case_images: PMC10860505_01
case_images: Axial T2-weighted images showing a CSF signal intensity cystic lesion in the prepontine cistern (A) and in the cisternal space along the midbrain (B). Axial FIESTA:Fast Imaging Employing Steady-state Acquisition images (C, D) aid better visualization of the lesions with thin internal septations.
case_images: uaae001f1.jpg
case_images: PMC10860505_01_uaae001f1.jpg
case_images: uaae001-F1
case_images: MRI imaging (T2WI) of the brain showed expansion of the left prepontine cistern with the subtle presence of fluid-signal intensity cystic lesions, which extended posterior to the midbrain and displaced it towards the contralateral side (Figure 1A and B). Moderate hydrocephalus was also noted. The lesions were better delineated on FIESTA images with thin septations as additional findings; these septations were not seen on T2 (Figure 1C and D).
case_images: PMC10860505_02
case_images: Axial T1-weighted image (A) showing a multiloculated cystic lesion in the pineal region with peripheral enhancement on the post-contrast sagittal image. (B) Axial T2 and FIESTA:Fast Imaging Employing Steady-state Acquisition images show a multiloculated cystic lesion in the pineal region (arrow).
case_images: uaae001f2.jpg
case_images: PMC10860505_02_uaae001f2.jpg
case_images: uaae001-F2
case_images: MRI brain revealed a multiloculated cystic lesion in the pineal region extending into the third ventricle with resultant obstruction (Figure 2). T1 (Figure 2A) with a thin rim of peripheral enhancement on the post-contrast study (Figure 2B). T2 and FIESTA images showed a characteristic multiloculated appearance (Figure 2C and D), classically called a "cluster of grapes" appearance. The lesion caused a mass effect on the tectum and thalami with the narrowing of the aqueduct of Sylvius.
case_images: PMC10860505_03
case_images: Axial T2-weighted image (A) shows a multiloculated cystic lesion along the roof of the third ventricle with further extension along the undersurface of the corpus callosum. The axial FIESTA:Fast Imaging Employing Steady-state Acquisition (B) image shows a better definition with thin internal septations.
case_images: uaae001f3.jpg
case_images: PMC10860505_03_uaae001f3.jpg
case_images: uaae001-F3
case_images: The third ventricle roof was displaced posteriorly into the basal cisterns (Figure 3A and B).
case_images: PMC10860505_04
case_images: Axial T2-weighted image (A) shows dilated ambient cistern with an indentation on the pons. Axial T2 image (B) shows dilated lateral ventricles with widened sulcal spaces in the temporoparietal region. Axial FIESTA:Fast Imaging Employing Steady-state Acquisition image (C) revealed a cystic lesion in the ambient cistern, causing indentation on the pons. In addition to the widening of sulcal spaces, the axial FIESTA:Fast Imaging Employing Steady-state Acquisition image (D) shows thin septations.
case_images: uaae001f4.jpg
case_images: PMC10860505_04_uaae001f4.jpg
case_images: uaae001-F4
case_images: It showed a dilated ambient cistern with indentation on the pons (Figure 4A). The lateral ventricles were markedly dilated along with dilatation of bilateral CSF spaces in the temporoparietal region with dominant involvement of Sylvian fissures (Figure 4B). MRI (Figure 4C and D), the lesion showed thin septations in the ambient cistern and Sylvian fissures, which strongly suggested the diagnosis of racemose NCC. Moderate hydrocephalus was also present.
case_images: PMC10860505_05
case_images: Axial T2-weighted images show a cystic lesion in the right Sylvian fissure (A) with asymmetric prominence of the right Sylvian fissure (B). Axial T1 image (C) showing smooth peripheral enhancement. The susceptibility-weighted image (D) shows a blooming focus in the cystic lesion, representing a scolex. Axial FIESTA:Fast Imaging Employing Steady-state Acquisition (E, F) images better visualize the cystic lesion and additionally demonstrate multiple thin septations in the widened right Sylvian fissure.
case_images: uaae001f5.jpg
case_images: PMC10860505_05_uaae001f5.jpg
case_images: uaae001-F5
case_images: On T2W MRI, a hyperintense multilobulated cystic lesion was detected in the right Sylvian fissure (Figure 5A and B). It showed smooth peripheral enhancement (Figure 5C). Eccentric blooming focus representing scolex was seen on susceptibility-weighted imaging (SWI, Figure 5D). In addition to showing cystic lesions, the FIESTA image showed multiple thin septations in the rest of the Sylvian fissure, suggesting a more extensive involvement (Figure 5D and E).