White epidermoid

White epidermoids are a rare type of epidermoid cyst that do not follow the usual near-CSF density and signal intensity on CT and MR respectively. To make matters worse the literature uses the term inconsistently, although generally the 'white' refers to the T1 weighted imaging appearance. 

Radiographic features

In some cases the intrinsic high T1 signal is due to a high protein content, which renders them relatively hyperattenuating on CT 3. In this case T2 signal can vary from hyper to hypo intense.

Alternatively, high T1 signal can be due to high lipid content (mixed triglycerides and no cholesterol), which are associated with fat density on CT 3-4. This need not be uniform and may also result in signal suppression on fat attenuated sequences (see case 2).  

Additionally intrinsic high T1 signal can be seen in rare instances of haemorrhage into the cyst 3.

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Article Information

rID: 2289
Section: Pathology
Tag: cases
Synonyms or Alternate Spellings:

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Cases and Figures

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    Case 1: non-contrast CT
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    Case 1:T1WI
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    Case 2
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