--- title: "Calcified Suprasellar Mass" docid: "b61b0b70-de36-45f9-88a2-162a9758b729" authors: - key: "e0282a62-994d-4550-a127-1eb773b1e920" value: "Blair A. Winegar, MD" - key: "5cff4116-3654-4b3a-bb75-5ebe0b8c9850" value: "Anne G. Osborn, MD, FACR" - key: "8d5254e9-8dda-478b-8f08-bdee97a32c79" value: "Karen L. Salzman, MD, FACR" breadcrumbs: - name: "Brain" slug: "brain" treeNodeId: "6d8829f1-14d7-45af-8675-255189aa526a" - name: "Differential Diagnosis" slug: "differential-diagnosis" treeNodeId: "a7fdd139-664e-4bb8-8d18-400e4733ff60" - name: "Sella/Juxtasellar, Pineal Region" slug: "sellajuxtasellar-pineal-region" treeNodeId: "5e38b9c1-3137-47e3-aa83-1fc82cb4099a" - name: "Anatomically Based Differentials" slug: "anatomically-based-differentials" treeNodeId: "7a51b2ca-8fee-4c16-aff3-b7189f68ea60" - name: "Calcified Suprasellar Mass" slug: "calcified-suprasellar-mass" treeNodeId: null category: "Brain" documentVersionId: "9a1f2879-7179-44a8-abaa-f97284492f8d" imageCount: 15 lastUpdated: "02/01/23" pageDescription: "Calcified Suprasellar Mass" pageKeywords: "Brain, Differential Diagnosis, Sella/Juxtasellar, Pineal Region, Anatomically Based Differentials, Calcified Suprasellar Mass" pageTitle: "Calcified Suprasellar Mass | STATdx" enhancedTitle: "Calcified Suprasellar Mass" type: "DDX" references: true breadcrumbs: - "Brain" - "Differential Diagnosis" - "Sella/Juxtasellar, Pineal Region" - "Anatomically Based Differentials" - "Calcified Suprasellar Mass" --- # ESSENTIAL INFORMATION - ## Key Differential Diagnosis Issues - Is Ca⁺⁺ curvilinear, punctate, globular, etc.? - Does lesion enhance? - ## Helpful Clues for Common Diagnoses - **Atherosclerosis****, Intracranial** - Curvilinear Ca⁺⁺ along vessel walls - Usually bilateral, often multifocal - Older patients - **Craniopharyngioma** - Globular, punctate, &/or ring Ca⁺⁺ - **Adamantinomatous**: Bimodal age distribution (peaks 5-15 years and 45-60 years) - **Papillary**: Older adult tumors more often solid, Ca⁺⁺ less frequent - **Meningioma** - Psammomatous (sand-like) Ca⁺⁺ - Solid > rim enhancement - Middle-aged, older patients (unless NF2) - **Aneurysm** - **Saccular****a****neurysm** - Calcification less common than with fusiform aneurysm, ASVD - Curvilinear (peripheral arcs, rings) pattern - **Fusiform****a****neurysm, atherosclerotic** - Linear ± rim Ca⁺⁺ - Ca⁺⁺ often present in other vessels - ## Helpful Clues for Less Common Diagnoses - **Neurocysticercosis** - Nodular calcified stage - Usually parenchymal > > cisternal Ca⁺⁺ - **Pilocytic Astrocytoma** - Common in children, young adults - Ca⁺⁺ uncommon in hypothalamic PA - **Dermoid Cyst** - 20% have capsular Ca⁺⁺ - Contain lipid - Look for evidence of rupture (fatty droplets in subarachnoid spaces, cisterns) - No enhancement unless chemical meningitis - ## Helpful Clues for Rare Diagnoses - **Pituitary Macroadenoma** - Only 1-2% of macroadenomas calcify - Adenomas usually isodense with gray matter - Majority result in smooth enlargement of sella turcica - **Rathke Cleft Cyst** - Vast majority have no calcification (> 85%) - May rarely see thin, curvilinear rim calcification (10-15%) - Typically hypodense to brain parenchyma - **Tuberculosis** - TB, healing/healed granulomatous infections cause parenchymal > > cisternal Ca⁺⁺ - **Chondroid Tumor** - Chondromas, enchondromas arise from central skull base - Chondroid matrix on CT - May extend to suprasellar region ## References # Selected References 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) ## Images ### Selected Images ![Axial NECT shows a fusiform, partially calcified mass in the suprasellar cistern that represents an ectatic, supraclinoid, internal carotid artery (ICA) with calcified atherosclerotic plaque. Coronal and sagittal reformatted images make this diagnosis straightforward.](images/app.statdx.com_image_thumbnail_eecea3f1-ae69-42be-a896-9b64a38071b4_annotated_true_size_900_quality_90_b311b11e.jpg) **Atherosclerosis, Intracranial** *Axial NECT shows a fusiform, partially calcified mass in the suprasellar cistern that represents an ectatic, supraclinoid, internal carotid artery (ICA) with calcified atherosclerotic plaque. Coronal and sagittal reformatted images make this diagnosis straightforward.