates the size of the fluid collection better (arrowheads). Arrows = bilateral internal carotid arteries. (c) Axial T2-weighted MR image corroborates the US findings and shows a small, hypoplastic cerebellum (C) on the left. (d) Left parasagittal T1-weighted MR image shows findings similar to those in a.

 

View larger version (147K): [in a new window]   Figure 6b.  Arachnoid cyst and complex posterior fossa malformations in a full-term 1-day-old neonate. (a) Left parasagittal US scan shows a CSF collection (arrowheads) anterior to the cerebellum in the cerebellopontine angle region. (b) Axial transmastoid US scan demonstrates the size of the fluid collection better (arrowheads). Arrows = bilateral internal carotid arteries. (c) Axial T2-weighted MR image corroborates the US findings and shows a small, hypoplastic cerebellum (C) on the left. (d) Left parasagittal T1-weighted MR image shows findings similar to those in a.

 

View larger version (156K): [in a new window]   Figure 6c.  Arachnoid cyst and complex posterior fossa malformations in a full-term 1-day-old neonate. (a) Left parasagittal US scan shows a CSF collection (arrowheads) anterior to the cerebellum in the cerebellopontine angle region. (b) Axial transmastoid US scan demonstrates the size of the fluid collection better (arrowheads). Arrows = bilateral internal carotid arteries. (c) Axial T2-weighted MR image corroborates the US findings and shows a small, hypoplastic cerebellum (C) on the left. (d) Left parasagittal T1-weighted MR image shows findings similar to those in a.

 

View larger version (150K): [in a new window]   Figure 6d.  Arachnoid cyst and complex posterior fossa malformations in a full-term 1-day-old neonate. (a) Left parasagittal US scan shows a CSF collection (arrowheads) anterior to the cerebellum in the cerebellopontine angle region. (b) Axial transmastoid US scan demonstrates the size of the fluid collection better (arrowheads). Arrows = bilateral internal carotid arteries. (c) Axial T2-weighted MR image corroborates the US findings and shows a small, hypoplastic cerebellum (C) on the left. (d) Left parasagittal T1-weighted MR image shows findings similar to those in a.

 

View larger version (144K): [in a new window]   Figure 7a.  Vein of Galen malformation. (a) Midline sagittal US scan shows an apparent cystic mass in a supracerebellar location (arrowheads). (b) Color Doppler image shows flow within the apparent mass (arrowheads). This finding indicates that the "mass" is a large vein of Galen malformation with a prominent internal carotid artery (ICA) and pericallosal branches (P). (c) Sagittal T1-weighted MR image shows the same findings as the US images. The dilated vein of Galen communicates with a persistent falcine sinus (arrow). Note the extensive phase artifact due to the malformation. (d) Lateral MR venogram shows numerous dilated arteries and drainage of the large vein of Galen malformation (arrowheads) into a prominent torcular through a persistent falcine sinus (arrows).

 

View larger version (125K): [in a new window]   Figure 7b.  Vein of Galen malformation. (a) Midline sagittal US scan shows an apparent cystic mass in a supracerebellar location (arrowheads). (b) Color Doppler image shows flow within the apparent mass (arrowheads). This finding indicates that the "mass" is a large vein of Galen malformation with a prominent internal carotid artery (ICA) and pericallosal branches (P). (c) Sagittal T1-weighted MR image shows the same findings as the US images. The dilated vein of Galen communicates with a persistent falcine sinus (arrow). Note the extensive phase artifact due to the malformation. (d) Lateral MR venogram shows numerous dilated arteries and drainage of the large vein of Galen malformation (arrowheads) into a prominent torcular through a persistent falcine sinus (arrows).

