MRI and pathological features of Rathke cleft cysts in the sellar region

Wang,Shousen; Nie,Qun; Wu,Zhifeng; Zhang,Jianhe; Wei,Liangfeng

doi:10.3892/etm.2019.8272

MRI and pathological features of Rathke cleft cysts in the sellar region

Authors:
- Shousen Wang
- Qun Nie
- Zhifeng Wu
- Jianhe Zhang
- Liangfeng Wei
View Affiliations

Affiliations: Department of Neurosurgery, Fuzhou General Hospital, Fujian Medical University, Fuzhou, Fujian 350025, P.R. China
Published online on: December 3, 2019 https://doi.org/10.3892/etm.2019.8272
Pages: 611-618
Copyright: © Wang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The aim of the present study was to investigate the MRI and pathological features of Rathke cleft cysts (RCC) in the sellar region. A total of 45 RCC cases were retrospectively analyzed. RCC size, location, intracyst nodules and general signals, as well as the posterior pituitary bright spot (PPBS) were analyzed using MRI‑T1 weighted images (T1WI) and T2WI. The relationship between the presence of PPBS and histopathological features was additionally evaluated. On T1WI, there were 18 cases of isointense signal, 16 cases of hyperintense signal, 9 cases of hypointense signal, 1 case of heterogeneous signal and 1 case with a stratification effect, with isointense signal in the upper part and hyperintense signal in the lower part. On T2WI, there were 5 cases of isointense signal, 27 cases of hyperintense signal, 11 cases of hypointense signal and 1 case of the stratification effect. There were 10 cases of PPBS+ and 35 cases of PPBS‑. There were no significant differences in the age, sex, cyst location and size between PPBS+ and PPBS‑ cases. However, PPBS+ cases had significantly lower inflammation than PPBS‑ cases. A total of 20 cases of intracystic nodules were identified on MRI scans, most of which exhibited T2 ‑hypointense signals. The shape of RCC nodules varied and there were 17 cases where the nodules were non‑adherent to the cyst wall. The MRI signals of RCCs varied and most nodules were floating within cysts. Intracystic nodules are characteristic features of RCCs when observed by MRI and thus are of high diagnostic value. Most patients with RCC were also PPBS‑, which may be associated with an increased inflammatory response.

