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title: "Suprasellar Mass, Child"
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docid: "9c0d2762-4b8b-4ede-a9ca-859a789262da"
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authors:
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- key: "f184750a-90b4-47a7-907b-23b05d70357a"
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value: "Chang Yueh Ho, 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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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: "Suprasellar Mass, Child"
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slug: "suprasellar-mass-child"
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treeNodeId: null
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category: "Brain"
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cmeTopicId: "38e131be-6afe-4add-8f04-8fce2cc41533"
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documentVersionId: "1dae76e0-450f-443c-9c52-f6f462a95608"
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imageCount: 78
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lastUpdated: "02/17/23"
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pageDescription: "Suprasellar Mass, Child"
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pageKeywords: "Brain, Differential Diagnosis, Sella/Juxtasellar, Pineal Region, Anatomically Based Differentials, Suprasellar Mass, Child"
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pageTitle: "Suprasellar Mass, Child | STATdx"
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enhancedTitle: "Suprasellar Mass, Child"
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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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- "Suprasellar Mass, Child"
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---
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# ESSENTIAL INFORMATION
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- ## Key Differential Diagnosis Issues
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- Location is important
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- Pituitary: Craniopharyngioma, Rathke cleft cyst, macroadenoma
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- Stalk: Langerhans cell histiocytosis, lymphocytic hypophysitis, Rathke cleft cyst, craniopharyngioma, ectopic neurohypophysis
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- Optic chiasm and hypothalamus: Astrocytomas
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- Hypothalamus: Hamartoma, ectopic neurohypophysis
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- ## Helpful Clues for Common Diagnoses
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- **Craniopharyngioma**
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- Proposed to arise from cellular elements related to Rathke pouch (craniopharyngeal duct)
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- Most common suprasellar mass in childhood; 2nd peak in adults (45-60 years)
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- Adamantinomatous ("90% tumor")
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- 90% Ca⁺⁺, 90% cystic
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- 90% enhance (rim ± nodule)
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- Papillary: Solid > cystic or solid/cystic; Ca⁺⁺ uncommon
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- Adults > > children
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- **Pilocytic Astrocytoma**
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- 2nd most common suprasellar mass in children
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- Hypothalamus/optic pathways
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- Pilocytic > > pilomyxoid subtype
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- Typically T2 hyperintense with enhancement
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- Cysts less common than other CNS locations
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- WHO grade 1 tumor
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- **Germ Cell Tumor**
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- Germinomatous = germinoma
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- Nongerminomatous = teratoma and miscellaneous
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- **Germinoma**
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- Stalk ± gland; lobular, homogeneous, enhancing mass
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- CT hyperdense
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- Ca⁺⁺ and cystic change uncommon
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- Can be only site, but look for pineal mass and leptomeningeal dissemination
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- **Teratoma**
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- Mature tumors with Ca⁺⁺, cysts, and fat
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- Immature tumors with heterogeneous enhancement and predominantly soft tissue
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- **Nongerminomatous germ cell tumors**
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- Choriocarcinoma, endodermal sinus tumor, embryonal cell carcinoma, mixed
