Enhancing Suprasellar Mass



Enhancing Suprasellar Mass


Anne G. Osborn, MD, FACR



DIFFERENTIAL DIAGNOSIS


Common



  • Pituitary Macroadenoma


  • Meningioma


  • Saccular Aneurysm


  • Craniopharyngioma


  • Pilocytic Astrocytoma


Less Common



  • Diffuse Astrocytoma, Low Grade


  • Neurosarcoid


  • Langerhans Cell Histiocytosis


  • Germinoma


  • Lymphocytic Hypophysitis


Rare but Important



  • Metastasis


  • Lymphoma


  • Leukemia


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Effect of age on differential diagnosis important


  • Common lesions (“big five”) account for > 75% of all suprasellar masses


  • Most other lesions < 1-2% each


  • Differential diagnosis narrows if mass confined to infundibulum


Helpful Clues for Common Diagnoses



  • Macroadenoma vs. Meningioma



    • Macroadenoma: Gland can’t be identified separate from mass


    • Meningioma: Mass distinct from gland (hypointense diaphragma sellae separates mass above from pituitary gland below)


  • Saccular Aneurysm



    • Coronal plane helpful in distinguishing aneurysm from normal pituitary


    • Look for phase artifact, “flow void” on MR


  • Craniopharyngioma



    • 90% Ca++, 90% cystic, 90% enhance


    • Papillary variant (more common in adults) may be solid, noncalcified, enhances strongly


  • Pilocytic Astrocytoma



    • More common in children


    • Expands hypothalamus, optic chiasm, may extend into optic nerves/tracts


    • Variable enhancement


    • Pilomyxoid variant



      • Infant > child


      • Aggressive behavior


      • Large, bulky tumor with lateral extension to temporal lobe common


      • Hemorrhage in 20-25%


Helpful Clues for Less Common Diagnoses



  • Histiocytosis, germinoma in children/young adults


  • Neurosarcoid in older patients


Helpful Clues for Rare Diagnoses



  • Solitary metastasis to gland/stalk rare


  • Lymphoma, leukemia usually with systemic disease






Image Gallery









Coronal T1 C+ MR shows inhomogeneously enhancing intra- and suprasellar mass image. Pituitary gland can’t be found separate from and indeed IS the mass.

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Enhancing Suprasellar Mass

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