Torcular pseudomass in newborns and its association with delivery: follow up or leave it alone?

Arda H. Ceylan; David R. Nascene; Haitao Huang; Christopher J Luedemann; Nathan Rubin; Can Özütemiz

doi:10.1007/s00234-022-02981-2

Torcular pseudomass in newborns and its association with delivery: follow up or leave it alone?

Arda H. Ceylan, David R. Nascene, Haitao Huang, Christopher J Luedemann, Nathan Rubin, Can Özütemiz

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Abstract

Purpose: The cranial epidural space (ES) is a potential space and is not generally recognized unless there is underlying pathology. With MRI in newborns, we have frequently observed T2 hyperintense thickening of the ES posterior to the confluence of sinuses, also referred to as “torcular pseudomass” (TP). We aim to identify the frequency of TP and possible associations with delivery. Methods: Retrospectively, brain MRIs of 194 neonates obtained within the first 2 weeks of life were evaluated. If TP was present, imaging characteristics and thickness were assessed by two observers, using fat-suppressed T2WI/FLAIR, T1WI, and SWI. Exclusion criteria were motion artifact, lack of sagittal T2WI, and lack of clinical data. Medical records were evaluated for demographic and clinical data. Follow-up exams were evaluated if available. Patients with TP and without were compared using Student t and chi-square tests. Results: TP was present in 64/158 (40%). No difference was found between the groups regarding sex, gestational age, birth weight, delivery type, fetal presentation during delivery, birth difficulty, and neurological sequelae (p > 0.05). Eight patients with TP underwent follow-up imaging, and in 6/8, TP completely resolved. Two patients showed persistent TP, improving from 3.2 to 1 mm in one child and from 3.2 to 2.8 mm in the other within a week. Conclusion: TP frequently occurs in early newborns. TP does not appear to be associated with factors related to delivery, shows complete resolution in most cases with a follow-up, and is likely of no clinical importance.

Original language	English (US)
Pages (from-to)	2069-2076
Number of pages	8
Journal	Neuroradiology
Volume	64
Issue number	10
DOIs	https://doi.org/10.1007/s00234-022-02981-2
State	Published - Oct 2022

Bibliographical note

Funding Information:
Nathan Rubin: Research reported in this publication was supported by NIH grant P30CA077598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota, and by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1-TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Keywords

Epidural edema
Epidural space
MRI
Newborn
Pitfall
Torcular pseudomass

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10.1007/s00234-022-02981-2

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@article{c53c0d7e29054395aa2e6e83f0a030d1,

title = "Torcular pseudomass in newborns and its association with delivery: follow up or leave it alone?",

abstract = "Purpose: The cranial epidural space (ES) is a potential space and is not generally recognized unless there is underlying pathology. With MRI in newborns, we have frequently observed T2 hyperintense thickening of the ES posterior to the confluence of sinuses, also referred to as “torcular pseudomass” (TP). We aim to identify the frequency of TP and possible associations with delivery. Methods: Retrospectively, brain MRIs of 194 neonates obtained within the first 2 weeks of life were evaluated. If TP was present, imaging characteristics and thickness were assessed by two observers, using fat-suppressed T2WI/FLAIR, T1WI, and SWI. Exclusion criteria were motion artifact, lack of sagittal T2WI, and lack of clinical data. Medical records were evaluated for demographic and clinical data. Follow-up exams were evaluated if available. Patients with TP and without were compared using Student t and chi-square tests. Results: TP was present in 64/158 (40%). No difference was found between the groups regarding sex, gestational age, birth weight, delivery type, fetal presentation during delivery, birth difficulty, and neurological sequelae (p > 0.05). Eight patients with TP underwent follow-up imaging, and in 6/8, TP completely resolved. Two patients showed persistent TP, improving from 3.2 to 1 mm in one child and from 3.2 to 2.8 mm in the other within a week. Conclusion: TP frequently occurs in early newborns. TP does not appear to be associated with factors related to delivery, shows complete resolution in most cases with a follow-up, and is likely of no clinical importance.",

keywords = "Epidural edema, Epidural space, MRI, Newborn, Pitfall, Torcular pseudomass",

author = "Ceylan, {Arda H.} and Nascene, {David R.} and Haitao Huang and Luedemann, {Christopher J} and Nathan Rubin and Can {\"O}z{\"u}temiz",

note = "Funding Information: Nathan Rubin: Research reported in this publication was supported by NIH grant P30CA077598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota, and by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1-TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2022",

month = oct,

doi = "10.1007/s00234-022-02981-2",

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TY - JOUR

T1 - Torcular pseudomass in newborns and its association with delivery

T2 - follow up or leave it alone?

