“Giant” Arachnoid Granulations Just Like CSF?: NOT!!
Open accessAbstract
"Giant" AGs (>1 cm) are uncommon and can be misdiagnosed as venous sinus pathology such as a neoplasm or thrombosis. Seventeen patients with a total of 19 venous sinus AGs of >1 cm were collected from contributing authors. MR imaging was available for all AGs; CT, for 5/19; and DSA, for 7/19. Intra-AG fluid was compared with CSF in subarachnoid spaces. Nonfluid AG tissue was compared with gray matter. Diagnosis was based on imaging findings. Fluid within giant AGs did not follow CSF signal intensity on at least 1 MR image in nearly 80% (15/19) of AGs. Nine of these 15 AGs had CSF-incongruent signal intensity on ≥2 MR images. CSF-incongruent signal intensity was seen in 8/8 AGs on FLAIR, 7/10 on precontrast T1WI, 13/19 on T2WI, and 8/14 on contrast-enhanced T1WI. Nonfluid signal intensity was present in 18/19 AGs and varied from absent/hypointense (intra-AG flow voids) to gray matter isointense (stromal tissue).
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The extent of enhancing tissue within parasagittal dura does not resemble previously reported appearance of true dural lymphatic vessels (tubular-shaped, sub-millimeter, near venous sinus wall) nor classical MRI appearance of arachnoid granulations bulging into venous sinuses.
“The extent of enhancing tissue within parasagittal dura does not resemble the previously reported appearance of true dural lymphatic vessels, which are tubular-shaped structures of sub-millimeter cross-sectional diameter near the venous sinus wall3,4,11, and also far from the classical MRI appearance of arachnoid granulations bulging into venous sinuses12.”
From Cerebrospinal fluid tracer efflux to parasagittal dura in humans (2020) · cites this paper as [12]
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Cerebrospinal fluid tracer efflux to parasagittal dura in humans
Ringstad, G., & Eide, P. K. (2020) · Nature Communications · doi:10.1038/s41467-019-14195-x · Cited by 292 · see citing works
- Authors
- Trimble, C. R., Harnsberger, H. R., Castillo, M., Brant-Zawadzki, M., & Osborn, A. G.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Trimble, C.R.
- Venue
- American Journal of Neuroradiology
- Published
- 2010-06-25
- Volume
- 31
- Issue
- 9
- Pages
- 1724-1728
- ISSN
- 0195-6108 (ISSN-L)
- 1936-959X
- PMC
- PMC7964997
- OpenAlex
- W2168074220
- Cited by
- 63
- References
- 29
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 5 · 2022: 6 · 2021: 4 · 2020: 4 · 2019: 6 · 2018: 5 · 2017: 8 · 2016: 4 · 2015: 1 · 2014: 6 · 2013: 4 · 2012: 3
- FWCI
- 1.34
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- American Journal of Neuroradiology (publishedVersion, cc-by)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Cerebral Venous Sinus Thrombosis
- Health Sciences › Medicine › Neurology › Neurosurgical Procedures and Complications
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Cerebrospinal fluid and hydrocephalus
- Keywords
- cerebrospinal fluid signal intensity, flow voids, misdiagnosis
- MeSH terms
- Aged, Brain, Cerebrospinal Fluid, Cranial Sinuses, Diagnosis, Differential, Diagnostic Errors, Female, Humans, Magnetic Resonance Imaging, Middle Aged, Sinus Thrombosis, Intracranial, Observer Variation, Arachnoid Cysts
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