Intracranial Cystic Tumors with a Mural Nodule: Conventional, Diffusion Tensor and Perfusion Magnetic Resonance Imaging Findings

Introduction: Intracranial cystic tumors with mural nodule have been extensively studied. None of these studies have established the role of conventional, fractional anisotropy diffusion tensor imaging (FADTI) and dynamic susceptibility contrast magnetic resonance imaging (MRI) in the assessment of grade and type of cystic brain tumors with a mural nodule. Materials and Methods: This was a retrospective cross-sectional study, which was conducted at Severance Hospital. Brain MRI of 15 consecutive patients with a cystic brain tumor with a mural nodule was analyzed. Results: Among the 15 studied patients 11 were females. The age ranged from 12 to 54 years. Six of the patients had high‑grade tumors. Most five of the high‑grade tumors showed cystic wall contrast enhancement while none was found among the low-grade group. All high-grade tumors showed increased regional cerebral blood volume (rCBV) compared to three of low-grade tumors. Hemangioblastomas, glioblastoma multiforme (GBM) and the primitive neuroectodermal tumor showed increased rCBV while pilocytic astrocytoma, ependymoma, and ganglioglioma showed decreased rCBV. There were no difference in fractional anisotropy (FA) values between tumor grades and types. Conclusion: Postcontrast T1-weighted image and perfusion MRI showed in this study to be very useful in differentiating high- and low-grade cystic tumors with the mural nodule. FA values added no benefit to tumor differentiation. Hemangioblastoma was the only tumor with increased rCBV among low‑grade tumors. GBM, which is a malignant tumor, can present as a cystic lesion with a mural nodule.