Torcular pseudomass

a potential diagnostic pitfall in infants and young children

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: Incidental findings on brain MRI may constitute a diagnostic pitfall. We observed an incidental extra-axial midline rounded pseudomass between the torcular Herophili and the occipital squama, with spontaneous resolution, which we called "torcular pseudomass."

OBJECTIVE: We investigated the frequency, imaging features, natural history and developmental background of this finding in a large group of infants and young children.

MATERIALS AND METHODS: We conducted a single-center retrospective study by reviewing all brain MRIs performed in children younger than 3 years between 2007 and 2013 in a specialized pediatric hospital. We looked for soft tissue (minimum 2 mm thick) interposed between the torcula and the occipital squama on midsagittal T1 and T2 images; we recorded the maximal diameters and outcome.

RESULTS: Of 2,283 the children who had brain MRIs during the study period, 291 (12.7%, 95% confidence interval [CI] 0.11, 0.14) presented with a torcular pseudomass (median age 4 months, range 0 days to 35 months, 56% male). MRI features were the same in all of these children: T1 isointensity and T2 hyperintensity to the cerebral cortex, facilitated diffusion on diffusion-weighted imaging and apparent diffusion coefficient maps, and contrast enhancement. The median diameters were: anteroposterior, 5.8 mm; transverse, 10.5 mm; cranio-caudal, 20.6 mm. Follow-up MRI was available in 34.7% (95% CI: 0.20, 0.40) of the children; median follow-up time was 18 months. Among these children, 35.6% (95% CI: 0.26, 0.45) had total involution, 52.5% (95% CI: 0.26, 0.62) had partial involution and 4.1% (95% CI: 0.05, 0.18) showed stability.

CONCLUSION: Redundant soft tissue in the torcular region, or torcular pseudomass, is not an infrequent finding in infants and young children. It should be considered a physiological tissue, reflecting the postnatal developmental process of the brain and cranial vault, without the need for further investigation or follow-up imaging studies.

Original languageEnglish
Pages (from-to)227-234
Number of pages8
JournalPediatric Radiology
Volume47
Issue number2
DOIs
Publication statusPublished - Feb 2017

Fingerprint

Confidence Intervals
Brain
Facilitated Diffusion
Pediatric Hospitals
Incidental Findings
Natural History
Cerebral Cortex
Retrospective Studies

Keywords

  • Brain
  • Child, Preschool
  • Diagnosis, Differential
  • Female
  • Humans
  • Incidental Findings
  • Infant
  • Infant, Newborn
  • Magnetic Resonance Imaging
  • Male
  • Retrospective Studies
  • Journal Article

Cite this

Torcular pseudomass : a potential diagnostic pitfall in infants and young children. / Sampaio, Luísa; Morana, Giovanni; Severino, Mariasavina; Tortora, Domenico; Leão, Miguel; Rossi, Andrea.

In: Pediatric Radiology, Vol. 47, No. 2, 02.2017, p. 227-234.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Incidental findings on brain MRI may constitute a diagnostic pitfall. We observed an incidental extra-axial midline rounded pseudomass between the torcular Herophili and the occipital squama, with spontaneous resolution, which we called {"}torcular pseudomass.{"}OBJECTIVE: We investigated the frequency, imaging features, natural history and developmental background of this finding in a large group of infants and young children.MATERIALS AND METHODS: We conducted a single-center retrospective study by reviewing all brain MRIs performed in children younger than 3 years between 2007 and 2013 in a specialized pediatric hospital. We looked for soft tissue (minimum 2 mm thick) interposed between the torcula and the occipital squama on midsagittal T1 and T2 images; we recorded the maximal diameters and outcome.RESULTS: Of 2,283 the children who had brain MRIs during the study period, 291 (12.7{\%}, 95{\%} confidence interval [CI] 0.11, 0.14) presented with a torcular pseudomass (median age 4 months, range 0 days to 35 months, 56{\%} male). MRI features were the same in all of these children: T1 isointensity and T2 hyperintensity to the cerebral cortex, facilitated diffusion on diffusion-weighted imaging and apparent diffusion coefficient maps, and contrast enhancement. The median diameters were: anteroposterior, 5.8 mm; transverse, 10.5 mm; cranio-caudal, 20.6 mm. Follow-up MRI was available in 34.7{\%} (95{\%} CI: 0.20, 0.40) of the children; median follow-up time was 18 months. Among these children, 35.6{\%} (95{\%} CI: 0.26, 0.45) had total involution, 52.5{\%} (95{\%} CI: 0.26, 0.62) had partial involution and 4.1{\%} (95{\%} CI: 0.05, 0.18) showed stability.CONCLUSION: Redundant soft tissue in the torcular region, or torcular pseudomass, is not an infrequent finding in infants and young children. It should be considered a physiological tissue, reflecting the postnatal developmental process of the brain and cranial vault, without the need for further investigation or follow-up imaging studies.",
keywords = "Brain, Child, Preschool, Diagnosis, Differential, Female, Humans, Incidental Findings, Infant, Infant, Newborn, Magnetic Resonance Imaging, Male, Retrospective Studies, Journal Article",
author = "Lu{\'i}sa Sampaio and Giovanni Morana and Mariasavina Severino and Domenico Tortora and Miguel Le{\~a}o and Andrea Rossi",
year = "2017",
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TY - JOUR