AU - Ceylan, Arda H.

AU - Nascene, David R.

AU - Huang, Haitao

AU - Luedemann, Christopher J

AU - Rubin, Nathan

AU - Özütemiz, Can

N1 - Funding Information: Nathan Rubin: Research reported in this publication was supported by NIH grant P30CA077598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota, and by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1-TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

PY - 2022/10

Y1 - 2022/10

N2 - Purpose: The cranial epidural space (ES) is a potential space and is not generally recognized unless there is underlying pathology. With MRI in newborns, we have frequently observed T2 hyperintense thickening of the ES posterior to the confluence of sinuses, also referred to as “torcular pseudomass” (TP). We aim to identify the frequency of TP and possible associations with delivery. Methods: Retrospectively, brain MRIs of 194 neonates obtained within the first 2 weeks of life were evaluated. If TP was present, imaging characteristics and thickness were assessed by two observers, using fat-suppressed T2WI/FLAIR, T1WI, and SWI. Exclusion criteria were motion artifact, lack of sagittal T2WI, and lack of clinical data. Medical records were evaluated for demographic and clinical data. Follow-up exams were evaluated if available. Patients with TP and without were compared using Student t and chi-square tests. Results: TP was present in 64/158 (40%). No difference was found between the groups regarding sex, gestational age, birth weight, delivery type, fetal presentation during delivery, birth difficulty, and neurological sequelae (p > 0.05). Eight patients with TP underwent follow-up imaging, and in 6/8, TP completely resolved. Two patients showed persistent TP, improving from 3.2 to 1 mm in one child and from 3.2 to 2.8 mm in the other within a week. Conclusion: TP frequently occurs in early newborns. TP does not appear to be associated with factors related to delivery, shows complete resolution in most cases with a follow-up, and is likely of no clinical importance.

AB - Purpose: The cranial epidural space (ES) is a potential space and is not generally recognized unless there is underlying pathology. With MRI in newborns, we have frequently observed T2 hyperintense thickening of the ES posterior to the confluence of sinuses, also referred to as “torcular pseudomass” (TP). We aim to identify the frequency of TP and possible associations with delivery. Methods: Retrospectively, brain MRIs of 194 neonates obtained within the first 2 weeks of life were evaluated. If TP was present, imaging characteristics and thickness were assessed by two observers, using fat-suppressed T2WI/FLAIR, T1WI, and SWI. Exclusion criteria were motion artifact, lack of sagittal T2WI, and lack of clinical data. Medical records were evaluated for demographic and clinical data. Follow-up exams were evaluated if available. Patients with TP and without were compared using Student t and chi-square tests. Results: TP was present in 64/158 (40%). No difference was found between the groups regarding sex, gestational age, birth weight, delivery type, fetal presentation during delivery, birth difficulty, and neurological sequelae (p > 0.05). Eight patients with TP underwent follow-up imaging, and in 6/8, TP completely resolved. Two patients showed persistent TP, improving from 3.2 to 1 mm in one child and from 3.2 to 2.8 mm in the other within a week. Conclusion: TP frequently occurs in early newborns. TP does not appear to be associated with factors related to delivery, shows complete resolution in most cases with a follow-up, and is likely of no clinical importance.

KW - Epidural edema

KW - Epidural space

KW - MRI

KW - Newborn

KW - Pitfall

KW - Torcular pseudomass

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Torcular pseudomass in newborns and its association with delivery: follow up or leave it alone?

Abstract

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Keywords

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