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Characteristics of Rathke's cleft cyst in MR imaging
Jun-Ya Tominaga1, Shuichi Higano, Shoki Takahashi
1Division of diagnostic Radiology, Tohoku University, Sendai, Japan. jrtomi@jf6.so-net.ne.jp
Purpose:
Symptoms, macroscopic appearances and microscopic findings of Rathke's cleft cysts with magnetic resonance (MR) imaging.
Patients And Methods:
We analyzed the data from 31 patients with pathologically confirmed Rathke's cleft cysts. MR appearances were evaluated on T1WI, T2WI and contrast T1WI. Symptoms, macroscopic appearances and pathological findings were obtained from available medical records. We analyzed the images according to the following criteria: 1. findings on the location and shape of the lesions and form of the lesional wall; 2. the relationship between the maximum diameter of the lesions and symptoms; 3. the relationship between MR and macroscopic appearance; 4. the sites of adjacent contrast enhancement.
Results:
The lesions were located mostly in both the intrasellar and suprasellar regions for a total of 87%. All lesions revealed either an oval or dumbbell shape with a smooth lesional wall. When correlated with physical symptoms, asymptomatic cases were associated with smaller lesions, while visual disturbances and dizziness were associated with relatively larger lesions. MR lesion signal intensity was related to the content of macroscopic appearance to some degree: the selected lesions showed shortening of T1 and T2 relaxation times in relation to the increase in protein concentration. This should have been macroscopically reflected in the color and turbidity of the liquid within the cyst. Adjacent contrast enhancement around the lesion was found at various sites, but anterior enhancement was most frequent. Circumferential enhancement was revealed to be derived from inflammatory changes.
Conclusion:
Rathke's cleft cyst exhibits a varied MR signal. It may be difficult to differentiate from craniopharyngioma from the intensity alone.
Insights
Magnetic resonance (MR) imaging reveals Rathke's cleft cysts often in the intrasellar/suprasellar regions. Larger cysts correlate with symptoms like visual disturbances, while MR signal intensity relates to cyst content and protein concentration.
Area of Science:
- Neuroradiology
- Endocrinology
- Pathology
Background:
- Rathke's cleft cysts (RCC) are common sellar/suprasellar lesions.
- Accurate diagnosis is crucial for appropriate management.
- Differentiating RCC from other sellar masses can be challenging.
Purpose of the Study:
- To correlate symptoms, macroscopic, and microscopic findings of Rathke's cleft cysts with their appearance on magnetic resonance (MR) imaging.
- To analyze MR imaging characteristics in relation to clinical presentation and pathological findings.
Main Methods:
- Retrospective analysis of 31 pathologically confirmed Rathke's cleft cysts.
- Evaluation of MR imaging (T1WI, T2WI, contrast-enhanced T1WI).
- Correlation of imaging findings with clinical symptoms, macroscopic appearance, and histopathology.
Main Results:
- Lesions predominantly located in intrasellar and suprasellar regions (87%).
- Oval or dumbbell shapes with smooth walls were common.
- Smaller lesions associated with asymptomatic cases; larger lesions with visual disturbances/dizziness.
- MR signal intensity correlated with protein concentration; anterior contrast enhancement was most frequent.
Conclusions:
- Rathke's cleft cysts display varied MR signal characteristics.
- Distinguishing Rathke's cleft cysts from craniopharyngioma based solely on MR signal intensity can be difficult.
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