When do we find normal variants and incidentalomas
• „Routine“ – investigations (e.g. following seizure )
• Imaging following trauma
• Neuroimaging in context of studies
(cardiac malformations, follow-up of neonatal HIE…)
• Healthy volunteers («controls» in studies)
• Prenatal screening !!
• Patients with a syndrome – MRI «for interest»
• Check-up „ Wellness scans “
Normal variants
• Temporal lobe hypoplasia–middle fossa arachnoid cyst (Fig.1)
• Enlarged Virchow-Robin spaces ( Perivascular Spaces ) (Fig.2)
• Pineal cyst (Fig.3)
• Rathke cyst
• Developmental Venous Anomaly [DVA]
• Benign enlargement of subarachnoid space ( frontal / occipital )
• Mega Cisterna Magna (Fig.4)
• Plexus chorioideus cyst
• Fissura chorioidea cyst
• Cavum septi pellucidi, cavum vergae
• Cavum veli interpositi
• Peritrigonal white matter hyperintensities
• Fluid retention in paranasal sinuses („Sinusitis“) / Mastoid (Fig.5)
• Ventriculus terminalis of conus medullaris
• Persistent central canal of spinal cord
• Extracranial variants- Naso-pharyngeal cyst, Ductus thyreoglossus cyst (Fig.6, Fig.7)
How to deal with normal variants
• no indication for repetition of imaging
• Information of parents
clear message = normal finding !
• Only variant with a potential consequence
Temporal lobe hypoplasia / middle fossa arachnoid cyst
• ev. ipsilateral subdural effusion following minor head trauma
Insidental MRI findings
- Arachnoid cys t(large, space-occupying)
- Tumors- benign
- Vascular-cavernoma, AVM, arterial stenosis
- Malformations (e.g.agenesis corpus callosum)
- Chiari I (Tonsillar ectopia, > 5mm)
- Residual changes
- Prenatal imaging!!(cysts, malformationsm hemorrhages, ...)
Incidental MRI findings in patients with a syndrome
- White matter lesions
- Mega Cisterna Magna
- Unilateral cerebellar hypoplasia
Managment of incidentalomas
Individual approach
Involve parents / patient
Interdisciplinary discussion