Pediatric Pineal Cyst

  • Etiology: Possibly results from degenerative changes in gland
  • Imaging MRI:
    — Usually 2-15 millimeters in size
    — Typically remain stable over time
    — Round or oval
    — Thin wall
    — Circumscribed
    — Fine internal septa or cysts can be seen with high resolution
    — Typically cerebrospinal fluid signal
    — Calcification of cyst wall common
    — T1WI post contrast: Uniform enhancement can be seen on delayed imaging
    — FLAIR: May be bright (proteinaceous)
  • DDX: Pineal tumors (pineoblastoma, germ cell tumor) are rare – less than 0.2% of all intracranial neoplasms – and both have restricted diffusion
  • Complications: None
  • Treatment: Routine followup not necessary in absence of unusual radiological characteristics or related clinical symptoms
  • Clinical:
    — Typically asymptomatic
    — Common – in 23% of normal volunteers in imaging studies and 25-40% of cadavers in autopsy series

Radiology Cases of Pineal Cyst

MR of pineal cyst
Sagittal (above left), axial (above right) and coronal (below left) T1 MRI without contrast of the brain shows a small round low signal intensity lesion with thin walls in the location of the pineal gland. Coronal T2 MRI (below right) shows the lesion to have high signal intensity.