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. Acta Neurochir (Wien) 149: 759-769; discussion 769
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.
- SourceAvailable from: Shousen Wang
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- "It may be somewhat easier to differentiate RCCs from craniopharyngiomas than from intracellular arachnoid cysts because craniopharyngiomas are more associated with psychiatric symptoms and calcifications or solid components on imaging . It has also been reported that singleshot fast spin-echo diffusion-weighted MR imaging is of value for differentiating RCCs from craniopharyngiomas and hemorrhagic components of pituitary adenomas, but not from cystic components of pituitary adenoma . Making "
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
Article: Tumoren der Sellaregion[Show abstract] [Hide abstract]
ABSTRACT: Aufgrund der komplexen Anatomie bedarf es bei der Untersuchung der Sella und der Hypophyse eines dezidierten MR-Sequenzprotokolls. Nicht jede selläre Raumforderung ist ein Hypophysenadenom. Daher fasst diese Übersichtsarbeit die häufigsten intra-, supra- und parasellären Tumoren bzw. Raumforderungen zusammen. Die Differenzialdiagnostik umfasst neben Adenomen u.a. Kraniopharyngeome, Meningeome, Gliome, Germinome, Hamartome, Aneurysmen, Trigeminusneurinome, Hypophysenkarzinome, Chordome, Metastasen, Entzündungen und die „empty sella“. Charakteristische Bildzeichen werden präsentiert und mit der Mikro- und Makropathologie korreliert. Because of the complex anatomy, examination of the sella turcica and hypophysis needs a dedicated MR sequence protocol. Not every sellar lesion is a pituitary adenoma. Thus, this review article summarizes the most frequently encountered intra-, supra-, and parasellar tumors and lesions. Differential diagnoses comprise besides adenoma among others craniopharyngioma, meningioma, glioma, germinoma, hamartoma, aneurysm, trigeminal schwannoma, pituitary carcinoma, chordoma, metastasis, infection, and empty sella. Characteristic imaging findings are presented and correlated to micro- and macropathology.Der Radiologe 06/2007; 47(6):492-500. DOI:10.1007/s00117-007-1495-7 · 0.41 Impact Factor