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- Poor prognosis
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- Heterogeneously enhancing mass
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- Elevation of serum β-hCG &/or α-fetoprotein
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- **Langerhans Cell Histiocytosis**
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- Thickened, enhancing, mass-like stalk
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- Look for beveled skull lesions, vertebra plana
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- Most common etiology of child with diabetes insipidus
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- Lack of posterior pituitary bright spot
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- ## Helpful Clues for Less Common Diagnoses
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- **Dilated 3rd Ventricle**
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- Most common "cystic" suprasellar mass
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- 3rd ventricle enlarged secondary to hydrocephalus
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- Inferior displacement of suprasellar structures
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- **Pituitary Macroadenoma**
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- Rare in children, more common in teenagers and adults
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- Suprasellar extension of macroadenoma
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- Gland and mass are inseparable
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- Cystic, hemorrhagic changes less common
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- **Tuber Cinereum Hamartoma**
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- Clinical presentation helpful (gelastic seizures; male with precocious puberty)
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- Can be "collar button" or "sessile"
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- Between infundibulum (anteriorly), mammillary bodies (posteriorly)
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- Signal intensity like gray matter, no enhancement
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- Mild T2 hyperintensity may be seen
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- **Leptomeningeal Metastases**
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- Typically from primary CNS high-grade neoplasm
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- Medulloblastoma, germinoma
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- **Arachnoid Cyst**
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- Elevates, displaces 3rd ventricle
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- Follows CSF on all sequences
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- **Rathke Cleft Cyst**
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- Similar embryologic origin as craniopharyngioma
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- Variable T1 hyperintensity and T2 hypointensity in cyst
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- Look for intracystic nodule from protein concretions
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- Rim enhancement rare; contents do not enhance
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- Pituitary gland/infundibulum displaced by mass
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- **Basilar Meningitis**
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- Most commonly bacterial but may be fungal or mycobacterial
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- Leptomeningeal enhancement
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- Look for basal ganglia infarcts from arteritis
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- **Tuberculoma**
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- TB meningitis > tuberculoma in suprasellar cistern
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- Focal mass with ring enhancement common
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- If caseating, mass is hypointense on T2WI
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- If noncaseating, mass is generally hyperintense on T2WI
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- **Neurocysticercosis**
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- Suprasellar cistern, sylvian fissures common sites
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- Variable size cysts, enhancement
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- Reactive meningeal changes may show intense enhancement
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- **Dermoid Cyst**
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- Fat containing: MR fat suppression or negative HU
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- Rupture = leptomeningeal fat and chemical meningitis
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- Surface ectoderm inclusion with neural tube closure
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- **Lipoma**
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- Fatty mass stuck on hypothalamus
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- Use fat-saturated T1WI
