Apparent diffusion coefficient measurements within intracranial epidermoid cysts in six patients

The purpose was to determine whether a strong decrease in apparent diffusion coefficient (ADC) within epidermoid cysts (ECs) is actually responsible for their bright signal intensity on diffusion-weighted (DW) trace images. We studied six patients with surgically proven ECs in whom ADC calculation from T2-weighted DW-EPI-SE data were performed within the ECs and within the deep white matter and cerebrospinal fluid (CSF) as references. All ECs displayed highest signal intensity on the DW trace images. ADC values ranged from 1,280 to 807x10(-6) mm(2)/s within cysts (with a mean value of 1,070), from 849 to 698x10(-6) mm(2)/s within white matter (with a mean value of 764) and from 3,370 to 2,980x10(-6) mm(2)/s within CSF (with a mean value of 3,185). ECs exhibited slightly higher ADC values than white matter, and not the strongly decreased ones which would have been expected if diffusion-weighting were the prominent mechanism for bright signal intensity of the ECs on DW images. However, the EC ADC values are much lower than those of the CSF. Other mechanisms must therefore be involved, i.e. the T2 shine-through effect. Reduced ADC is not the only explanation of the EC bright signal intensity on the DW trace images.