Figure 1
Post gadolinium T1 weighted images
Rathke cleft cyst
SectionNeuroradiology
Case TypeClinical Cases
AuthorsMahmoud Shahin, Alberto Palomar Estrada
Connected authors
30 years, female
Clinical History
A 30-year-old woman with headache was studied. There were no endocrine disorders.
Cranial MRI was performed in which a nodule was seen at the level of the sella turcica (no available images), so MRI for hypothalamic-pituitary region was done.
Cranial MRI was performed in which a nodule was seen at the level of the sella turcica (no available images), so MRI for hypothalamic-pituitary region was done.
Imaging Findings
T1 weighted images showed a hyperintense, intrasellar and well-circumscribed nodule. This nodule is hypointense en T2 weighted images and didn't enhance with intravenous gadolinium. There no deviation of the pituitary stalk (Fig. 1-5).
Discussion
MR imaging is the modality of choice for evaluation of the sellar and parasellar regions. It provides multiplanar images with high tissue contrast differentiation, and it is noninvasive. [1]
The most common abnormalities that arise in the pituitary gland are pituitary adenoma, Rathke's cleft cyst and craniopharyngioma. [1, 2]
Rathke cleft cysts (also known as pars intermedia cysts) are non-neoplastic, sellar or suprasellar epithelium-lined cysts arising from the embryologic remnants of Rathke’s pouch in the pituitary gland. [1, 2, 3]
Rathke cleft cysts are common and are found in 11-22% of autopsies. Although Rathke cleft cysts are usually asymptomatic, they may produce symptoms by compressing the pituitary gland or hypothalamus, most frequently in patients 50 to 60 years of age and causing visual disturbances, pituitary dysfunction or headaches. [2, 3]
On imaging a Rathke’s cleft cyst is seen as a well defined non enhancing midline cyst within the sella arising between the anterior and intermediate lobes of the pituitary. 40% are purely intrasellar and 60% have suprasellar extension. Purely suprasellar location, although reported, is rare. [2, 3, 4]
On CT; it is typically non-calcified and of homogenous low attenuation. Uncommonly it may be mixed, iso- and low-attenuation, or contain small curvilinear calcifications in the wall. They are typically non-enhancing. [2, 3]
MR imaging shows a round, sharply defined intra- or suprasellar mass that typically lies anterior to the infundibular stalk. The cystic contents may have variable signal intensity: Either low signal intensity on T1-weighted images and high signal intensity on T2-weighted images resembling CSF, or high signal intensity on T1-weighted images and variable signal intensity on T2-weighted images owing to a high mucopolysaccharide content. Neither contrast enhancement nor calcifications are usually seen. [2, 3, 4]
The most common abnormalities that arise in the pituitary gland are pituitary adenoma, Rathke's cleft cyst and craniopharyngioma. [1, 2]
Rathke cleft cysts (also known as pars intermedia cysts) are non-neoplastic, sellar or suprasellar epithelium-lined cysts arising from the embryologic remnants of Rathke’s pouch in the pituitary gland. [1, 2, 3]
Rathke cleft cysts are common and are found in 11-22% of autopsies. Although Rathke cleft cysts are usually asymptomatic, they may produce symptoms by compressing the pituitary gland or hypothalamus, most frequently in patients 50 to 60 years of age and causing visual disturbances, pituitary dysfunction or headaches. [2, 3]
On imaging a Rathke’s cleft cyst is seen as a well defined non enhancing midline cyst within the sella arising between the anterior and intermediate lobes of the pituitary. 40% are purely intrasellar and 60% have suprasellar extension. Purely suprasellar location, although reported, is rare. [2, 3, 4]
On CT; it is typically non-calcified and of homogenous low attenuation. Uncommonly it may be mixed, iso- and low-attenuation, or contain small curvilinear calcifications in the wall. They are typically non-enhancing. [2, 3]
MR imaging shows a round, sharply defined intra- or suprasellar mass that typically lies anterior to the infundibular stalk. The cystic contents may have variable signal intensity: Either low signal intensity on T1-weighted images and high signal intensity on T2-weighted images resembling CSF, or high signal intensity on T1-weighted images and variable signal intensity on T2-weighted images owing to a high mucopolysaccharide content. Neither contrast enhancement nor calcifications are usually seen. [2, 3, 4]
Differential Diagnosis List
Rathke’s cleft cyst
Craniopharyngioma
Cystic pituitary adenoma
Arachnoid cyst
Epidermoid
Cyst teratoma
Final Diagnosis
Rathke’s cleft cyst
References
[1] Johnsen DE, Woodruff WW, Allen IS, Cera PJ, Funkhouser GR, Coleman LL. (1991) MR imaging of the sellar and juxtasellar regions. RadioGraphics 11, 727-758. (PMID: 1947311)
[2] Saleem SN, et al. (2007) Lesions of the hypothalamus: MR imaging diagnostic features. RadioGraphics 27:1087–1108 (PMID: 17620469)
[3] Bonneville F, et al (2006) T1 signal hyperintensity in the sellar region: spectrum of findings. Radiographics 26(1):93-113. (PMID: 16418246)
[4] Osborn AG, et al. (2006) Intracranial cysts: radiologic-pathologic correlation and imaging approach. Radiology 239(3):650-64. (PMID: 16714456)
Case information
| URL: | https://www.eurorad.org/case/11284 |
| DOI: | 10.1594/EURORAD/CASE.11284 |
| ISSN: | 1563-4086 |
Post gadolinium T1 weighted images
Sagittal post gadolinium administration T1 weighted images show that the nodule doesn’t enhance.
Shahin M, Department of Radiology, Santa Barbara Hospital, Puertollano, Spain.
Shahin M, Department of Radiology, Santa Barbara Hospital, Puertollano, Spain.
Coronal post gadolinium administration T1 weighted images show that the nodule doesn’t enhance.
Shahin M, Department of Radiology, Santa Barbara Hospital, Puertollano, Spain.
Shahin M, Department of Radiology, Santa Barbara Hospital, Puertollano, Spain.
T2 weighted images
Sagittal T2 weighted images show a hypointense, intrasellar and well-circumscribed nodule.
Shahin M, Department of Radiology, Santa Barbara Hospital, Puertollano, Spain.
Shahin M, Department of Radiology, Santa Barbara Hospital, Puertollano, Spain.
Coronal T2 weighted images show a hypointense, intrasellar and well-circumscribed nodule.
Shahin M, Department of Radiology, Santa Barbara Hospital, Puertollano, Spain.
Shahin M, Department of Radiology, Santa Barbara Hospital, Puertollano, Spain.
T1 weighted images
Sagittal T1 weighted images show a hyperintense, intrasellar and well-circumscribed nodule.
Shahin M, Department of Radiology, Santa Barbara Hospital, Puertollano, Spain.
Shahin M, Department of Radiology, Santa Barbara Hospital, Puertollano, Spain.
Coronal T1 weighted images show a hyperintense, intrasellar and well-circumscribed nodule.
Shahin M, Department of Radiology, Santa Barbara Hospital, Puertollano, Spain.
Shahin M, Department of Radiology, Santa Barbara Hospital, Puertollano, Spain.