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- ## Helpful Clues for Rare Diagnoses
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- **Pilocytic Astrocytoma, Pilomyxoid Subtype**
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- Rare, more aggressive than pilocytic astrocytoma (PA)
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- Infant/young child with bulky, H-shaped suprasellar mass
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- Often hemorrhages (less common in PA)
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- More likely than PA to have leptomeningeal dissemination
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- **Ectopic Neurohypophysis**
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- Failure of neurohypophysis descent from hypothalamus
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- T1-hyperintense lesion from hypothalamus through stalk
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- Associated with septo-optic dysplasia
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- **Lymphocytic Hypophysitis**
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- Thick, nontapering stalk ± pituitary mass
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- Diabetes insipidus common
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- Often occurs in peripartum females; rare in children
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- May be autoimmune, inflammatory, granulomatous (sarcoid, Langerhans cell histiocytosis, infectious, etc.), IgG4 related or drug related (cancer immunotherapy)
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- **Epidermoid Cyst**
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- Lobulated, irregular cyst not following CSF
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- Incomplete FLAIR suppression; decreased diffusion
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- Surface ectoderm inclusion with neural tube closure
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## References
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# Selected References
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1. [Pascual JM et al: Duct-like recess in the infundibular portion of third ventricle craniopharyngiomas: an MRI sign identifying the papillary type. AJNR Am J Neuroradiol. 43(9):1333-40, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=35953277%5Bpmid%5D)
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1. [Serrallach BL et al: Duplication of the pituitary gland: CT, MRI and DTI findings and updated review of the literature. Brain Sci. 12(5):574, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=35624961%5Bpmid%5D)
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1. [Tierney TS et al: Initial experience with magnetic resonance-guided focused ultrasound stereotactic surgery for central brain lesions in young adults. J Neurosurg. ePub, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=35171812%5Bpmid%5D)
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1. [Yao Y et al: Magnetic resonance-guided laser interstitial thermal therapy for hypothalamic hamartoma: surgical approach and treatment outcomes. J Clin Med. 11(21):6579, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=36362807%5Bpmid%5D)
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1. [Zucchini S et al: Management of childhood-onset craniopharyngioma in Italy: a multicenter, 7-year follow-up study of 145 patients. J Clin Endocrinol Metab. 107(3):e1020-31, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=34718649%5Bpmid%5D)
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1. [Kirsch CFE: Imaging of sella and parasellar region. Neuroimaging Clin N Am. 31(4):541-52, 2021](http://www.ncbi.nlm.nih.gov/pubmed/?term=34689932%5Bpmid%5D)
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1. [Ji X et al: Clinical characteristics of pediatric patients with sellar and suprasellar lesions who initially present with central diabetes insipidus: a retrospective study of 55 cases from a large pituitary center in China. Front Endocrinol (Lausanne). 11:76, 2020](http://www.ncbi.nlm.nih.gov/pubmed/?term=32153511%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. [Deopujari CE et al: Pediatric suprasellar lesions. J Pediatr Neurosci. 6(Suppl 1):S46-55, 2011](http://www.ncbi.nlm.nih.gov/pubmed/?term=22069431%5Bpmid%5D)
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1. [Warmuth-Metz M et al: Differential diagnosis of suprasellar tumors in children. Klin Padiatr. 216(6):323-30, 2004](http://www.ncbi.nlm.nih.gov/pubmed/?term=15565547%5Bpmid%5D)
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## Images
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### Selected Images
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**Craniopharyngioma**
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*Sagittal NECT shows a heterogeneous mass with coarse Ca⁺⁺ <img src='img/arrows/CS.png'/>. Adamantinomatous craniopharyngiomas are WHO grade 1.*
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**Craniopharyngioma**
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*Sagittal NECT shows a heterogeneous mass with coarse Ca⁺⁺ <img src='img/arrows/CS.png'/>. Adamantinomatous craniopharyngiomas are WHO grade 1.*
