Answer of October 2013


Clinical History:

A 40 years old woman presented with visual disturbance and headache. MRI pituitary was performed.

T1W Coronal and post-contrast

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T1W Coronal Images

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T1W Sagittal and post-contrast

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T1W Sagittal Images

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T2W Coronal Image

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MRI showed a T1W hypointense, T2W hyperintense homogenously enhancing lesion at sella/suprasella region. Dural tail appearance is seen on sagittal image. Pituitary appears spared. Features compatible with meningioma.

Main differential diagnosis is pituitary macroadenoma. Pituitary macroadenoma is usually isointense on T1W image, moderately hyperintense on T2W image, and can shows homogenous enhancement. Because pituitary macroadenoma is soft tumor, it can give a 'snowman' configuration caused by constriction by the diaphragma sellae. This constriction is not seen in current case, making this diagnosis less likely.

Craniopharyngioma is the most common suprasellar mass. It is commonly cystic, therefore is usually markedly T2W hyperintense. It can demonstrate variable signal on T1W due to presence of internal hemorrhage, fat or proteinaceous products. Calcification can be seen, commonly in younger patients. The signal intensities are not typical of craniopharyngioma in current case.

Rathke�䏭 cleft cyst is cystic lesion located at the junction between anterior and posterior pituitary gland without enhancement.

Hypothalamic harmatoma arises from the posterior hypothalamus in the region of tuber cinereum, with image characteristics of grey matter on MRI but no enhancement.

Correct diagnosis is important as the approach of surgical treatment for pituitary macroadenoma and meningioma is different. The most commonly employed approach to pituitary tumour is transphenoidally, whereas in meningioma, craniotomy is usually necessary.