Calcified Suprasellar Mass

Anne G. Osborn, MD, FACR

DIFFERENTIAL DIAGNOSIS

Common

Less Common

Rare but Important

ESSENTIAL INFORMATION

Key Differential Diagnosis Issues

Helpful Clues for Common Diagnoses

Atherosclerosis, Intracranial
- Curvilinear Ca++
- Usually bilateral
- Often multifocal
- Older patients
Craniopharyngioma
- Globular, punctate, &/or ring Ca++
- Younger patients (older adult tumors more often solid, Ca++ less frequent)
Meningioma
- Psammomatous (sand-like) Ca++
- Solid > rim enhancement
- Middle-aged, older patients (unless NF2)
Aneurysm
- Saccular Aneurysm
  - Calcification less common than with fusiform aneurysm, ASVD
  - Curvilinear (peripheral arcs, rings) pattern
- Fusiform Aneurysm, ASVD
  - Linear ± rim Ca++
  - Ca++ often present in other vessels

Helpful Clues for Less Common Diagnoses

Neurocysticercosis
- Nodular calcified stage
- Usually parenchymal > > cisternal Ca++
Pilocytic Astrocytoma
- Common in children, young adults
- Ca++ uncommon in hypothalamic PA
Dermoid Cyst
- 20% have capsular Ca++
- Contain lipid
- Look for evidence of rupture (fatty droplets in subarachnoid spaces, cisterns)
- No enhancement unless chemical meningitis

Helpful Clues for Rare Diagnoses

Only 1-2% of macroadenomas calcify
TB, healing/healed granulomatous infections cause parenchymal > > cisternal Ca++
Chondromas, enchondromas arise from central base of skull