* ![Axial NECT shows a fusiform, partially calcified mass in the suprasellar cistern that represents an ectatic, supraclinoid, internal carotid artery (ICA) with calcified atherosclerotic plaque. Coronal and sagittal reformatted images make this diagnosis straightforward.](images/app.statdx.com_image_thumbnail_eecea3f1-ae69-42be-a896-9b64a38071b4_size_174_quality_85_f64bfc5f.jpg) **Atherosclerosis, Intracranial** *Axial NECT shows a fusiform, partially calcified mass in the suprasellar cistern that represents an ectatic, supraclinoid, internal carotid artery (ICA) with calcified atherosclerotic plaque. Coronal and sagittal reformatted images make this diagnosis straightforward.* ![Axial NECT shows a cystic suprasellar mass with globular calcifications typical of an adamantinomatous craniopharyngioma. These tumors are WHO grade 1 and are typically treated with surgical resection.](images/app.statdx.com_image_thumbnail_056d0e22-497b-47d2-92c0-632887d9c322_annotated_true_size_900_quality_90_dafeab3f.jpg) **Craniopharyngioma** *Axial NECT shows a cystic suprasellar mass with globular calcifications typical of an adamantinomatous craniopharyngioma. These tumors are WHO grade 1 and are typically treated with surgical resection.* ![Sagittal NECT shows a partially calcified extraaxial mass projecting from the tuberculum sella , related to a meningioma. This is separate from the adjacent pituitary gland within a normal-sized sella turcica. Meningiomas in this location often involve the planum sphenoidale and have a dural tail on contrast-enhanced imaging.](images/app.statdx.com_image_thumbnail_ae28f3d5-00a6-4764-9a86-47904bee32be_annotated_true_size_900_quality_90_173c54ee.jpg) **Meningioma** *Sagittal NECT shows a partially calcified extraaxial mass projecting from the tuberculum sella , related to a meningioma. This is separate from the adjacent pituitary gland within a normal-sized sella turcica. Meningiomas in this location often involve the planum sphenoidale and have a dural tail on contrast-enhanced imaging.* ![Coronal arterial-phase CTA shows a saccular aneurysm projecting medially from the right cavernous ICA with internal arterial enhancement and rim calcifications .](images/app.statdx.com_image_thumbnail_bd4f9717-20ae-478c-bb19-10e0a1b49b41_annotated_true_size_900_quality_90_48710b22.jpg) **Saccular Aneurysm** *Coronal arterial-phase CTA shows a saccular aneurysm projecting medially from the right cavernous ICA with internal arterial enhancement and rim calcifications .* ![Axial NECT shows a hyperdense, fusiform basilar artery aneurysm and calcified, fusiform aneurysmal ectasias of both ICAs . Fusiform aneurysms are often related to atherosclerotic disease, as in this patient.](images/app.statdx.com_image_thumbnail_c4bf6e23-0c1b-480d-98f2-364c5dd61993_annotated_true_size_900_quality_90_f5e9fda8.jpg) **Fusiform Aneurysm, Atherosclerotic** *Axial NECT shows a hyperdense, fusiform basilar artery aneurysm and calcified, fusiform aneurysmal ectasias of both ICAs . Fusiform aneurysms are often related to atherosclerotic disease, as in this patient.* ![Axial NECT shows a low-density, suprasellar mass with rim and globular calcification . 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.](d01dec64-a534-45b7-8fdf-e179fbbe9998) **Pilocytic Astrocytoma** *Axial NECT shows a low-density, suprasellar mass with rim and globular calcification . 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.