 

View larger version (142K): [in a new window]   Figure 7c.  Vein of Galen malformation. (a) Midline sagittal US scan shows an apparent cystic mass in a supracerebellar location (arrowheads). (b) Color Doppler image shows flow within the apparent mass (arrowheads). This finding indicates that the "mass" is a large vein of Galen malformation with a prominent internal carotid artery (ICA) and pericallosal branches (P). (c) Sagittal T1-weighted MR image shows the same findings as the US images. The dilated vein of Galen communicates with a persistent falcine sinus (arrow). Note the extensive phase artifact due to the malformation. (d) Lateral MR venogram shows numerous dilated arteries and drainage of the large vein of Galen malformation (arrowheads) into a prominent torcular through a persistent falcine sinus (arrows).

 

View larger version (99K): [in a new window]   Figure 7d.  Vein of Galen malformation. (a) Midline sagittal US scan shows an apparent cystic mass in a supracerebellar location (arrowheads). (b) Color Doppler image shows flow within the apparent mass (arrowheads). This finding indicates that the "mass" is a large vein of Galen malformation with a prominent internal carotid artery (ICA) and pericallosal branches (P). (c) Sagittal T1-weighted MR image shows the same findings as the US images. The dilated vein of Galen communicates with a persistent falcine sinus (arrow). Note the extensive phase artifact due to the malformation. (d) Lateral MR venogram shows numerous dilated arteries and drainage of the large vein of Galen malformation (arrowheads) into a prominent torcular through a persistent falcine sinus (arrows).

 

View larger version (45K): [in a new window]   Figure 8.  Differential diagnosis between the cystic lesions seen in periventricular leukomalacia (PVL), connatal cyst (CC), and subependymal cyst (SC) is facilitated by noting their distinct anatomic locations.

 

View larger version (151K): [in a new window]   Figure 9a.  Connatal cysts in a 30-week gestation preterm infant. (a) Coronal US scan shows connatal cysts just inferior to the superolateral angles of the lateral ventricles (arrows). (b) Parasagittal US scan shows several small connatal cysts (arrows) lined up just lateral to the frontal horn and body of the lateral ventricle.

 

View larger version (155K): [in a new window]   Figure 9b.  Connatal cysts in a 30-week gestation preterm infant. (a) Coronal US scan shows connatal cysts just inferior to the superolateral angles of the lateral ventricles (arrows). (b) Parasagittal US scan shows several small connatal cysts (arrows) lined up just lateral to the frontal horn and body of the lateral ventricle.

 

View larger version (135K): [in a new window]   Figure 10a.  Bilateral connatal cysts in a 3-week-old full-term neonate who underwent a Norwood operation for hypoplastic left heart syndrome. (a) Coronal US scan shows bilateral areas of CSF echogenicity at the superolateral angles of the lateral ventricles (arrows). (b, c) Right (b) and left (c) magnified coronal US scans obtained with a linear-array transducer show the abnormalities more clearly (arrows). (d) Coronal contrast-enhanced CT image shows the left-sided connatal cyst (arrow).

 

View larger version (94K): [in a new window]   Figure 10b.  Bilateral connatal cysts in a 3-week-old full-term neonate who underwent a Norwood operation for hypoplastic left heart syndrome. (a) Coronal US scan shows bilateral areas of CSF echogenicity at the superolateral angles of the lateral ventricles (arrows). (b, c) Right (b) and left (c) magnified coronal US scans obtained with a linear-array transducer show the abnormalities more clearly (arrows). (d) Coronal contrast-enhanced CT image shows the left-sided connatal cyst (arrow).

 

View larger version (101K): [in a new window]   Figure 10c.  Bilateral connatal cysts in a 3-week-old full-term neonate who underwent a Norwood operation for hypoplastic left heart syndrome. (a) Coronal US scan shows bilateral areas of CSF echogenicity at the superolateral angles of the lateral ventricles (arrows). (b, c) Right (b) and left (c) magnified coronal US scans obtained with a linear-array transducer show the abnormalities more clearly (arrows). (d) Coronal contrast-enhanced CT image shows the left-sided connatal cyst (arrow).

