Presentation
Recurrent headaches, no weakness/vomiting/photophobia.
Patient Data
A well-defined, extra-axial lesion in the right quadrigeminal cistern. The lesion is T1 markely hyperintense and FLAIR hyperintense, T2 heterogeneous intensity. Importantly, fat-supressed T1 shows a drop in signal and a prominent chemical shift artefact on gradient echo. On DWI there is profound signal loss, rendering ADC uninterpretable. No mass effect, no hydrocephalus noted. The rest of the brain parenchyma appeared normal. Features were suggestive of lipoma thus no contrast scan was done.
Case Discussion
The location of the lesion in the quadrigeminal cistern with a typical fat signal with a drop on fat-suppressed sequence and chemical shift artefact confirms a fat-containing lesion like a lipoma.
These lesions are benign and asymptomatic (or may cause headaches, or seizures) with the majority detected incidentally on CT or MRI. They require no treatment and are diagnosed based on radiological features, requiring no histological confirmation. Fat suppression sequence plays an important role in confirming the diagnosis. Blooming on SWI is due to susceptibility artefact.
Typical locations in the brain are corpus callosum, cistern spaces like CP angle, suprasellar, or quadrigeminal. On CT scan, typical fatty attenuation is noted without post-contrast enhancement.
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