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title: "Calcified Suprasellar Mass"
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docid: "b61b0b70-de36-45f9-88a2-162a9758b729"
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authors:
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- key: "e0282a62-994d-4550-a127-1eb773b1e920"
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value: "Blair A. Winegar, MD"
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- key: "5cff4116-3654-4b3a-bb75-5ebe0b8c9850"
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value: "Anne G. Osborn, MD, FACR"
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- key: "8d5254e9-8dda-478b-8f08-bdee97a32c79"
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value: "Karen L. Salzman, MD, FACR"
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breadcrumbs:
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-
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name: "Brain"
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slug: "brain"
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treeNodeId: "6d8829f1-14d7-45af-8675-255189aa526a"
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-
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name: "Differential Diagnosis"
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slug: "differential-diagnosis"
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treeNodeId: "a7fdd139-664e-4bb8-8d18-400e4733ff60"
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-
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name: "Sella/Juxtasellar, Pineal Region"
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slug: "sellajuxtasellar-pineal-region"
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treeNodeId: "5e38b9c1-3137-47e3-aa83-1fc82cb4099a"
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-
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name: "Anatomically Based Differentials"
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slug: "anatomically-based-differentials"
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treeNodeId: "7a51b2ca-8fee-4c16-aff3-b7189f68ea60"
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-
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name: "Calcified Suprasellar Mass"
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slug: "calcified-suprasellar-mass"
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treeNodeId: null
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category: "Brain"
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documentVersionId: "9a1f2879-7179-44a8-abaa-f97284492f8d"
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imageCount: 15
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lastUpdated: "02/01/23"
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pageDescription: "Calcified Suprasellar Mass"
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pageKeywords: "Brain, Differential Diagnosis, Sella/Juxtasellar, Pineal Region, Anatomically Based Differentials, Calcified Suprasellar Mass"
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pageTitle: "Calcified Suprasellar Mass | STATdx"
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enhancedTitle: "Calcified Suprasellar Mass"
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type: "DDX"
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references: true
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breadcrumbs:
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- "Brain"
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- "Differential Diagnosis"
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- "Sella/Juxtasellar, Pineal Region"
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- "Anatomically Based Differentials"
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- "Calcified Suprasellar Mass"
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---
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# ESSENTIAL INFORMATION
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- ## Key Differential Diagnosis Issues
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- Is Ca⁺⁺ curvilinear, punctate, globular, etc.?
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- Does lesion enhance?
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- ## Helpful Clues for Common Diagnoses
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- **Atherosclerosis****, Intracranial**
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- Curvilinear Ca⁺⁺ along vessel walls
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- Usually bilateral, often multifocal
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- Older patients
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- **Craniopharyngioma**
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- Globular, punctate, &/or ring Ca⁺⁺
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- **Adamantinomatous**: Bimodal age distribution (peaks 5-15 years and 45-60 years)
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- **Papillary**: Older adult tumors more often solid, Ca⁺⁺ less frequent
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- **Meningioma**
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- Psammomatous (sand-like) Ca⁺⁺
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- Solid > rim enhancement
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- Middle-aged, older patients (unless NF2)
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- **Aneurysm**
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- **Saccular****a****neurysm**
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- Calcification less common than with fusiform aneurysm, ASVD
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- Curvilinear (peripheral arcs, rings) pattern
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- **Fusiform****a****neurysm, atherosclerotic**
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- Linear ± rim Ca⁺⁺
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- Ca⁺⁺ often present in other vessels
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- ## Helpful Clues for Less Common Diagnoses
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- **Neurocysticercosis**
