Sellar/Juxtasellar Calcification



Sellar/Juxtasellar Calcification


Anne G. Osborn, MD, FACR



DIFFERENTIAL DIAGNOSIS


Common



  • Physiologic Calcification, Vascular


  • Physiologic Calcification, Dura


  • Atherosclerosis, Intracranial


  • Saccular Aneurysm


  • Meningioma


  • Craniopharyngioma


  • Neurocysticercosis


Less Common



  • Astrocytoma



    • Pilocytic Astrocytoma


    • Diffuse Astrocytoma, Low Grade


    • Pilomyxoid Astrocytoma


    • Chordoid Glioma


  • Dermoid Cyst


  • Arteriovenous Malformation


Rare but Important



  • Cavernous Malformation


  • Chordoma, Clivus


  • Pituitary Macroadenoma


  • Chondrosarcoma, Skull Base


  • Rathke Cleft Cyst


  • Benign Nonmeningothelial Tumors



    • Chondroma


    • Osteochondroma


    • Osteoma


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Is patient asymptomatic?


  • Is calcification physiologic or pathologic?



    • Physiologic



      • Vascular (age-related changes of ASVD)


      • Dural (petroclinoid ligament often calcified)


    • Pathologic



      • Look for associated mass in/around sella, cavernous sinus


  • Anatomic sublocation important



    • Dura (cavernous sinus, tentorium, petroclinoid ligaments) calcifies but less often than falx


    • Arteries (cavernous/supraclinoid ICA) physiologic Ca++ common


    • Pituitary, infundibulum, hypothalamus almost never show physiologic Ca++


Helpful Clues for Common Diagnoses



  • Physiologic Calcification, Vascular



    • Juxtasellar dura, vessels, not brain


  • Atherosclerosis, Intracranial



    • Some age-related ASVD Ca++ normal, physiologic


    • Relationship to stenosis, stroke controversial



      • Thickness of Ca++ plaque does not correlate directly with luminal stenosis


      • Dense, globular Ca++ may be more significant than mural/laminar


      • Some authors suggest high grade of cavernous ICA Ca++ correlates with small (not large) vessel ischemia


  • Saccular Aneurysm



    • Supra/juxtasellar > intracavernous


    • Mural Ca++ common


    • Can be rim, globular


    • Aneurysm often partial/completely thrombosed


  • Meningioma



    • Ca++ 20-25%



      • Diffuse or focal


      • Solid (“brain rock”) or scattered


      • Ca++ pattern highly variable


      • Psammomatous (“sand-like”) or “sunburst” > globular > rim


    • Look for dural “tail”


    • Look for changes in adjacent planum sphenoidale


    • Can cause blistering, hyperostosis, hypertrophied ethmoid or sphenoid sinuses (“pneumosinus dilatans”)


  • Craniopharyngioma



    • In children, 90% cystic, 90% Ca++ (rim, globular)


    • Adults often solid with globular Ca++


  • Neurocysticercosis



    • Healed racemose NCC in basal cisterns may Ca++


Helpful Clues for Less Common Diagnoses



  • Astrocytoma



    • Pilocytic Astrocytoma



      • Common in optic chiasm/hypothalamus/3rd ventricle (2nd most common location after cerebellum)


      • Enhancement varies (none to striking)


      • Ca++ uncommon in supratentorial PAs!


    • Diffuse Astrocytoma, Low Grade




      • WHO grade II may calcify but uncommon in this location


      • No enhancement


    • Pilomyxoid Astrocytoma



      • Rare tumor; common location


      • Hemorrhage common, Ca++ uncommon


    • Chordoid Glioma



      • Newly described distinct tumor entity


      • Hypothalamus/anterior 3rd ventricle mass


      • Ovoid, well-circumscribed


      • Usually solid mass; may have associated cysts (rare)


      • Hyperdense on NECT


      • Ca++ uncommon


      • Hypointense on T1-, iso- to mildly hyperintense on T2WI


      • Enhances strongly, usually uniformly


  • Dermoid Cyst



    • Sellar/parasellar/frontonasal region most common site


    • Unilocular fat-like cyst


    • Look for “droplets” in sulci, cisterns (ruptured dermoid)


    • 20% have capsular Ca++


  • Arteriovenous Malformation



    • Supra/juxtasellar < hemispheres


    • 25-30% Ca++


Helpful Clues for Rare Diagnoses

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Sellar/Juxtasellar Calcification

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