 

View larger version (103K): [in a new window]   Figure 10d.  Bilateral connatal cysts in a 3-week-old full-term neonate who underwent a Norwood operation for hypoplastic left heart syndrome. (a) Coronal US scan shows bilateral areas of CSF echogenicity at the superolateral angles of the lateral ventricles (arrows). (b, c) Right (b) and left (c) magnified coronal US scans obtained with a linear-array transducer show the abnormalities more clearly (arrows). (d) Coronal contrast-enhanced CT image shows the left-sided connatal cyst (arrow).

 

View larger version (95K): [in a new window]   Figure 11a.  Acquired subependymal cyst due to an evolving subependymal hemorrhage. (a) Coronal US scan obtained with a linear-array transducer in the region of the caudothalamic groove shows a well-defined cyst (arrowheads), a finding consistent with an evolving subependymal hemorrhage. (b) Parasagittal US scan shows a multiseptate cyst (arrowheads) within the caudothalamic notch area. The linear echogenic structure (arrow) is the ipsilateral cingulate gyrus. (c) Magnified parasagittal US scan obtained with a linear-array transducer shows the multiple septa within the cyst (arrowheads) more clearly. (d) Coronal T2-weighted MR image shows the subependymal hemorrhagic cyst as an area of low signal intensity (arrow). (e) Sagittal T1-weighted MR image shows the hemorrhage as an area of high signal intensity (arrow).

 

View larger version (134K): [in a new window]   Figure 11b.  Acquired subependymal cyst due to an evolving subependymal hemorrhage. (a) Coronal US scan obtained with a linear-array transducer in the region of the caudothalamic groove shows a well-defined cyst (arrowheads), a finding consistent with an evolving subependymal hemorrhage. (b) Parasagittal US scan shows a multiseptate cyst (arrowheads) within the caudothalamic notch area. The linear echogenic structure (arrow) is the ipsilateral cingulate gyrus. (c) Magnified parasagittal US scan obtained with a linear-array transducer shows the multiple septa within the cyst (arrowheads) more clearly. (d) Coronal T2-weighted MR image shows the subependymal hemorrhagic cyst as an area of low signal intensity (arrow). (e) Sagittal T1-weighted MR image shows the hemorrhage as an area of high signal intensity (arrow).

 

View larger version (137K): [in a new window]   Figure 11c.  Acquired subependymal cyst due to an evolving subependymal hemorrhage. (a) Coronal US scan obtained with a linear-array transducer in the region of the caudothalamic groove shows a well-defined cyst (arrowheads), a finding consistent with an evolving subependymal hemorrhage. (b) Parasagittal US scan shows a multiseptate cyst (arrowheads) within the caudothalamic notch area. The linear echogenic structure (arrow) is the ipsilateral cingulate gyrus. (c) Magnified parasagittal US scan obtained with a linear-array transducer shows the multiple septa within the cyst (arrowheads) more clearly. (d) Coronal T2-weighted MR image shows the subependymal hemorrhagic cyst as an area of low signal intensity (arrow). (e) Sagittal T1-weighted MR image shows the hemorrhage as an area of high signal intensity (arrow).

 

View larger version (168K): [in a new window]   Figure 11d.  Acquired subependymal cyst due to an evolving subependymal hemorrhage. (a) Coronal US scan obtained with a linear-array transducer in the region of the caudothalamic groove shows a well-defined cyst (arrowheads), a finding consistent with an evolving subependymal hemorrhage. (b) Parasagittal US scan shows a multiseptate cyst (arrowheads) within the caudothalamic notch area. The linear echogenic structure (arrow) is the ipsilateral cingulate gyrus. (c) Magnified parasagittal US scan obtained with a linear-array transducer shows the multiple septa within the cyst (arrowheads) more clearly. (d) Coronal T2-weighted MR image shows the subependymal hemorrhagic cyst as an area of low signal intensity (arrow). (e) Sagittal T1-weighted MR image shows the hemorrhage as an area of high signal intensity (arrow).

