T1 Isointense Suprasellar Mass

T1 Isointense Suprasellar Mass

Anne G. Osborn, MD, FACR



  • Pituitary Macroadenoma

  • Pituitary Hyperplasia

  • Meningioma

  • Pilocytic Astrocytoma

  • Diffuse Astrocytoma, Low Grade

Less Common

  • Rathke Cleft Cyst

  • Germinoma

  • Neurosarcoid

  • Langerhans Cell Histiocytosis

  • Tuber Cinereum Hamartoma

  • Lymphocytic Hypophysitis

Rare but Important

  • Metastasis (Pituitary &/or Stalk)

  • Pituicytoma


Key Differential Diagnosis Issues

  • Where does lesion arise from?

    • Pituitary gland/sella turcica (macroadenoma, hyperplasia, hypophysitis, metastasis)

    • Infundibulum (germinoma, histiocytosis, pituicytoma)

    • Brain (astrocytoma), meninges (meningioma)

  • Does it enhance?

    • Yes: Macroadenoma, meningioma, aneurysm, neoplasm

    • No: Tuber cinereum hamartoma, RCC

  • Few lesions remain isointense with cortex on all MR sequences

    • Pituitary macroadenoma or hyperplasia

    • Meningioma, tuber cinereum hamartoma

    • Histiocytosis, sarcoidosis

Helpful Clues for Common Diagnoses

  • Pituitary Macroadenoma, Hyperplasia

    • Both isointense to gray matter (GM)

  • Meningioma

    • Usually isointense on all sequences

    • ± Ca++, enhances

  • Astrocytomas (pilocytic > diffusely infiltrating)

    • Usually iso-/hypo- on T1, hyperintense on T2WI

    • Variable enhancement (none to striking)

Helpful Clues for Less Common Diagnoses

  • Rathke Cleft Cyst (depends on cyst content)

    • Most are hypointense

    • 25% iso-, 10% hyperdense

    • Rim may enhance (“claw sign”)

  • Germinoma

    • Isointense on T1-, iso/hypo on T2WI

    • Enhances strongly, uniformly

  • Neurosarcoid, Langerhans Cell Histiocytosis

    • LCH (child), sarcoid (adult) → thick, enhancing stalk

  • Tuber Cinereum Hamartoma

    • > 90% isointense on T1WI, nonenhancing

    • May be slightly hyperintense on PD, FLAIR

Image Gallery

Coronal T1WI MR shows a large intra- and suprasellar mass image elevating and compressing the optic chiasm image. The mass cannot be distinguished from the pituitary gland.

Only gold members can continue reading. Log In or Register to continue

Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on T1 Isointense Suprasellar Mass
Premium Wordpress Themes by UFO Themes