statdx/docs_md/articles/calcified-suprasellar-mass_b61b0b70-de36-45f9-88a2-162a9758b729.md

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Calcified Suprasellar Mass	b61b0b70-de36-45f9-88a2-162a9758b729	key value e0282a62-994d-4550-a127-1eb773b1e920 Blair A. Winegar, MD key value 5cff4116-3654-4b3a-bb75-5ebe0b8c9850 Anne G. Osborn, MD, FACR key value 8d5254e9-8dda-478b-8f08-bdee97a32c79 Karen L. Salzman, MD, FACR	name slug treeNodeId Brain brain 6d8829f1-14d7-45af-8675-255189aa526a name slug treeNodeId Differential Diagnosis differential-diagnosis a7fdd139-664e-4bb8-8d18-400e4733ff60 name slug treeNodeId Sella/Juxtasellar, Pineal Region sellajuxtasellar-pineal-region 5e38b9c1-3137-47e3-aa83-1fc82cb4099a name slug treeNodeId Anatomically Based Differentials anatomically-based-differentials 7a51b2ca-8fee-4c16-aff3-b7189f68ea60 name slug treeNodeId Calcified Suprasellar Mass calcified-suprasellar-mass null	Brain	9a1f2879-7179-44a8-abaa-f97284492f8d	15	02/01/23	Calcified Suprasellar Mass	Brain, Differential Diagnosis, Sella/Juxtasellar, Pineal Region, Anatomically Based Differentials, Calcified Suprasellar Mass	Calcified Suprasellar Mass | STATdx	Calcified Suprasellar Mass	DDX	true	Brain Differential Diagnosis Sella/Juxtasellar, Pineal Region Anatomically Based Differentials Calcified Suprasellar Mass

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title: "Calcified Suprasellar Mass" docid: "b61b0b70-de36-45f9-88a2-162a9758b729" authors:

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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 - Saccularaneurysm - Calcification less common than with fusiform aneurysm, ASVD - Curvilinear (peripheral arcs, rings) pattern - Fusiformaneurysm, 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
2. 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
3. Jipa A et al: Imaging of the sellar and parasellar regions. Clin Imaging. 77:254-75, 2021
4. Chapman PR et al: Neuroimaging of the pituitary gland: practical anatomy and pathology. Radiol Clin North Am. 58(6):1115-33, 2020
5. Snyder MH et al: Neurocysticercosis presenting as an isolated suprasellar lesion. World Neurosurg. 141:352-6, 2020
6. Xin WQ et al: Patient with epilepsy caused by the spontaneous rupture of an intracerebral dermoid cyst. World Neurosurg. 136:140-5, 2020
7. Jacków J et al: Ruptured intracranial dermoid cysts: a pictorial review. Pol J Radiol. 83:e465-70, 2018
8. Seeburg DP et al: Imaging of the sella and parasellar region in the pediatric population. Neuroimaging Clin N Am. 27(1):99-121, 2017
9. 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
10. Pan J et al: Growth patterns of craniopharyngiomas: clinical analysis of 226 patients. J Neurosurg Pediatr. 17(4):418-33, 2016
11. 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
12. Yildiz AE et al: Suprasellar masses in children: characteristic MR imaging features. J Neuroradiol. 43(4):246-59, 2016
13. 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

Images

Selected Images

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.

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.

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.

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.

Saccular Aneurysm Coronal arterial-phase CTA shows a saccular aneurysm projecting medially from the right cavernous ICA with internal arterial enhancement and rim calcifications .

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.