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**Craniopharyngioma**
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*Sagittal T1 C+ MR in the same patient shows the sellar and suprasellar mass has solid, enhancing components <img src='img/arrows/CS.png'/> and large cysts with intrinsic T1 shortening <img src='img/arrows/CC.png'/>. Craniopharyngiomas are the most common suprasellar mass in children and should be considered when a tumor has cysts, enhancement, and Ca⁺⁺.*
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**Pilocytic Astrocytoma**
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*Axial T2 MR shows a heterogeneous suprasellar mass with solid <img src='img/arrows/CS.png'/> and cystic components <img src='img/arrows/CO.png'/>. This WHO grade 1 tumor causes mass effect on the midbrain, R > L <img src='img/arrows/CC.png'/>.*
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**Pilocytic Astrocytoma**
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*Sagittal T1 C+ MR in the same patient shows an enhancing, solid and cystic mass in the suprasellar cistern with involvement of the sella turcica. Note the flattened pituitary gland <img src='img/arrows/CS.png'/>, which is separate from the mass. This tumor likely arises from the optic chiasm &/or the hypothalamus.*
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**Pilocytic Astrocytoma**
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*Axial b = 1000 DWI trace MR in the same patient shows the solid portions of the mass are predominantly isointense <img src='img/arrows/CS.png'/> compared to normal brain. These features support the diagnosis of a low-grade neoplasm, pilocytic astrocytoma, WHO grade 1, in this case.*
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**Germinoma**
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*Sagittal T1 C+ MR shows a heterogeneously enhancing mass involving the pituitary gland and stalk <img src='img/arrows/CS.png'/>. There is heterogeneous enlargement of the pineal gland <img src='img/arrows/CC.png'/>, which is also involved by germinoma. Germinomas are classically CT hyperdense.*
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**Teratoma**
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*Sagittal T1 MR shows a large, heterogeneous mass, which appears to arise from the suprasellar cistern and cause severe hydrocephalus. Note the T1-hyperintense area consistent with fat <img src='img/arrows/CS.png'/>. Also note the T1-bright posterior pituitary gland <img src='img/arrows/CC.png'/>.*
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**Teratoma**
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*Coronal T1 C+ MR in the same infant shows heterogeneous enhancement of the mass. This was a congenital tumor. With the fat products and central location, this is consistent with a teratoma. Mature teratomas are more common than immature teratomas.*
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**Langerhans Cell Histiocytosis**
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*Sagittal T1 C+ MR shows enhancing thickening of the infundibulum <img src='img/arrows/CS.png'/>. This child presented with diabetes insipidus and had a bone lesion consistent with Langerhans cell histiocytosis (LCH). LCH is the most common finding in a child with diabetes insipidus.*
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**Dilated 3rd Ventricle**
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*Sagittal T1 MR shows enlargement of the 3rd ventricle from obstructive hydrocephalus. There is anterior displacement of the lamina terminalis <img src='img/arrows/CS.png'/> and depression of the hypothalamus and suprasellar structures <img src='img/arrows/CC.png'/>.*
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**Pituitary Macroadenoma**
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*Coronal T1 C+ MR shows a large sellar and suprasellar mass related to a pituitary macroadenoma. There is extension of the mass over the cavernous carotid artery beyond the medial tangential line <img src='img/arrows/CS.png'/>, consistent with grade 1 Knosp classification for risk of cavernous sinus invasion.*
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**Tuber Cinereum Hamartoma**
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*Sagittal T2 MR shows a hypothalamic mass centered on the tuber cinereum <img src='img/arrows/CS.png'/>. The mass follows brain parenchyma on all sequences and does not enhance, consistent with a hypothalamic hamartoma.*
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**Leptomeningeal Metastases**
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*Axial T1 C+ MR shows nodular and leptomeningeal enhancement in the suprasellar cistern <img src='img/arrows/CS.png'/>. In addition, there is abnormal enhancement in the 4th ventricle <img src='img/arrows/CC.png'/>. This was a disseminated diffuse midline glioma of the brainstem, WHO grade 4.*
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**Arachnoid Cyst**
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*Sagittal T1 MR shows cystic dilatation of the suprasellar cistern with superior displacement of the tuber cinereum <img src='img/arrows/CS.png'/>. There is stretching of the stalk with incidental T1 hyperintensity from an ectopic posterior pituitary gland <img src='img/arrows/CC.png'/>.*
