Residual giant-cystic craniopharyngiomas are amenable to intracavitary bleomycin treatment. Radiologic identification of potential cyst leaks is of paramount for treatment decisions. This report describes our experience in the use of intracystic Gadolinium (Gd)-enhanced MR imaging to determine potential communications between the tumoral cysts and other intra-axial spaces in 4 pediatric patients with residual giant-cystic craniopharyngiomas in whom intracavitary bleomycin treatment was planned after the injection of .1-.2 mL of gadopentetate dimeglumine (Gd-DTPA). In three cases no leaks were found. In one case, whose previous water-soluble iodinated contrast-enhanced CT cystography was negative for leaks, intracystic Gd-enhanced MR showed intraventricular Gd enhancement. We conclude that MR imaging after intracystic administration of Gd-based contrast paramagnetic agents is useful in the detection of potential leaks in cases of giant residual craniopharyngiomas.
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