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- Nodular calcified stage
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- Usually parenchymal > > cisternal Ca⁺⁺
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- **Pilocytic Astrocytoma**
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- Common in children, young adults
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- Ca⁺⁺ uncommon in hypothalamic PA
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- **Dermoid Cyst**
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- 20% have capsular Ca⁺⁺
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- Contain lipid
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- Look for evidence of rupture (fatty droplets in subarachnoid spaces, cisterns)
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- No enhancement unless chemical meningitis
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- ## Helpful Clues for Rare Diagnoses
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- **Pituitary Macroadenoma**
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- Only 1-2% of macroadenomas calcify
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- Adenomas usually isodense with gray matter
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- Majority result in smooth enlargement of sella turcica
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- **Rathke Cleft Cyst**
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- Vast majority have no calcification (> 85%)
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- May rarely see thin, curvilinear rim calcification (10-15%)
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- Typically hypodense to brain parenchyma
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- **Tuberculosis**
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- TB, healing/healed granulomatous infections cause parenchymal > > cisternal Ca⁺⁺
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- **Chondroid Tumor**
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- Chondromas, enchondromas arise from central skull base
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- Chondroid matrix on CT
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- May extend to suprasellar region
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## References
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# Selected References
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1. [Alali AA et al: Do we need gadolinium-based contrast agents for routine MRI surveillance of unoperated pituitary macroadenoma? AJNR Am J Neuroradiol. 43(7):1024-8, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=35738673%5Bpmid%5D)
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1. [Perret CM et al: A giant internal carotid bifurcation aneurysm as a rare and dangerous differential diagnosis of a craniopharyngioma. Cureus. 14(1):e21588, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=35228946%5Bpmid%5D)
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1. [Jipa A et al: Imaging of the sellar and parasellar regions. Clin Imaging. 77:254-75, 2021](http://www.ncbi.nlm.nih.gov/pubmed/?term=34153590%5Bpmid%5D)
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1. [Chapman PR et al: Neuroimaging of the pituitary gland: practical anatomy and pathology. Radiol Clin North Am. 58(6):1115-33, 2020](http://www.ncbi.nlm.nih.gov/pubmed/?term=33040852%5Bpmid%5D)
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1. [Snyder MH et al: Neurocysticercosis presenting as an isolated suprasellar lesion. World Neurosurg. 141:352-6, 2020](http://www.ncbi.nlm.nih.gov/pubmed/?term=32522639%5Bpmid%5D)
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1. [Xin WQ et al: Patient with epilepsy caused by the spontaneous rupture of an intracerebral dermoid cyst. World Neurosurg. 136:140-5, 2020](http://www.ncbi.nlm.nih.gov/pubmed/?term=31954900%5Bpmid%5D)
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1. [Jacków J et al: Ruptured intracranial dermoid cysts: a pictorial review. Pol J Radiol. 83:e465-70, 2018](http://www.ncbi.nlm.nih.gov/pubmed/?term=30655926%5Bpmid%5D)
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1. [Seeburg DP et al: Imaging of the sella and parasellar region in the pediatric population. Neuroimaging Clin N Am. 27(1):99-121, 2017](http://www.ncbi.nlm.nih.gov/pubmed/?term=27889026%5Bpmid%5D)
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1. [Hoffmann A et al: Fusiform dilatation of the internal carotid artery in childhood-onset craniopharyngioma: multicenter study on incidence and long-term outcome. Pituitary. 19(4):422-8, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=27125511%5Bpmid%5D)
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1. [Pan J et al: Growth patterns of craniopharyngiomas: clinical analysis of 226 patients. J Neurosurg Pediatr. 17(4):418-33, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=26636252%5Bpmid%5D)
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1. [Sekiguchi K et al: Osteochondroma presenting as a calcified mass in the sellar region and review of the literature. J Neurol Surg A Cent Eur Neurosurg. 78(4):380-5, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=27903019%5Bpmid%5D)
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1. [Yildiz AE et al: Suprasellar masses in children: characteristic MR imaging features. J Neuroradiol. 43(4):246-59, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=27131616%5Bpmid%5D)
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1. [Ben Nsir A et al: Calcified suprasellar xanthogranuloma presenting with primary amenorrhea in a 17-year-old girl: case report and literature review. World Neurosurg. 84(3):866.e11-4, 2015](http://www.ncbi.nlm.nih.gov/pubmed/?term=25916181%5Bpmid%5D)
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## Images
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### Selected Images
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**Atherosclerosis, Intracranial**
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*Axial NECT shows a fusiform, partially calcified mass in the suprasellar cistern <img src='img/arrows/CS.png'/> that represents an ectatic, supraclinoid, internal carotid artery (ICA) with calcified atherosclerotic plaque. Coronal and sagittal reformatted images make this diagnosis straightforward.*