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**Rathke Cleft Cyst**
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*Sagittal T1 C+ MR shows a sellar and suprasellar cystic lesion <img src='img/arrows/CS.png'/> with suprasellar extension and mass effect.*
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**Rathke Cleft Cyst**
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*Coronal T2 MR shows the cystic sellar/suprasellar mass has a faint T2-hypointense nodule <img src='img/arrows/CS.png'/>. This likely represents focal proteinaceous concretion and is consistent with Rathke cleft cyst. Note the mass effect on the chiasm <img src='img/arrows/CC.png'/>. Rathke cleft cysts have the same embryologic origin as craniopharyngioma and likely represent surface ectodermal rests during anterior pituitary migration.*
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**Basilar Meningitis**
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*Coronal T1 C+ FS MR shows diffuse abnormal enhancement throughout the suprasellar cistern with thickening of the stalk <img src='img/arrows/CS.png'/> and extension to the left temporal lobe and right basal ganglia.*
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**Basilar Meningitis**
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*Axial DWI trace MR shows multiple areas of diffusion hyperintensity. There is pus in the anterior 3rd ventricle <img src='img/arrows/WS.png'/> and less conspicuous pus in the occipital horn <img src='img/arrows/WO.png'/>. Diffusion restriction in the basal ganglia and thalamus may represent cerebritis; however, there is also likely arteritis with multiple areas of infarct <img src='img/arrows/CC.png'/>.*
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**Tuberculoma**
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*Axial T1 C+ MR shows abnormal enhancement in the suprasellar cistern, interpeduncular cistern <img src='img/arrows/CC.png'/>, and left ambient cistern <img src='img/arrows/CS.png'/>. This child has a known history of TB.*
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**Neurocysticercosis**
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*Coronal T1 C+ MR shows abnormal enhancement in the right suprasellar cistern <img src='img/arrows/CS.png'/> and right sylvian fissure <img src='img/arrows/CO.png'/> in this patient with known neurocysticercosis. Leptomeningeal disease occurs when larvae invade the subarachnoid space and cause extensive inflammation and arachnoiditis.*
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**Dermoid Cyst**
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*Axial T1 MR shows a heterogeneous, T1-hyperintense mass in the right suprasellar cistern <img src='img/arrows/CS.png'/>. Note the T1 punctate hyperintensities in the suprasellar cistern, interpeduncular cistern, and in the anterior cranial fossa <img src='img/arrows/CC.png'/> from fatty elements due to dermoid cyst rupture. This patient is at risk for chemical meningitis.*
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**Dermoid Cyst**
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*Coronal T1 C+ FS MR shows signal loss of the right suprasellar mass <img src='img/arrows/CS.png'/>, consistent with fat. Dermoid cysts arise from surface ectoderm rests during neural tube closure.*
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**Lipoma**
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*Sagittal T1 MR shows a intrinsically bright T1 lesion in the suprasellar cistern along the stalk <img src='img/arrows/CS.png'/>. Note the normal location of the posterior pituitary <img src='img/arrows/CC.png'/>, which makes ectopic posterior pituitary unlikely. Fat saturation images confirmed a lipoma.*
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**Pilocytic Astrocytoma, Pilomyxoid Subtype**
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*Coronal T1 C+ MR shows an intensely enhancing mass in the suprasellar cistern associated with a large cyst displacing the left frontal and temporal lobes. In an infant, pilomyxoid astrocytoma should be considered, an aggressive variant of pilocytic astrocytoma.*
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**Ectopic Neurohypophysis**
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*Sagittal T1 MR shows a hyperintense nodule in the hypothalamus <img src='img/arrows/CS.png'/>. There is hypoplastic pituitary gland without visualization of the normal posterior pituitary bright spot <img src='img/arrows/CO.png'/>. This is consistent with ectopic neurohypophysis. Note the absence of the infundibulum <img src='img/arrows/CC.png'/>.*
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**Lymphocytic Hypophysitis**
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*Sagittal T1 C+ MR shows thickening of the stalk with extension into the pituitary gland <img src='img/arrows/CS.png'/>. There is loss of the normal posterior pituitary bright spot on noncontrast T1 MR (not shown).*
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**Epidermoid Cyst**
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*Axial FLAIR MR shows heterogeneous nonsuppression of a cystic mass in the suprasellar cistern. This showed T2 hyperintensity and no contrast enhancement.*