View Figures

View References

1	Kuan EC, Yoo F, Chyu J, Bergsneider M and Wang MB: Treatment outcomes of Rathke's cleft cysts managed with marsupialization. J Neurol Surg B Skull Base. 78:112–115. 2017. View Article : Google Scholar : PubMed/NCBI
2	Lin M, Wedemeyer MA, Bradley D, Donoho DA, Fredrickson VL, Weiss MH, Carmichael JD and Zada G: Long-term surgical outcomes following transsphenoidal surgery in patients with Rathke's cleft cysts. J Neurosurg. 130:831–837. 2018. View Article : Google Scholar : PubMed/NCBI
3	Kim JE, Kim JH, Kim OL, Paek SH, Kim DG, Chi JG and Jung HW: Surgical treatment of symptomatic Rathke cleft cysts: Clinical features and results with special attention to recurrence. J Neurosurg. 100:33–40. 2004. View Article : Google Scholar : PubMed/NCBI
4	Jahangiri A, Molinaro AM, Tarapore PE, Blevins L Jr, Auguste KI, Gupta N, Kunwar S and Aghi MK: Rathke cleft cysts in pediatric patients: Presentation, surgical management and postoperative outcomes. Neurosurg Focus. 31:E32011. View Article : Google Scholar : PubMed/NCBI
5	Mrelashvili A, Braksick SA, Murphy LL, Morparia NP, Neena N and Neeraj K: Chemical meningitis: A rare presentation of Rathke's cleft cyst. J Clin Neurosci. 21:692–694. 2014. View Article : Google Scholar : PubMed/NCBI
6	Naama O, Gazzaz M, Boulahroud O and Elmoustarchid B: Infection of a Rathke cleft cyst: A rare cause of pituitary abscess. Surg Infect (Larchmt). 15:358–360. 2014. View Article : Google Scholar : PubMed/NCBI
7	Jimbo H, Ichikawa M, Fukami S, Otsuka K, Tsurukiri J, Sunaga S and Lkeda Y: Rapid De Novo aneurysm formation after Rathke cleft cyst rupture. World Neurosurg. 88:690.e11–690.e16. 2016. View Article : Google Scholar
8	Han X and Zhao DJ: Imaging diagnosis of Rathke's cleft cyst. J Med Imag. 20:782–784. 2010.
9	Wang SS, Xiao DY, Yu YH, Jing JJ, Zhao L and Wang RM: Diagnostic significance of intracystic nodules on MRI in Rathke's cleft cyst. Int J Endocrinol. 2012:9587322012. View Article : Google Scholar : PubMed/NCBI
10	Binning MJ, Gottfried ON, Osborn AG and Couldwell WT: Rathke cleft cyst intracystic nodule: A characteristic magnetic resonance imaging finding. J Neurosurg. 103:837–840. 2005. View Article : Google Scholar : PubMed/NCBI
11	Byun WM, Kim OL and Kim D: MR imaging findings of Rathke's cleft cysts: Significance of intracystic nodules. AJNR Am J Neuroradiol. 21:485–488. 2000.PubMed/NCBI
12	QI C and Wang N: Value of intracystic nodules on MRI to diagnosis of Rathke's cleft cyst. Chin J Clin Neurosurg. 19:212–214. 2014.
13	Kilday JP, Laughlin S, Urbach S, Bouffet E and Bartels U: Diabetes insipidus in pediatric germinomas of the suprasellar region: Characteristic features and significance of the pituitary bright spot. J Neurooncol. 121:167–175. 2015. View Article : Google Scholar : PubMed/NCBI
14	Saeki N, Hoshi S, Sunada S, Sunami K, Murai H, Kubota M, Tatsuno I, Iuchi T and Yamaura A: Correlation of high signal intensity of the pituitary stalk in macroadenoma and postoperative diabetes insipidus. AJNRAm J Neuroradiol. 23:822–827. 2002.
15	Benveniste RJ, King WA, Walsh J, Lee JS, Naidich TP and Post KD: Surgery for Rathke cleft cysts: Technical considerations and outcomes. J Neurosurg. 101:577–584. 2004. View Article : Google Scholar : PubMed/NCBI
16	Côté M, Salzman KL, Sorour M and Couldwell WT: Normal dimensions of the posterior pituitary bright spot on magnetic resonance imaging. J Neurosurg. 120:357–362. 2014. View Article : Google Scholar : PubMed/NCBI
17	Schreckinger M, Szerlip N and Mittal S: Diabetes insipidus following resection of pituitary tumors. Clin Neurol Neurosurg. 115:121–126. 2013. View Article : Google Scholar : PubMed/NCBI
18	Wang S, Lin K, Xiao D, Zhao L, Qin Y and Wei L: MR imaging analysis of posterior pituitary in patients with pituitary adenoma. Int J Clin Exp Med. 8:7634–7640. 2015.PubMed/NCBI
19	Klyn V, Dekeyzer S, Van Eetvelde R, Roels P, Vergauwen O, Devolder P, Wiesmann M, Achten E and Nikoubashman O: Presence of the posterior pituitary bright spot sign on MRI in the general population: A comparison between 1.5 and 3T MRI and between 2D-T1 spin-echo- and 3D-T1 gradient-echo sequences. Pituitary. 21:379–383. 2018. View Article : Google Scholar : PubMed/NCBI
20	Ogawa Y, Watanabe M and Tominaga T: Intraparenchymal infiltration of Rathke's cleft cysts manifesting as severe neurological deficits and hypopituitarism: 2 Case reports. BMC Res Notes. 9:2252016. View Article : Google Scholar : PubMed/NCBI
21	Locatelli D, Pozzi F, Agresta G, Padovan S, Karligkiltis A and Castelnuovo P: Extended endoscopic endonasal approach for suprasellar craniopharyngioma. J Neurol Surg B Skull Base. 79:S196–S198. 2018. View Article : Google Scholar : PubMed/NCBI
22	Abbas M, Khairy S, AlWohaibi M, Aloraidi A and AlQurrashi WW: Bilateral temporal extradural hematoma on top of bilateral temporal arachnoid cyst: First case report and extensive literature review. World Neurosurg. 115:134–137. 2018. View Article : Google Scholar : PubMed/NCBI
23	Ifergan H, Cazeneuve N, Merenda P and Magni C: MR imaging features of a pituitary abscess: A case report. Ann Endocrinol (Paris). 80:62–63. 2019. View Article : Google Scholar : PubMed/NCBI