 

View larger version (99K): [in a new window]   Figure 11e.  Acquired subependymal cyst due to an evolving subependymal hemorrhage. (a) Coronal US scan obtained with a linear-array transducer in the region of the caudothalamic groove shows a well-defined cyst (arrowheads), a finding consistent with an evolving subependymal hemorrhage. (b) Parasagittal US scan shows a multiseptate cyst (arrowheads) within the caudothalamic notch area. The linear echogenic structure (arrow) is the ipsilateral cingulate gyrus. (c) Magnified parasagittal US scan obtained with a linear-array transducer shows the multiple septa within the cyst (arrowheads) more clearly. (d) Coronal T2-weighted MR image shows the subependymal hemorrhagic cyst as an area of low signal intensity (arrow). (e) Sagittal T1-weighted MR image shows the hemorrhage as an area of high signal intensity (arrow).

 

View larger version (129K): [in a new window]   Figure 12.  Multiple small choroid plexus cysts in a normal infant. Parasagittal US scan shows a row of five subcentimeter (2–3-mm) choroid plexus cysts (arrowheads), which disappeared in follow-up studies.

 

View larger version (168K): [in a new window]   Figure 13a.  Extensive cystic PVL in a 29-week gestation premature neonate. (a) Coronal US scan shows extensive multiseptate cystic areas located superiorly to the frontal horns (arrows). There is ex vacuo dilatation of the ventricles secondary to white matter loss. (b) Parasagittal US scan shows extensive cystic PVL with more cystic components anteriorly (arrows). Posteriorly, the area of ischemia is hyperechoic, which may reflect the presence of very small cysts. Note in both a and b that the cystic components are extremely irregular in outline and multiseptate. (c) Sagittal MR image obtained through the cystic areas shows the multiseptate nature of the PVL.

 

View larger version (145K): [in a new window]   Figure 13b.  Extensive cystic PVL in a 29-week gestation premature neonate. (a) Coronal US scan shows extensive multiseptate cystic areas located superiorly to the frontal horns (arrows). There is ex vacuo dilatation of the ventricles secondary to white matter loss. (b) Parasagittal US scan shows extensive cystic PVL with more cystic components anteriorly (arrows). Posteriorly, the area of ischemia is hyperechoic, which may reflect the presence of very small cysts. Note in both a and b that the cystic components are extremely irregular in outline and multiseptate. (c) Sagittal MR image obtained through the cystic areas shows the multiseptate nature of the PVL.

 

View larger version (144K): [in a new window]   Figure 13c.  Extensive cystic PVL in a 29-week gestation premature neonate. (a) Coronal US scan shows extensive multiseptate cystic areas located superiorly to the frontal horns (arrows). There is ex vacuo dilatation of the ventricles secondary to white matter loss. (b) Parasagittal US scan shows extensive cystic PVL with more cystic components anteriorly (arrows). Posteriorly, the area of ischemia is hyperechoic, which may reflect the presence of very small cysts. Note in both a and b that the cystic components are extremely irregular in outline and multiseptate. (c) Sagittal MR image obtained through the cystic areas shows the multiseptate nature of the PVL.

 

View larger version (135K): [in a new window]   Figure 14a.  Porencephaly (no communication with the ventricles) mimicking a cleft in a 1-day-old term infant with thrombocytopenia. (a, b) Coronal (a) and sagittal (b) US scans show a fairly well-defined cystic lesion within the right insular area (arrow). The margins of the cavity are hyperechoic, a finding suggestive of calcification or hemorrhage. The insult occurred antenatally. (c) Axial unenhanced CT image shows that the cystic lesion does not communicate with the lateral ventricles. Note that there are calcifications along the margins of the cavity (arrowheads). These are probably sequelae of a remote infarct in the distribution of the middle cerebral artery.