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**Epidermoid Cyst**
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*Axial b = 1000 DWI MR shows decreased diffusion of the cystic mass, confirming the diagnosis of epidermoid cyst. Epidermoid cysts and dermoid cysts derive from surface ectoderm rests during neural tube closure. Dermoid cysts differ from epidermoid cysts due to inclusion of epidermal appendages, which can secrete fatty sebum.*
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### Additional Images
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**Pituitary Macroadenoma**
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*Sagittal T1 C+ FS MR shows a pituitary macroadenoma <img src='img/arrows/WS.png'/>. The pituitary gland cannot be seen separate from the mass. The mass is the gland, which is diffusely enlarged by the tumor.*
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**Craniopharyngioma**
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*Sagittal T1 MR shows a craniopharyngioma <img src='img/arrows/WO.png'/> with variable T1 shortening within the multiloculated cystic components. The pituitary gland <img src='img/arrows/WC.png'/> is clearly distinct from the mass.*
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**Pilocytic Astrocytoma**
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*Sagittal T1 C+ MR shows a large pilocytic astrocytoma, seen here as a lobulated, inhomogeneously enhancing suprasellar mass <img src='img/arrows/WS.png'/>. The pituitary <img src='img/arrows/WO.png'/> is clearly separate from the mass.*
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**Dilated 3rd Ventricle**
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*Sagittal T1 C+ MR shows obstructive hydrocephalus with a dilated 3rd ventricle <img src='img/arrows/WO.png'/>. The large anterior recesses compress and displace the infundibular stalk and hypothalamus <img src='img/arrows/WS.png'/> inferiorly.*
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**Arachnoid Cyst**
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*Sagittal T1 MR shows a classic suprasellar arachnoid cyst. Note that the CSF-like suprasellar mass <img src='img/arrows/WS.png'/> elevates the 3rd ventricle and displaces the infundibular stalk anteriorly <img src='img/arrows/WO.png'/>.*
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**Neurocysticercosis**
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*Sagittal T1 MR in a patient with known neurocysticercosis shows a markedly thickened infundibulum <img src='img/arrows/WO.png'/> as well as multiple supra- and intrasellar cysts <img src='img/arrows/WS.png'/>. Basal cistern lesions are common in neurocysticercosis.*
|
||||
|
||||
|
||||
**Rathke Cleft Cyst**
|
||||
*Sagittal T1 MR shows a typical Rathke cleft cyst. Note that the well-delineated, hyperintense suprasellar mass <img src='img/arrows/WS.png'/> is clearly distinct from the pituitary gland <img src='img/arrows/WC.png'/> below.*
|
||||
|
||||
|
||||
**Langerhans Cell Histiocytosis**
|
||||
*Sagittal T1 C+ MR in a child with known histiocytosis and diabetes insipidus shows a strongly enhancing mass involving the infundibular stalk and hypothalamus <img src='img/arrows/WS.png'/>.*
|
||||
|
||||
|
||||
**Germ Cell Tumor**
|
||||
*Sagittal T1 C+ MR shows a germinoma with sellar <img src='img/arrows/WO.png'/> and suprasellar <img src='img/arrows/WS.png'/> involvement. The infundibular stalk is markedly thickened, while the pineal gland is normal.*
|
||||
|
||||
|
||||
**Dermoid Cyst**
|
||||
*Sagittal T1 C+ MR shows a ruptured dermoid cyst <img src='img/arrows/WO.png'/> with a large supra-/parasellar component. Note multiple high signal intensity droplets <img src='img/arrows/WS.png'/> scattered throughout the subarachnoid space.*
|
||||
|
||||
|
||||
**Lipoma**
|
||||
*Sagittal T1 MR shows a hypothalamic lipoma <img src='img/arrows/WS.png'/>, seen here as a lobulated, hyperintense mass above and behind the sella. This was an incidental finding in an asymptomatic patient.*
|
||||
|
||||
|
||||
**Lymphocytic Hypophysitis**
|
||||
*Sagittal T1 C+ FS MR in a 19-year-old pregnant woman shows a uniformly enhancing sellar/suprasellar mass <img src='img/arrows/WS.png'/>. Note reactive dural thickening <img src='img/arrows/WO.png'/>. Lymphocytic hypophysitis was found at surgery.*
|
||||
|
||||
|
||||
**Tuber Cinereum Hamartoma**
|
||||
*Sagittal T1 MR shows a classic tuber cinereum hamartoma <img src='img/arrows/WS.png'/>. The hamartoma looks like a "collar button" of gray matter interposed between the infundibulum and mammillary bodies.*
|
||||
|
||||
|
||||
**Epidermoid Cyst**
|
||||
*Axial T1 MR shows an epidermoid cyst <img src='img/arrows/WS.png'/>. The lobulated, CSF-like mass extends into the suprasellar <img src='img/arrows/WC.png'/> and quadrigeminal <img src='img/arrows/WO.png'/> cisterns.*
|
||||
|
||||
|
||||
**Pilocytic Astrocytoma, Pilomyxoid Subtype**
|
||||
*Coronal T2 MR in a 21-year-old man with sudden headache and visual problems shows a hemorrhagic suprasellar mass <img src='img/arrows/WS.png'/>. Initial diagnosis was pilocytic astrocytoma. The final diagnosis was pilomyxoid astrocytoma.*
|
||||
|
||||
|
||||
**Ectopic Neurohypophysis**
|
||||
