Synonyms
• Lipomatous hamartoma
Definitions
- Mass of mature nonneoplastic adipose tissue
- CNS lipomas are congenital malformations, not true neoplasms
- Lipoma variants in CNS include angiolipoma, hibernoma, osteolipoma
Diagnostic criteria
- Well-delineated lobulated extraaxial mass pial-based fatty mass that may encase vessels and cranial nerves with fat attenuation/intensity
- Midline location common
- 80% supratentorial
- 40-50% interhemispheric fissure (over corpus callosum [CC]; may extend into lateral ventricles, choroid plexus)
- 15-20% suprasellar (attached to infundibulum, hypothalamus)
- 10-15% tectal region (usually inferior colliculus/superior vermis)
- Uncommon: Meckel cave, lateral cerebral fissures, middle cranial fossa
- 20% infratentorial : Cerebellopontine angle (may extend into internal auditory canal, vestibule)
- Uncommon: Jugular foramen, foramen magnum
- Varies from tiny to very large
- CT: -50 to -100 Hounsfield units (HU) (fat density)
- Ca++ varies from none to extensive .
- Standard SE MR: Hyperintense on T1WI
- Becomes hypointense with fat suppression
- 2 kinds of interhemispheric lipoma
- – Curvilinear type (thin ICL curves around callosal body, splenium)
- – Tubulonodular type (bulky mass; frequent Ca++, usually associated with callosal agenesis)
TOP DIFFERENTIAL DIAGNOSES
• Teratoma
○ Locations similar to lipoma
○ Tissue from all 3 embryonic germ layers
DIAGNOSTIC CHECKLIST
• When in doubt, use fat-saturation sequence
• Could high signal on T1WI be due to other substances with short T1 (e.g., subacute hemorrhage)
• Beware: Lipoma can mimic intracranial air on NECT (use bone windows to distinguish)
• Best imaging tool
○ MR
• Protocol advice
○ Add fat-suppression sequence for confirmation
• Associated abnormalities
○ Most common: Interhemispheric lipoma with corpus callosum anomalies
○ Other congenital malformations: Cephaloceles, closed spinal dysraphism
○ Encephalocraniocutaneous lipomatosis → Fishman syndrome
○ Pai syndrome → facial clefts, skin lipomas; occasional ICLs, usually interhemispheric
DIAGNOSTIC CHECKLIST
Consider
• Could high signal on T1WI be due to other substances with short T1 (e.g., subacute hemorrhage)
Image Interpretation Pearls
• When in doubt, use fat-saturation sequence
• Beware: Lipoma can mimic intracranial air on NECT (use bone windows to distinguish)
Imaging gallery
Coronal graphic shows callosal agenesis with a bulky tubulonodular interhemispheric lipoma that encases the arteries and extends into the lateral ventricles. |
Sagittal T1WI MR in a neonate shows a large, tubulonodular, interhemispheric lipoma dorsal to a wedge-shaped callosal remnant . The brain is otherwise normal. |
Axial NECT in a young woman studied for an unrelated headache shows a hypodense linear structure in the midline. |
Axial T1WI MR shows a round lipoma in the right cerebellopontine angle cistern, adjacent to the internal auditory canal (IAC). Lipomas do not cause hearing loss and should not be resected. |
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