由于大多数在前纵隔意外发现的病变是呈软组织外观的小结节，因此鉴别诊断通常涉及胸腺肿瘤和前血管淋巴结，以及良性囊肿。对这些病变的过度评估或误诊可能会导致为最终良性情况进行不必要的手术，因此需要非手术治疗前纵隔病变。前纵隔囊性病变的MRI评估的误区如下：首先，我们承认T2加权图像在评估良性囊性病变时的局限性。由于良性囊性病变中的可变内容，例如出血，T2信号强度可能是可变的。其次，由于广泛的坏死和囊性变化，在扩散加权图像（DWI）上可能会出现T2闪亮效应，小的实性部分可能会在增强图像上漏诊。因此，应考虑使用增强和具有明显扩散系数值的DWI。将提出前纵隔囊性病变的诊断评估算法，并最终建议基于MRI特征的管理策略。版权所有© 2023年韩国放射学会。

As the majority of incidentally detected lesions in the anterior mediastinum is small nodules with soft tissue appearance, the differential diagnosis has typically included thymic neoplasm and prevascular lymph node, with benign cyst. Overestimation or misinterpretation of these lesions can lead to unnecessary surgery for ultimately benign conditions. nonsurgical anterior mediastinal lesions. The pitfalls of MRI evaluation for anterior mediastinal cystic lesions are as follows: first, we acknowledge the limitation of T2-weighted images for evaluating benign cystic lesions. Due to variable contents within benign cystic lesions, such as hemorrhage, T2 signal intensity may be variable. Second, owing to extensive necrosis and cystic changes, the T2 shine-through effect may be seen on diffusion-weighted images (DWI), and small solid portions might be missed on enhanced images. Therefore, both enhancement and DWI with apparent diffusion coefficient values should be considered. An algorithm will be suggested for the diagnostic evaluation of anterior mediastinal cystic lesions, and finally, a management strategy based on MRI features will be suggested.Copyright © 2023 The Korean Society of Radiology.