 

View larger version (148K): [in a new window]   Figure 14b.  Porencephaly (no communication with the ventricles) mimicking a cleft in a 1-day-old term infant with thrombocytopenia. (a, b) Coronal (a) and sagittal (b) US scans show a fairly well-defined cystic lesion within the right insular area (arrow). The margins of the cavity are hyperechoic, a finding suggestive of calcification or hemorrhage. The insult occurred antenatally. (c) Axial unenhanced CT image shows that the cystic lesion does not communicate with the lateral ventricles. Note that there are calcifications along the margins of the cavity (arrowheads). These are probably sequelae of a remote infarct in the distribution of the middle cerebral artery.

 

View larger version (158K): [in a new window]   Figure 14c.  Porencephaly (no communication with the ventricles) mimicking a cleft in a 1-day-old term infant with thrombocytopenia. (a, b) Coronal (a) and sagittal (b) US scans show a fairly well-defined cystic lesion within the right insular area (arrow). The margins of the cavity are hyperechoic, a finding suggestive of calcification or hemorrhage. The insult occurred antenatally. (c) Axial unenhanced CT image shows that the cystic lesion does not communicate with the lateral ventricles. Note that there are calcifications along the margins of the cavity (arrowheads). These are probably sequelae of a remote infarct in the distribution of the middle cerebral artery.

 

View larger version (142K): [in a new window]   Figure 15a.  Porencephaly in a 26-week gestation premature neonate. (a) Parasagittal US scan shows a cystic structure with debris (arrowheads) and a wide communication with the lateral ventricle, an appearance that represents porencephaly. (b) Magnified US scan obtained with a linear-array transducer shows the complex echotexture of the area of porencephaly more clearly.

 

View larger version (95K): [in a new window]   Figure 15b.  Porencephaly in a 26-week gestation premature neonate. (a) Parasagittal US scan shows a cystic structure with debris (arrowheads) and a wide communication with the lateral ventricle, an appearance that represents porencephaly. (b) Magnified US scan obtained with a linear-array transducer shows the complex echotexture of the area of porencephaly more clearly.

 

View larger version (98K): [in a new window]   Figure 16a.  Hydranencephaly in a newborn. Sagittal (a) and axial (b) US scans show a large cystic space involving the entire supratentorial area bilaterally. There is no evidence of a cortical rim, a finding that allows differentiation of this entity from severe hydrocephalus.

 

View larger version (82K): [in a new window]   Figure 16b.  Hydranencephaly in a newborn. Sagittal (a) and axial (b) US scans show a large cystic space involving the entire supratentorial area bilaterally. There is no evidence of a cortical rim, a finding that allows differentiation of this entity from severe hydrocephalus.

 

View larger version (127K): [in a new window]   Figure 17a.  Schizencephaly with bilateral clefts in a 36-week gestation preterm infant. (a) Coronal US scan shows an open lip cleft (arrows). (b) Coronal US scan angled more posteriorly than a shows bilateral clefts, with the left cleft (arrows) being larger than the right. The left lateral ventricle communicates widely with the subarachnoid space. (c) Axial T1-weighted MR image shows the left cleft (arrows). (d) Three-dimensional MR image shows the communication between the ventricles and the subarachnoid space more clearly.

 

View larger version (168K): [in a new window]   Figure 17b.  Schizencephaly with bilateral clefts in a 36-week gestation preterm infant. (a) Coronal US scan shows an open lip cleft (arrows). (b) Coronal US scan angled more posteriorly than a shows bilateral clefts, with the left cleft (arrows) being larger than the right. The left lateral ventricle communicates widely with the subarachnoid space. (c) Axial T1-weighted MR image shows the left cleft (arrows). (d) Three-dimensional MR image shows the communication between the ventricles and the subarachnoid space more clearly.

 

View larger version (156K): [in a new window]   Figure 17c.  Schizencephaly with bilateral clefts in a 36-week gestation preterm infant. (a) Coronal US scan shows an open lip cleft (arrows). (b) Coronal US scan angled more posteriorly than a shows bilateral clefts, with the left cleft (arrows) being larger than the right. The left lateral ventricle communicates widely with the subarachnoid space. (c) Axial T1-weighted MR image shows the left cleft (arrows). (d) Three-dimensional MR image shows the communication between the ventricles and the subarachnoid space more clearly.

