Hyperdense Suprasellar Mass
Anne G. Osborn, MD, FACR
DIFFERENTIAL DIAGNOSIS
Common
Pituitary Macroadenoma
Aneurysm
Saccular Aneurysm
Fusiform Aneurysm, ASVD
Meningioma
Less Common
Craniopharyngioma
Rathke Cleft Cyst
Germinoma
Neurosarcoid
Rare but Important
Parenchymal Metastases
Primary CNS Lymphoma
Pilomyxoid Astrocytoma
Tuberculosis
Fungal Diseases
Chordoid Glioma
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Is mass from pituitary gland or other structure?
Helpful Clues for Common Diagnoses
Pituitary Macroadenoma
Approximately 10% hyperdense
Cellularity, hemorrhage
Pituitary gland can’t be separated from mass
Gland is the mass
Saccular Aneurysm
Nonthrombosed aneurysms slightly hyperdense to brain
Partially/completely thrombosed aneurysms may be very hyperdense
Fusiform Aneurysm, ASVD
May involve either ICA or BA
Nonaneurysmal dolichoectasia common in older patients
ASVD > non-ASVD (e.g., inherited vasculopathy, AIDS-related, etc.)
ASVD often Ca++
Meningioma
10% in sellar/suprasellar region
Pituitary gland separate from mass
Helpful Clues for Less Common Diagnoses
Craniopharyngioma
Children: Adamantinomatous type
Usually cystic, Ca++
Rarely hyperdense
Adults: Papillary type more common
Iso/slightly hyperdense
Solid, rarely calcified
Rathke Cleft Cyst
Only 10% purely suprasellar, hyperdense
Germinoma
Mildly hyperdense to brain
Look for pineal mass (but can be primary infundibulum/3rd ventricle lesion)
Alternative Differential Approaches
Hyperdense suprasellar mass with Ca++
Children: Craniopharyngioma
Adults: Aneurysm, meningioma