Histology and neuro-imaging in cystic acoustic neuromas

Tumor configuration and attenuation on CT scan with contrast enhancement or gadolinium-DTPA-enhanced MR depends upon tumor histology. Various elements are responsible for the density on CT or MR, e.g. blood vessels, fatty tissue, connective tissue, calcium, necrotic tissue, hemorrhage and intra- or extratumoral cyst formation. In a series of 571 acoustic neuromas we found 23 cystic tumors. The diagnosis was based on neuro-imaging examination, confirmed at surgery and finally verified histologically. Eight tumors with small or large cysts were diagnosed by CT or MR scan as intratumoral, and 15 with large cysts were diagnosed as extratumoral. We found a good correlation between the histology of cystic acoustic neuromas and the CT or MR scans. The tumors were predominantly hypodense, corresponding to the cystic areas, but also iso- or hyperdense areas were observed, corresponding to other tissue types. Antoni type B tissue and xanthomatous areas were found in all 23 cases.