 

View larger version (129K): [in a new window]   Figure 17d.  Schizencephaly with bilateral clefts in a 36-week gestation preterm infant. (a) Coronal US scan shows an open lip cleft (arrows). (b) Coronal US scan angled more posteriorly than a shows bilateral clefts, with the left cleft (arrows) being larger than the right. The left lateral ventricle communicates widely with the subarachnoid space. (c) Axial T1-weighted MR image shows the left cleft (arrows). (d) Three-dimensional MR image shows the communication between the ventricles and the subarachnoid space more clearly.

 

View larger version (99K): [in a new window]   Figure 18a.  Severe obstructive hydrocephalus due to aqueductal stenosis. (a) Sagittal US scan shows a large fluid-filled space posteriorly (arrowheads), which represents a markedly dilated lateral ventricle that simulates a large cyst. Note the choroid plexus (CP) within the ventricle. (b) Axial transmastoid US scan shows enlargement of both lateral ventricles (arrowheads). Also note the bilateral choroid plexuses (CP) and the thalami (T) on either side of a mildly distended third ventricle (3). (c) Coronal US scan obtained with a linear-array transducer shows the presence of cortex (C), which helps in the differentiation of severe hydrocephalus from hydranencephaly. (d) Sagittal MR image demonstrates the degree of hydrocephalus better and shows the thin cortical rim.

 

View larger version (133K): [in a new window]   Figure 18b.  Severe obstructive hydrocephalus due to aqueductal stenosis. (a) Sagittal US scan shows a large fluid-filled space posteriorly (arrowheads), which represents a markedly dilated lateral ventricle that simulates a large cyst. Note the choroid plexus (CP) within the ventricle. (b) Axial transmastoid US scan shows enlargement of both lateral ventricles (arrowheads). Also note the bilateral choroid plexuses (CP) and the thalami (T) on either side of a mildly distended third ventricle (3). (c) Coronal US scan obtained with a linear-array transducer shows the presence of cortex (C), which helps in the differentiation of severe hydrocephalus from hydranencephaly. (d) Sagittal MR image demonstrates the degree of hydrocephalus better and shows the thin cortical rim.

 

View larger version (130K): [in a new window]   Figure 18c.  Severe obstructive hydrocephalus due to aqueductal stenosis. (a) Sagittal US scan shows a large fluid-filled space posteriorly (arrowheads), which represents a markedly dilated lateral ventricle that simulates a large cyst. Note the choroid plexus (CP) within the ventricle. (b) Axial transmastoid US scan shows enlargement of both lateral ventricles (arrowheads). Also note the bilateral choroid plexuses (CP) and the thalami (T) on either side of a mildly distended third ventricle (3). (c) Coronal US scan obtained with a linear-array transducer shows the presence of cortex (C), which helps in the differentiation of severe hydrocephalus from hydranencephaly. (d) Sagittal MR image demonstrates the degree of hydrocephalus better and shows the thin cortical rim.

 

View larger version (138K): [in a new window]   Figure 18d.  Severe obstructive hydrocephalus due to aqueductal stenosis. (a) Sagittal US scan shows a large fluid-filled space posteriorly (arrowheads), which represents a markedly dilated lateral ventricle that simulates a large cyst. Note the choroid plexus (CP) within the ventricle. (b) Axial transmastoid US scan shows enlargement of both lateral ventricles (arrowheads). Also note the bilateral choroid plexuses (CP) and the thalami (T) on either side of a mildly distended third ventricle (3). (c) Coronal US scan obtained with a linear-array transducer shows the presence of cortex (C), which helps in the differentiation of severe hydrocephalus from hydranencephaly. (d) Sagittal MR image demonstrates the degree of hydrocephalus better and shows the thin cortical rim.