*Sagittal T1 MR shows posterior pituitary ectopia, seen here as a hyperintense focus <img src='img/arrows/WC.png'/> along the upper infundibulum. Note a small pituitary gland <img src='img/arrows/WO.png'/> with an absent bright spot.*
|
||||
|
||||
|
||||
**Tuberculoma**
|
||||
*Axial CECT shows a tuberculoma <img src='img/arrows/WS.png'/> in the suprasellar cistern, seen here as a ring-enhancing mass. Note accompanying findings of TB meningitis <img src='img/arrows/WO.png'/>. (Courtesy S. Candy, MD.)*
|
||||
|
||||
|
||||
**Langerhans Cell Histiocytosis**
|
||||
*Sagittal T1 C+ MR in a child with known histiocytosis and diabetes insipidus shows an enhancing mass involving the hypothalamus and infundibular stalk <img src='img/arrows/WS.png'/>.*
|
||||
|
||||
|
||||
**Tuber Cinereum Hamartoma**
|
||||
*Sagittal T1 MR shows a variant case of tuber cinereum hamartoma <img src='img/arrows/BS.png'/> with a large, lobulated suprasellar mass extending posteroinferiorly behind the clivus, displacing the brainstem backwards.*
|
||||
|
||||
|
||||
**Dermoid Cyst**
|
||||
*Sagittal T1 MR shows an irregular mass with predominantly T1-hyperintense signal involving the pituitary, stalk, and hypothalamus. Dermoid cysts are an inclusion of the surface ectoderm during neural tube closure and classically occur midline.*
|
||||
|
||||
|
||||
**Tuber Cinereum Hamartoma**
|
||||
*Sagittal T1 MR shows a variant case of tuber cinereum hamartoma <img src='img/arrows/BS.png'/> with a large, lobulated suprasellar mass extending posteroinferiorly behind the clivus, displacing the brainstem backwards.*
|
||||
|
||||
|
||||
**Pituitary Macroadenoma**
|
||||
*Sagittal T1 C+ FS MR shows an enhancing mass expanding the sella. The infundibulum is intact above the mass <img src='img/arrows/CS.png'/>, suggesting the mass is the pituitary gland. Macroadenomas are not typically seen in young children but may be seen in teenagers and adults.*
|
||||
|
||||
|
||||
**Dermoid Cyst**
|
||||
*Sagittal T1 MR shows an irregular mass with predominantly T1-hyperintense signal involving the pituitary, stalk, and hypothalamus. Dermoid cysts are an inclusion of the surface ectoderm during neural tube closure and classically occur midline.*
|
||||
|
||||
|
||||
**Dermoid Cyst**
|
||||
*Coronal T2 FS MR shows signal loss of the T1-hyperintense sellar/suprasellar mass <img src='img/arrows/CS.png'/>, consistent with fatty dermal elements from a dermoid cyst. Leptomeningeal fat suggests cyst rupture.*
|
||||
|
||||
|
||||
**Epidermoid Cyst**
|
||||
*Axial DWI b = 1000 MR shows decreased diffusion in a heterogeneous, cystic mass arising from the suprasellar cistern, consistent with an epidermoid cyst. Like dermoid cysts, epidermoid cysts arise from surface ectoderm rests included during neural tube closure.*
|
||||
|
||||
|
||||
**Epidermoid Cyst**
|
||||
*Sagittal T1 C+ MR shows a nonenhancing cystic mass in the suprasellar cistern effacing the pituitary gland. There is mild rim enhancement <img src='img/arrows/CS.png'/>. Epidermoid cysts have incomplete FLAIR suppression but are otherwise similar to CSF signal.*
|
||||
|
||||
|
||||
**Lymphocytic Hypophysitis**
|
||||
*Sagittal T1 C+ FS MR shows an enhancing mass in the pituitary stalk. This is a child with lymphocytic hypophysitis, a rare finding in children. Enhancing lesions of the stalk in a child are most likely to be Langerhans cell histiocytosis.*
|
||||
|
||||
|
||||
**Ectopic Neurohypophysis**
|
||||
*Axial T1 MR shows a T1-hyperintense nodule along the pituitary stalk. There is absence of the normal T1 posterior pituitary bright signal, and this mass is consistent with an ectopic posterior pituitary. An ectopic neurohypophysis can be located along the hypothalamus or stalk.*
|
||||
|
||||
|
||||
**Pilocytic Astrocytoma, Pilomyxoid Subtype**
|
||||
*Axial T1 C+ MR shows a bilobed mass with the largest portion in the suprasellar cistern. Pilomyxoid astrocytomas, despite being WHO grade 2, can demonstrate leptomeningeal dissemination, and the entire neuraxis should be imaged.*
|
||||
|
||||
|
||||
**Pilocytic Astrocytoma, Pilomyxoid Subtype**
|
||||
*Axial T2 FS MR shows a bilobed mass in the suprasellar cistern, which is predominantly T2 hyperintense with central T2 hypointensity <img src='img/arrows/CS.png'/> from blood products. Hemorrhage is more common in pilomyxoid astrocytomas rather than pilocytic astrocytomas.*
|
||||
|
||||
|
||||
**Neurocysticercosis**
|
||||
*Coronal T1 C+ FS MR shows multiple cysts with rim enhancement in the suprasellar cistern and left sylvian fissure from racemose neurocysticercosis. In addition, there is nodular enhancement <img src='img/arrows/CS.png'/> in the left basal ganglia from a cyst in the granular nodular phase.*
|
||||
|
||||
|
||||
**Neurocysticercosis**
|
||||
*Axial T2 FS MR shows multiple cysts in the suprasellar cistern with extension into the interhemispheric fissure and left sylvian fissure. Racemose neurocysticercosis typically presents as grape-like cysts in the cisterns.*
|
||||
|
||||
|
||||
**Tuberculoma**
|
||||
*Axial T2 FS MR shows an isointense nodule in the suprasellar cistern and interpeduncular cistern. There is central hypointensity <img src='img/arrows/CC.png'/> within the nodular mass from Ca⁺⁺. There is also adjacent midbrain edema <img src='img/arrows/CO.png'/>. This is consistent with a caseating tuberculous granuloma.*
|
||||
|
||||
|
||||
