Purpose

The clinical variability of Blakeʼs pouch cysts (BPC) may range from asymptomatic via ataxia to sequelae of decompensated hydrocephalus. On the other hand, Dandy-Walker malformation (DWM) and cerebellar vermis hypoplasia generally correlate with less favorable neurologic development. The aim was to illustrate the potential of prenatal and postnatal neuroimaging to distinguish a BPC or persistent BP from other posterior fossa malformations.

Methods

This pictorial review addresses the inconsistent nomenclature, clinical features, and magnetic resonance imaging (MRI) patterns of BPC and five differential diagnoses. The MRI findings of 11 patients, acquired at up to 3 T in 3 institutions, are demonstrated. Furthermore, the literature was searched for recent improvements in genetic and embryological background knowledge.

Results

Posterior fossa malformations often resemble each other and may even be imitated by sequelae of hemorrhagic, ischemic or infectious disruptions, i.e. congenital anomalies of morphology despite normal developmental potential. Hydrocephalus is a typical, albeit not always congenital finding in BPC. It is frequently associated with cerebellar disruptions and DWM; however, it is also a rare complication of posterior fossa arachnoid cysts. A moderately elevated vermis needs follow-up to confirm persistent BP versus vermian hypoplasia or DWM. The fetal cerebellar tail, previously assumed to be specific for DWM, may be imitated in cases of persistent BP.

Conclusion

The accurate diagnosis of isolated BPC is not always straightforward, which is especially critical in the context of fetomaternal medicine. A detailed description of posterior fossa malformations is to be preferred over unspecific terminology.

中文翻译：

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布雷克囊袋囊肿和产前和产后MRI的鉴别诊断：画报审查。

目的

布莱克氏囊囊肿（BPC）的临床变异性可能从无症状到共济失调再到失代偿性脑积水的后遗症。另一方面，Dandy-Walker畸形（DWM）和小脑ver部发育不全通常与不良的神经系统发育相关。目的是说明产前和产后神经影像学将BPC或持续性BP与其他后颅窝畸形区分开的潜力。

方法

该图片审查解决了BPC的命名，临床特征和磁共振成像（MRI）模式不一致以及五种鉴别诊断的问题。证实了在3个机构中以3 T采集的11例患者的MRI表现。此外，在文献中寻找遗传和胚胎背景知识的最新进展。

结果

后颅窝畸形通常彼此相似，甚至可能因出血，缺血或感染性破坏（即先天性形态异常）的后遗症而模仿，尽管发育潜力正常。脑积水是典型的，尽管并非总是在BPC中先天性发现。它经常与小脑破坏和DWM相关；然而，它也是后颅蛛网膜囊肿的罕见并发症。中度升高的ver需要随访以确定持续的BP与Vermian增生或DWM。先前假设为DWM特有的胎儿小脑尾巴，在持续性BP的情况下可被模仿。

结论

分离出的BPC的准确诊断并不总是那么简单，这在胎儿母亲医学的背景下尤其重要。与非特定术语相比，优选后颅窝畸形的详细描述。