 

View larger version (128K): [in a new window]   Figure 19a.  Holoprosencephaly spectrum disorder in a newborn. (a) Midline sagittal US scan shows a large monoventricle (arrows). The third and fourth ventricles are normal. (b) Coronal US scan shows an absent septum pellucidum, the large monoventricle (arrows), and partially fused thalami (T). (c) Axial T2-weighted MR image shows partial fusing (arrowheads) of the thalami (T) and the large monoventricle posteriorly. (d) Sagittal T2-weighted MR image shows the shieldlike appearance of forebrain structures and the monoventricle (arrowheads).

 

View larger version (135K): [in a new window]   Figure 19b.  Holoprosencephaly spectrum disorder in a newborn. (a) Midline sagittal US scan shows a large monoventricle (arrows). The third and fourth ventricles are normal. (b) Coronal US scan shows an absent septum pellucidum, the large monoventricle (arrows), and partially fused thalami (T). (c) Axial T2-weighted MR image shows partial fusing (arrowheads) of the thalami (T) and the large monoventricle posteriorly. (d) Sagittal T2-weighted MR image shows the shieldlike appearance of forebrain structures and the monoventricle (arrowheads).

 

View larger version (158K): [in a new window]   Figure 19c.  Holoprosencephaly spectrum disorder in a newborn. (a) Midline sagittal US scan shows a large monoventricle (arrows). The third and fourth ventricles are normal. (b) Coronal US scan shows an absent septum pellucidum, the large monoventricle (arrows), and partially fused thalami (T). (c) Axial T2-weighted MR image shows partial fusing (arrowheads) of the thalami (T) and the large monoventricle posteriorly. (d) Sagittal T2-weighted MR image shows the shieldlike appearance of forebrain structures and the monoventricle (arrowheads).

 

View larger version (132K): [in a new window]   Figure 19d.  Holoprosencephaly spectrum disorder in a newborn. (a) Midline sagittal US scan shows a large monoventricle (arrows). The third and fourth ventricles are normal. (b) Coronal US scan shows an absent septum pellucidum, the large monoventricle (arrows), and partially fused thalami (T). (c) Axial T2-weighted MR image shows partial fusing (arrowheads) of the thalami (T) and the large monoventricle posteriorly. (d) Sagittal T2-weighted MR image shows the shieldlike appearance of forebrain structures and the monoventricle (arrowheads).

 

View larger version (145K): [in a new window]   Figure 20a.  Left frontal intraparenchymal hematoma in a newborn with increasing thrombocytopenia. The perinatal history was unremarkable aside from maternal cocaine abuse. (a, b) Coronal (a) and sagittal (b) US scans show a large hematoma with complex echogenicity in the left frontoparietal area. The irregular, thick, peripheral increased echogenicity (arrows) represents hematoma surrounding the hypoechoic center, which is undergoing resorption. (c) Sagittal T1-weighted MR image shows the complexity of the lesion (arrows). The hyperintense margins and hypointense center correspond to the US findings. Intraventricular hemorrhage is noted as layering of blood products in the left occipital horn (arrowhead). (d) Axial gradient-echo MR image shows blooming of the lesion margins due to the magnetic susceptibility of blood products. (e) Unenhanced CT image shows findings similar to those in c and d and no evidence of calcifications. Note the intraventricular hemorrhage in both occipital horns. Angiography revealed no abnormality in the vascular tree.

 

View larger version (148K): [in a new window]   Figure 20b.  Left frontal intraparenchymal hematoma in a newborn with increasing thrombocytopenia. The perinatal history was unremarkable aside from maternal cocaine abuse. (a, b) Coronal (a) and sagittal (b) US scans show a large hematoma with complex echogenicity in the left frontoparietal area. The irregular, thick, peripheral increased echogenicity (arrows) represents hematoma surrounding the hypoechoic center, which is undergoing resorption. (c) Sagittal T1-weighted MR image shows the complexity of the lesion (arrows). The hyperintense margins and hypointense center correspond to the US findings. Intraventricular hemorrhage is noted as layering of blood products in the left occipital horn (arrowhead). (d) Axial gradient-echo MR image shows blooming of the lesion margins due to the magnetic susceptibility of blood products. (e) Unenhanced CT image shows findings similar to those in c and d and no evidence of calcifications. Note the intraventricular hemorrhage in both occipital horns. Angiography revealed no abnormality in the vascular tree.