**Tuberculoma**
|
||||
*Sagittal T1 C+ FS MR shows an enhancing nodule <img src='img/arrows/CS.png'/> in the suprasellar cistern and interpeduncular cistern in a child with history of CNS TB. A 2nd tuberculoma can be seen at the pontomedullary junction <img src='img/arrows/CO.png'/>.*
|
||||
|
||||
|
||||
**Basilar Meningitis**
|
||||
*Axial T1 C+ MR shows diffuse irregular leptomeningeal enhancement filling the suprasellar cistern and extending into the sylvian fissures, interpeduncular cistern, and ambient cisterns. This was a pyogenic basilar meningitis.*
|
||||
|
||||
|
||||
**Basilar Meningitis**
|
||||
*Axial DWI b = 1000 MR shows a focus of decreased diffusion within the right pons <img src='img/arrows/CS.png'/> from infarct of a pontine perforator. This child had basilar meningitis and arteritis of an end artery supplying the pons. Classically, basal ganglia infarcts from lenticulostriate arteritis are seen.*
|
||||
|
||||
|
||||
**Rathke Cleft Cyst**
|
||||
*Coronal T1 C+ FS MR shows a rim-enhancing cystic mass in the suprasellar cistern involving the pituitary, stalk, and extending through the hypothalamus. This was a Rathke cleft cyst at resection. Craniopharyngioma typically will have larger, solid enhancing elements.*
|
||||
|
||||
|
||||
**Arachnoid Cyst**
|
||||
*Coronal T1 C+ FS MR shows an arachnoid cyst involving the suprasellar cistern. There is rightward displacement of the pituitary stalk <img src='img/arrows/CS.png'/> and extension into the left temporal horn with outward displacement and thinning of the temporal lobe <img src='img/arrows/CO.png'/>.*
|
||||
|
||||
|
||||
**Leptomeningeal Metastases**
|
||||
*Sagittal T1 C+ MR in a child with disseminated neuroblastoma shows enhancement along the lamina terminalis and hypothalamus <img src='img/arrows/CS.png'/> in addition to diffuse leptomeningeal enhancement, which also involves the cerebellum <img src='img/arrows/CO.png'/>.*
|
||||
|
||||
|
||||
**Leptomeningeal Metastases**
|
||||
*Coronal T1 C+ FS MR shows diffuse leptomeningeal enhancement predominantly in the suprasellar cistern, sylvian fissures, and interhemispheric fissure. This child had a history of neuroblastoma.*
|
||||
|
||||
|
||||
**Tuber Cinereum Hamartoma**
|
||||
*Sagittal T1 C+ FS shows a nonenhancing mass <img src='img/arrows/CS.png'/> in the suprasellar cistern pedunculated from the tuber cinereum of the hypothalamus. Tuber cinereum hamartomas can be pedunculated or sessile and generally follow gray matter in intensity.*
|
||||
|
||||
|
||||
**Tuber Cinereum Hamartoma**
|
||||
*Coronal T2 MR shows a sessile mass <img src='img/arrows/CS.png'/> centered in the hypothalamus, which follows gray matter in intensity. Tuber cinereum hamartomas classically present with gelastic seizures and precocious puberty.*
|
||||
|
||||
|
||||
**Pituitary Macroadenoma**
|
||||
*Sagittal T1 C+ FS MR shows an enhancing mass expanding the sella. The infundibulum is intact above the mass <img src='img/arrows/CS.png'/>, suggesting the mass is the pituitary gland. Macroadenomas are not typically seen in young children but may be seen in teenagers and adults.*
|
||||
|
||||
|
||||
**Dilated 3rd Ventricle**
|
||||
*Sagittal T1 C+ MR shows a tectal mass <img src='img/arrows/CO.png'/> causing obstructive hydrocephalus. There is downward displacement of the lamina terminalis and hypothalamus <img src='img/arrows/CS.png'/>, effacing the infundibulum and suprasellar cistern.*
|
||||
|
||||
|
||||
**Langerhans Cell Histiocytosis**
|
||||
*Coronal T1 C+ FS MR shows abnormal thickening of the infundibulum and pituitary gland. In a child with diabetes insipidus, Langerhans cell histiocytosis should be considered. Further search for bony lesions with beveled edges should be performed.*
|
||||
|
||||
|
||||
**Pilocytic Astrocytoma**
|
||||
*Axial T1 C+ MR shows the enhancing mass in the suprasellar cistern has a central nonenhancing structure consistent with an enlarged optic chiasm <img src='img/arrows/CS.png'/>. This tumor was a pilocytic astrocytoma at biopsy.*
|
||||
|
||||
|
||||
**Germinoma**
|
||||
*Sagittal T1 C+ MR shows lobular enhancing masses in both the pineal region and suprasellar cistern. The pineal region mass has a central hypointensity <img src='img/arrows/CS.png'/> consistent with engulfed pineal Ca⁺⁺, typical for germ cell tumor. Germinomas can disseminate, & these 2 locations are most common.*
|
||||
|
||||
|
||||
**Nongerminomatous Germ Cell Tumors**
|
||||
*Sagittal T1 C+ MR shows a lobular suprasellar mass involving the stalk and hypothalamus with extension into the 3rd ventricle <img src='img/arrows/CS.png'/>. This was a mixed germ cell tumor at resection.*
|
||||
|
||||
|
||||
**Pilocytic Astrocytoma**
|
||||
*Axial T2 MR shows a predominantly T2-hyperintense mass in the suprasellar cistern with a shape similar to the optic chiasm. Pilocytic astrocytomas are the 2nd most common suprasellar mass in children.*
|
||||
|
||||
|
||||
**Craniopharyngioma**
|
||||
*Coronal T1 C+ FS MR shows a heterogeneous mass with enhancing solid elements <img src='img/arrows/CS.png'/> and cystic change <img src='img/arrows/CO.png'/> involving the hypothalamus and pituitary stalk in the suprasellar cistern. Adamantinomatous craniopharyngiomas are the most common suprasellar mass in children.*
|
||||
|
||||
Reference in New Issue
Block a user