Rathke's cleft cysts: differentiation from other cystic lesions in the pituitary fossa by use of single-shot fast spin-echo diffusion-weighted MR imaging
ABSTRACT Rathke's cleft cysts are often difficult to differentiate from other sellar cystic lesions using conventional MR imaging. The purpose of this study was to investigate the usefulness of single-shot fast spin-echo (SSFSE) diffusion-weighted MR imaging (DWI) in the diagnosis of a Rathke's cleft cyst.
We examined retrospectively 29 patients with a histologically verified sellar or suprasellar lesion containing a fluid component; 12 patients had a Rathke's cleft cyst, 6 patients a craniopharyngioma, 5 patients a haemorrhagic pituitary adenoma, and 6 patients a cystic pituitary adenoma). Several regions of interest (ROIs) for apparent diffusion coefficient (ADC) measurements were identified in the fluid components of the lesions. For comparison, ADC values were normalized using a relative ADC (rADC), which was determined by dividing the ADC values of lesions by those of normal white matter and expressing the quotient as a ratio.
SSFSE provides diffusion-weighted images without significant susceptibility artifacts. DWI-SSFSE revealed Rathke's cleft cysts as hypointense relative to the normal brain parenchyma in all cases. The mean value of ADC for Rathke's cleft cysts was 2.12 x 10(-3) mm(2)/sec. Both the ADC and relative ADC of the Rathke's cleft cysts were significantly increased compared to those of the cystic components of craniopharyngiomas and haemorrhagic components of pituitary adenomas in the subacute phase (P < 0.05). There was not a statistically significant difference between Rathke's cleft cysts and cystic components of pituitary adenomas (P < 0.05).
DWI-SSFSE with ADC values provides objective information in the differential diagnosis of Rathke's cleft cysts from other sellar cystic lesions. In addition, DWI-SSFSE with ADC values is useful for differentiating Rathke's cleft cysts from craniopharyngiomas and haemorrhagic pituitary adenomas.
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ABSTRACT: Background and Purpose. To explore strategies for the diagnosis and treatment of Rathke's cleft cyst (RCC). Methods. The medical records of 24 patients with sellar RCC were retrospectively reviewed. Two patients had concomitant pituitary adenoma, 2 underwent transcranial surgery, and 22 underwent transsphenoidal surgery. The clinical features, especially the findings of intracystic nodules on MRI, were evaluated and compared with the pathological findings. Results. Preoperatively, only 2 patients were diagnosed with RCC or suspected RCC. Pre- and postoperative MRI images revealed 10 intracystic nodules in 9 (37.5%) patients. Two nodules had bull's eyelike changes. The signal intensity of the intracystic nodules varied on T1- and T2-weighted images. Not all nodules on T2-weighted images were visualized. Postoperative MRI revealed recurrence or residual lesion in 5 patients; none had new symptoms and a second surgery was not required. Conclusions. Identifying intracystic nodules is important in patients with sellar cystic lesions. Bull's eyelike change in an intracystic nodule on MRI, which is reported here for the first time, potentially might have value for confirming the diagnosis.International Journal of Endocrinology 09/2012; 2012:958732. DOI:10.1155/2012/958732 · 1.52 Impact Factor
- American Journal of Neuroradiology 01/2013; 35(1):99-99. DOI:10.3174/ajnr.A3648 · 3.68 Impact Factor
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ABSTRACT: This article aims to provide a brief overview of magnetic resonance imaging (MRI) of the brain for the clinician. A basic review of previous protocols for the region is followed by discussion of the most common imaging sequences. The appearance of normal brain anatomy is reviewed with emphasis on structures prone to pathogenesis; congenital and developmental abnormalities; normal variants and pathology. These are correlated to annotated images. Imaging of brain pathology is then discussed with emphasis on the identification of key elements for the manual physician. Illustrative examples are given with discussion of specific common conditions and their clinical correlation.Clinical Chiropractic 06/2008; 11(2):90-102. DOI:10.1016/j.clch.2008.04.004