 

View larger version (124K): [in a new window]   Figure 20c.  Left frontal intraparenchymal hematoma in a newborn with increasing thrombocytopenia. The perinatal history was unremarkable aside from maternal cocaine abuse. (a, b) Coronal (a) and sagittal (b) US scans show a large hematoma with complex echogenicity in the left frontoparietal area. The irregular, thick, peripheral increased echogenicity (arrows) represents hematoma surrounding the hypoechoic center, which is undergoing resorption. (c) Sagittal T1-weighted MR image shows the complexity of the lesion (arrows). The hyperintense margins and hypointense center correspond to the US findings. Intraventricular hemorrhage is noted as layering of blood products in the left occipital horn (arrowhead). (d) Axial gradient-echo MR image shows blooming of the lesion margins due to the magnetic susceptibility of blood products. (e) Unenhanced CT image shows findings similar to those in c and d and no evidence of calcifications. Note the intraventricular hemorrhage in both occipital horns. Angiography revealed no abnormality in the vascular tree.

 

View larger version (113K): [in a new window]   Figure 20d.  Left frontal intraparenchymal hematoma in a newborn with increasing thrombocytopenia. The perinatal history was unremarkable aside from maternal cocaine abuse. (a, b) Coronal (a) and sagittal (b) US scans show a large hematoma with complex echogenicity in the left frontoparietal area. The irregular, thick, peripheral increased echogenicity (arrows) represents hematoma surrounding the hypoechoic center, which is undergoing resorption. (c) Sagittal T1-weighted MR image shows the complexity of the lesion (arrows). The hyperintense margins and hypointense center correspond to the US findings. Intraventricular hemorrhage is noted as layering of blood products in the left occipital horn (arrowhead). (d) Axial gradient-echo MR image shows blooming of the lesion margins due to the magnetic susceptibility of blood products. (e) Unenhanced CT image shows findings similar to those in c and d and no evidence of calcifications. Note the intraventricular hemorrhage in both occipital horns. Angiography revealed no abnormality in the vascular tree.

 

View larger version (120K): [in a new window]   Figure 20e.  Left frontal intraparenchymal hematoma in a newborn with increasing thrombocytopenia. The perinatal history was unremarkable aside from maternal cocaine abuse. (a, b) Coronal (a) and sagittal (b) US scans show a large hematoma with complex echogenicity in the left frontoparietal area. The irregular, thick, peripheral increased echogenicity (arrows) represents hematoma surrounding the hypoechoic center, which is undergoing resorption. (c) Sagittal T1-weighted MR image shows the complexity of the lesion (arrows). The hyperintense margins and hypointense center correspond to the US findings. Intraventricular hemorrhage is noted as layering of blood products in the left occipital horn (arrowhead). (d) Axial gradient-echo MR image shows blooming of the lesion margins due to the magnetic susceptibility of blood products. (e) Unenhanced CT image shows findings similar to those in c and d and no evidence of calcifications. Note the intraventricular hemorrhage in both occipital horns. Angiography revealed no abnormality in the vascular tree.

 

View larger version (146K): [in a new window]   Figure 21a.  Spontaneous intracranial hematoma in a 2-month-old infant with an inherited thrombophilic disorder. (a, b) Coronal (a) and sagittal (b) US scans show a large complex cystic cavity (arrows) with low-level echoes in the right temporal-parietal area. (c) Sagittal T1-weighted MR image shows high signal intensity within the cyst (arrows), a finding in keeping with acute hemorrhage. No underlying vascular malformation was noted in follow-up studies.

 

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