Ventriculus terminalis in adults: unusual magnetic resonance imaging features and review of the literature

Abstract

Objective: The ventriculus terminalis (VT) in adults is a rare pathology. We report various MR imaging features of the adult VT.

Materials and methods: Ten patients were included in this retrospective review.. All patients had undergone magnetic resonance (MR imaging with a surface coil that used two different 1.5T MR systems. All patients had undergone initial and follow-up MR imaging with contrast enhancement using gadopentate dimeglumine. Three patients underwent additional MR imaging using the echocardiogram-gated spatial modulation of magnetization (SPAMM) technique. If a shift in tagging band during the systolic phase was less than half of the band space, it was defined as a "non-pulsatile fluid". Two neuroradiologists independently reviewed these images, while clinical symptoms and outcomes were statistically analyzed between the treated and non-treated group.

Results: All cases presented an intramedullary cystic lesion in the conus medullaris and showed the same signal intensity as CSF. Three VTs had intracystic septation and cord edema, which were pathologically confirmed after surgery; two of these were associated with kyphotic deformity and spinal arteriovenous malformation. SPAMM-MRI of 3 patients demonstrated non-pulsatile fluid motion within the VT. In the treated group, clinical symptoms improved better than the non-treated group.

Conclusion: The adult VT shows some unusual imaging features, including septation, cord edema, and coexistence of a spinal AVM, as well as the typical findings. Surgical maneuvers may be considered as a treatment option in adult VT with progressive neurological symptoms.

Keywords: Adult; Magnetic resonance imaging; Spine; Ventriculus terminalis.

Fig. 1

43-year-old man presented with back pain. A. High signal-intensity T2-weighted sagittal image shows intramedullary cystic lesion in conus medullaris with. B. On spatial modulation of magnetization magnetic resonance sagittal image, there is no movement of tagging band in cystic ventriculus terminalis with cardiac pulsation (arrow).

Fig. 2

50-year old man with left sciatic pain, who had kyphotic deformity. T2-weighted sagittal image shows cystic lesion of conus medullaris and accompanying cord edema (arrow) with thoracic kyphosis.

Fig. 3

T2-weighted coronal image shows cystic lesion of 33-year old man with urinary difficulty. Cystic lesion of conus medullaris has elements of septation and enlargement.