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**Atherosclerosis, Intracranial**
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*Axial NECT shows a fusiform, partially calcified mass in the suprasellar cistern <img src='img/arrows/CS.png'/> that represents an ectatic, supraclinoid, internal carotid artery (ICA) with calcified atherosclerotic plaque. Coronal and sagittal reformatted images make this diagnosis straightforward.*
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**Craniopharyngioma**
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*Axial NECT shows a cystic suprasellar mass with globular calcifications <img src='img/arrows/CS.png'/> typical of an adamantinomatous craniopharyngioma. These tumors are WHO grade 1 and are typically treated with surgical resection.*
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**Meningioma**
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*Sagittal NECT shows a partially calcified extraaxial mass projecting from the tuberculum sella <img src='img/arrows/CS.png'/>, related to a meningioma. This is separate from the adjacent pituitary gland <img src='img/arrows/CO.png'/> within a normal-sized sella turcica. Meningiomas in this location often involve the planum sphenoidale and have a dural tail on contrast-enhanced imaging.*
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**Saccular Aneurysm**
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*Coronal arterial-phase CTA shows a saccular aneurysm projecting medially from the right cavernous ICA with internal arterial enhancement <img src='img/arrows/CO.png'/> and rim calcifications <img src='img/arrows/CS.png'/>.*
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**Fusiform Aneurysm, Atherosclerotic**
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*Axial NECT shows a hyperdense, fusiform basilar artery aneurysm <img src='img/arrows/CO.png'/> and calcified, fusiform aneurysmal ectasias of both ICAs <img src='img/arrows/WS.png'/>. Fusiform aneurysms are often related to atherosclerotic disease, as in this patient.*
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**Pilocytic Astrocytoma**
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*Axial NECT shows a low-density, suprasellar mass with rim <img src='img/arrows/CS.png'/> and globular calcification <img src='img/arrows/CO.png'/>. Biopsy disclosed a pilomyxoid subtype of pilocytic astrocytoma. This variant often occurs in the hypothalamic region in an infant or young child. These tumors rarely calcify.*
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**Dermoid Cyst**
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*Sagittal NECT shows a fat density lesion <img src='img/arrows/CO.png'/> with rim calcification <img src='img/arrows/CC.png'/> in the suprasellar cistern. There are scattered fat droplets in the subarachnoid spaces <img src='img/arrows/CS.png'/> in this case of a ruptured dermoid cyst.*
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**Rathke Cleft Cyst**
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*Axial NECT shows curvilinear calcification <img src='img/arrows/CO.png'/> along the anterior aspect of a cystic suprasellar mass in a young adult. This mass was T1 hyperintense and did not enhance. A Rathke cleft cyst was diagnosed at resection. These benign cysts are usually not calcified, which helps to differentiate them from craniopharyngiomas.*
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### Additional Images
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**Pituitary Macroadenoma**
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*Axial CECT shows a very large intra- and suprasellar enhancing mass invading the central skull base. Note floccular calcifications <img src='img/arrows/BS.png'/> within the mass, an uncommon finding in macroadenomas.*
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**Chondroid Tumor**
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*Sagittal bone CT shows globular calcification in a suprasellar mass <img src='img/arrows/WS.png'/> in this typical osteochondroma of the central skull base with calcification in the cartilaginous cap.*
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**Meningioma**
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*Axial NECT shows a hyperdense suprasellar mass <img src='img/arrows/CS.png'/> with focal calcifications <img src='img/arrows/CO.png'/> in this patient with a classic meningioma arising from the central skull base. Note the associated hydrocephalus <img src='img/arrows/WS.png'/> related to ventricular obstruction.*
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**Saccular Aneurysm**
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*Axial NECT shows a huge, well-delineated, hyperdense suprasellar mass with rim calcifications <img src='img/arrows/CS.png'/>. A giant, mostly thrombosed, saccular aneurysm was diagnosed and treated surgically. MR may show a laminated appearance with pulsation artifact if the aneurysm is patent.*
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**Dermoid Cyst**
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*Axial NECT shows a large, hypodense, calcified suprasellar mass <img src='img/arrows/CS.png'/>. Note fat density droplets <img src='img/arrows/WO.png'/> in the subarachnoid space related to a ruptured dermoid cyst.*
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**Pituitary Macroadenoma**
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*Coronal NECT shows a complex cystic expansile mass in the sella and suprasellar cistern <img src='img/arrows/WO.png'/> with peripheral calcification <img src='img/arrows/WS.png'/> in this case of pituitary macroadenoma with cystic degeneration.*
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**Chondroid Tumor**
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*Coronal NECT shows a destructive low- density mass <img src='img/arrows/WO.png'/> with internal chondroid calcifications <img src='img/arrows/WS.png'/> extending from the central skull base into the suprasellar cistern in this case of chondrosarcoma.*
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