MR appearance of Rathke's cleft cysts

Two of three patients who proved to have symptomatic Rathke's cleft cysts presented with visual field deficit and all with diabetes insipidus. CT showed intra- and suprasellar cystic low density lesions with ring enhancement. MR showed intra- and suprasellar masses. On the T1-weighted images two of the three had hyperintense portions similar to fat and the other a hyperintense portion similar to white matter within the cysts. These portions were isointense to brain on the T2-weighted images in all cases. This characteristic intensity on MR images provides differentiation from cystic pituitary adenomas and cystic craniopharyngiomas, and leads to correct diagnosis of Rathke's cleft cyst.