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Intracranial Lipoma

Open Table of Contents: Intracranial Lipoma

Figure 1: This tectal plate lipoma demonstrates low density of fat on CT imaging (top left) and hyperintensity on T1WI (top right). (Bottom) Fat-suppression techniques should make the lesion appear dark, as on this axial T2-weighted fat-saturated sequence.

Figure 1: This tectal plate lipoma demonstrates low density of fat on CT imaging (top left) and hyperintensity on T1WI (top right). (Bottom) Fat-suppression techniques should make the lesion appear dark, as on this axial T2-weighted fat-saturated sequence.

Figure 2: Axial (top left) and sagittal (top right) T1-weighted images demonstrate an intrinsically T1 hyperintense pericallosal mass that is suppressed on T2-weighted fat-saturation imaging (bottom). The appearance and location are classic for intracranial lipoma, resulting from a developmental failure of the meninx primitiva to involute.

Figure 2: Axial (top left) and sagittal (top right) T1-weighted images demonstrate an intrinsically T1 hyperintense pericallosal mass that is suppressed on T2-weighted fat-saturation imaging (bottom). The appearance and location are classic for intracranial lipoma, resulting from a developmental failure of the meninx primitiva to involute.

BASIC DESCRIPTION

  • Fat-containing developmental or congenital abnormalities of neural crest origin
  • Rarely neoplastic
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PATHOLOGY

  • Arise secondary to abnormal differentiation of the meninx primitiva
  • Associated with other neural crest congenital anomalies in 60% of cases, often agenesis of the corpus callosum or underdevelopment of the inferior colliculus
  • Located in the pericallosal region or within the quadrigeminal, suprasellar, or cerebellopontine angle cisterns

CLINICAL FEATURES

  • All ages affected
  • Common presenting signs/symptoms
    • Usually asymptomatic (incidental finding on imaging performed for other reasons)
  • Treatment: usually no treatment required; resection or cerebrospinal fluid shunting if large with mass effect or hydrocephalus

IMAGING FEATURES

  • General
    • Well-marginated, low-attenuation or high-signal-intensity mass (fat density)
  • CT
    • Hypoattenuating (–20 to –100 Hounsfield units)
    • ±Peripheral calcification
    • No enhancement on contrast-enhanced CT imaging
  • MRI
    • T1WI: hyperintense
    • T2WI: similar signal as scalp fat
    • Suppresses on fat-saturated sequences
    • T1WI+C: no enhancement

IMAGING RECOMMENDATIONS

  • CT imaging is often definitive, MRI without and with intravenous contrast might be necessary to exclude mimics

For more information, please see the corresponding chapter in Radiopaedia.

Contributors: Rachel Seltman, MD, and Jacob A. Eitel, MD

DOI: https://doi.org/10.18791/nsatlas.v1.03.01.24

References

Gossner J. Small intracranial lipomas may be a frequent finding on computed tomography of the brain. A case series. Neuroradiol J 2013;26:27–29. doi.org/10.1177/197140091302600104.

Jabot G, Stoquart-Elsankari S, Saliou G, et al. Intracranial lipomas: clinical appearances on neuroimaging and clinical significance. J Neurol 2009;256:851–855. doi.org/10.1007/s00415-009-5087-5.

Osborn AG, Salzman KL, Jhaveri MD. Diagnostic Imaging (3rd ed). Elsevier, Philadelphia, PA; 2016.

Yildiz H, Hakyemez B, Koroglu M, et al. Intracranial lipomas: importance of localization. Neuroradiology 2006;48:1–7. doi.org/10.1007/s00234-005-0001-z.

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