* ![Sagittal NECT shows a fat density lesion with rim calcification in the suprasellar cistern. There are scattered fat droplets in the subarachnoid spaces in this case of a ruptured dermoid cyst.](b1cf55ae-d0d7-4a2d-92f4-3cedacf35c4c) **Dermoid Cyst** *Sagittal NECT shows a fat density lesion with rim calcification in the suprasellar cistern. There are scattered fat droplets in the subarachnoid spaces in this case of a ruptured dermoid cyst.* ![Axial NECT shows curvilinear calcification 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.](e9c364e9-ab7e-42cd-be55-44b8c19ef17d) **Rathke Cleft Cyst** *Axial NECT shows curvilinear calcification 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.* ### Additional Images ![Axial CECT shows a very large intra- and suprasellar enhancing mass invading the central skull base. Note floccular calcifications within the mass, an uncommon finding in macroadenomas.](95b8c653-566b-4169-8af8-5fe85a13bdfb) **Pituitary Macroadenoma** *Axial CECT shows a very large intra- and suprasellar enhancing mass invading the central skull base. Note floccular calcifications within the mass, an uncommon finding in macroadenomas.* ![Sagittal bone CT shows globular calcification in a suprasellar mass in this typical osteochondroma of the central skull base with calcification in the cartilaginous cap.](db0f24ca-c1e8-48f9-8071-f087589fa914) **Chondroid Tumor** *Sagittal bone CT shows globular calcification in a suprasellar mass in this typical osteochondroma of the central skull base with calcification in the cartilaginous cap.* ![Axial NECT shows a hyperdense suprasellar mass with focal calcifications in this patient with a classic meningioma arising from the central skull base. Note the associated hydrocephalus related to ventricular obstruction.](images/app.statdx.com_image_thumbnail_2111ba3c-137d-4717-9311-8d32dbfc155c_annotated_true_size_900_quality_90_73f0f783.jpg) **Meningioma** *Axial NECT shows a hyperdense suprasellar mass with focal calcifications in this patient with a classic meningioma arising from the central skull base. Note the associated hydrocephalus related to ventricular obstruction.* ![Axial NECT shows a huge, well-delineated, hyperdense suprasellar mass with rim calcifications . 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.](images/app.statdx.com_image_thumbnail_192bafea-6ad6-4a4b-b208-47af9165fc27_annotated_true_size_900_quality_90_e1a755d3.jpg) **Saccular Aneurysm** *Axial NECT shows a huge, well-delineated, hyperdense suprasellar mass with rim calcifications . 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.* ![Axial NECT shows a large, hypodense, calcified suprasellar mass . Note fat density droplets in the subarachnoid space related to a ruptured dermoid cyst.](aaeaa251-a331-4ca5-b854-b42d581c1782) **Dermoid Cyst** *Axial NECT shows a large, hypodense, calcified suprasellar mass . Note fat density droplets in the subarachnoid space related to a ruptured dermoid cyst.* ![Coronal NECT shows a complex cystic expansile mass in the sella and suprasellar cistern with peripheral calcification in this case of pituitary macroadenoma with cystic degeneration.](16317746-cdd8-4e58-a609-f831cab62bd6) **Pituitary Macroadenoma** *Coronal NECT shows a complex cystic expansile mass in the sella and suprasellar cistern with peripheral calcification in this case of pituitary macroadenoma with cystic degeneration.* ![Coronal NECT shows a destructive low- density mass with internal chondroid calcifications extending from the central skull base into the suprasellar cistern in this case of chondrosarcoma.](a4d5358b-ae13-4c83-b768-58c4c3c2881d) **Chondroid Tumor** *Coronal NECT shows a destructive low- density mass with internal chondroid calcifications extending from the central skull base into the suprasellar cistern in this case of chondrosarcoma.*