T1 - Torcular pseudomass

T2 - a potential diagnostic pitfall in infants and young children

AU - Sampaio, Luísa

AU - Morana, Giovanni

AU - Severino, Mariasavina

AU - Tortora, Domenico

AU - Leão, Miguel

AU - Rossi, Andrea

PY - 2017/2

Y1 - 2017/2

N2 - BACKGROUND: Incidental findings on brain MRI may constitute a diagnostic pitfall. We observed an incidental extra-axial midline rounded pseudomass between the torcular Herophili and the occipital squama, with spontaneous resolution, which we called "torcular pseudomass."OBJECTIVE: We investigated the frequency, imaging features, natural history and developmental background of this finding in a large group of infants and young children.MATERIALS AND METHODS: We conducted a single-center retrospective study by reviewing all brain MRIs performed in children younger than 3 years between 2007 and 2013 in a specialized pediatric hospital. We looked for soft tissue (minimum 2 mm thick) interposed between the torcula and the occipital squama on midsagittal T1 and T2 images; we recorded the maximal diameters and outcome.RESULTS: Of 2,283 the children who had brain MRIs during the study period, 291 (12.7%, 95% confidence interval [CI] 0.11, 0.14) presented with a torcular pseudomass (median age 4 months, range 0 days to 35 months, 56% male). MRI features were the same in all of these children: T1 isointensity and T2 hyperintensity to the cerebral cortex, facilitated diffusion on diffusion-weighted imaging and apparent diffusion coefficient maps, and contrast enhancement. The median diameters were: anteroposterior, 5.8 mm; transverse, 10.5 mm; cranio-caudal, 20.6 mm. Follow-up MRI was available in 34.7% (95% CI: 0.20, 0.40) of the children; median follow-up time was 18 months. Among these children, 35.6% (95% CI: 0.26, 0.45) had total involution, 52.5% (95% CI: 0.26, 0.62) had partial involution and 4.1% (95% CI: 0.05, 0.18) showed stability.CONCLUSION: Redundant soft tissue in the torcular region, or torcular pseudomass, is not an infrequent finding in infants and young children. It should be considered a physiological tissue, reflecting the postnatal developmental process of the brain and cranial vault, without the need for further investigation or follow-up imaging studies.

AB - BACKGROUND: Incidental findings on brain MRI may constitute a diagnostic pitfall. We observed an incidental extra-axial midline rounded pseudomass between the torcular Herophili and the occipital squama, with spontaneous resolution, which we called "torcular pseudomass."OBJECTIVE: We investigated the frequency, imaging features, natural history and developmental background of this finding in a large group of infants and young children.MATERIALS AND METHODS: We conducted a single-center retrospective study by reviewing all brain MRIs performed in children younger than 3 years between 2007 and 2013 in a specialized pediatric hospital. We looked for soft tissue (minimum 2 mm thick) interposed between the torcula and the occipital squama on midsagittal T1 and T2 images; we recorded the maximal diameters and outcome.RESULTS: Of 2,283 the children who had brain MRIs during the study period, 291 (12.7%, 95% confidence interval [CI] 0.11, 0.14) presented with a torcular pseudomass (median age 4 months, range 0 days to 35 months, 56% male). MRI features were the same in all of these children: T1 isointensity and T2 hyperintensity to the cerebral cortex, facilitated diffusion on diffusion-weighted imaging and apparent diffusion coefficient maps, and contrast enhancement. The median diameters were: anteroposterior, 5.8 mm; transverse, 10.5 mm; cranio-caudal, 20.6 mm. Follow-up MRI was available in 34.7% (95% CI: 0.20, 0.40) of the children; median follow-up time was 18 months. Among these children, 35.6% (95% CI: 0.26, 0.45) had total involution, 52.5% (95% CI: 0.26, 0.62) had partial involution and 4.1% (95% CI: 0.05, 0.18) showed stability.CONCLUSION: Redundant soft tissue in the torcular region, or torcular pseudomass, is not an infrequent finding in infants and young children. It should be considered a physiological tissue, reflecting the postnatal developmental process of the brain and cranial vault, without the need for further investigation or follow-up imaging studies.

KW - Brain

KW - Child, Preschool

KW - Diagnosis, Differential

KW - Female

KW - Humans

KW - Incidental Findings

KW - Infant

KW - Infant, Newborn

KW - Magnetic Resonance Imaging

KW - Male

KW - Retrospective Studies

KW - Journal Article

U2 - 10.1007/s00247-016-3734-4

DO - 10.1007/s00247-016-3734-4

M3 - Article

VL - 47

SP - 227

EP - 234

JO - Pediatric Radiology

JF - Pediatric Radiology

SN - 0301-0449

IS - 2

ER -