T1 Isointense Suprasellar Mass



T1 Isointense Suprasellar Mass


Anne G. Osborn, MD, FACR



DIFFERENTIAL DIAGNOSIS


Common



  • 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


ESSENTIAL INFORMATION


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.

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