In terms of intensity, how does a pineal cyst compare to CSF and brain parenchyma on a T1W sequence?
A pineal cyst is more hyperintense to CSF and hypointense to brain parenchyma.
Is imaging follow-up necessary for all pineal cysts?
Cysts with typical features may be followed up clinically, rather than with imaging. When cysts are above 10-12 mm in diameter, follow-up imaging may be necessary, as a cystic pineocytoma may appear similar.
List the differential diagnoses for a pineal cyst?
Usually there is no differential. In atypical cases, consider cystic pineocytoma (main concern), germ cell tumour, metastatic lesions.
Which imaging sequence will provide the highest signal for detection of a pineal cyst?
T2
Pineal cyst demonstrating a blood sedimentation level, consistent with prior haemorrhage. No internal enhancement is seen.
The pineal cyst has a thin wall which does not enhance.
No significant mass effect on the cerebral aqueduct.
No suprasellar mass or pituitary enlargement. .
Conclusion:
Pineal cyst complicated by haemorrhage.