Unveiling the Enigma of Sellar and Parasellar Pathologies: A Pictorial Essay

Abstract

Sellar and parasellar pathologies often present with nonspecific symptoms. Clinical examination and endocrine studies are useful but cross-sectional imaging is indispensable to characterize and accurately localize the lesion. Magnetic resonance imaging with its multiplanar capability and excellent soft tissue contrast resolution is workhorse in evaluation of sellar and parasellar pathologies. Imaging findings of a broad spectrum of lesions is presented in this article along with anatomy and literature review.

Keywords

magnetic resonance imaging - pituitary - sella turcica

Publikationsverlauf

Artikel online veröffentlicht:
19. September 2023

• References

• 1 Elster AD. Imaging of the sella: anatomy and pathology. Semin Ultrasound CT MR 1993; 14 (03) 182-194
• 2 Sakamoto Y, Takahashi M, Korogi Y, Bussaka H, Ushio Y. Normal and abnormal pituitary glands: gadopentetate dimeglumine-enhanced MR imaging. Radiology 1991; 178 (02) 441-445
• 3 Scotti G, Yu CY, Dillon WP. et al. MR imaging of cavernous sinus involvement by pituitary adenomas. AJR Am J Roentgenol 1988; 151 (04) 799-806
• 4 Yuh WT, Fisher DJ, Nguyen HD. et al. Sequential MR enhancement pattern in normal pituitary gland and in pituitary adenoma. AJNR Am J Neuroradiol 1994; 15 (01) 101-108
• 5 Bonneville JF, Cattin F, Gorczyca W, Hardy J. Pituitary microadenomas: early enhancement with dynamic CT–implications of arterial blood supply and potential importance. Radiology 1993; 187 (03) 857-861
• 6 Argyropoulou MI, Kiortsis DN. Magnetization transfer imaging of the pituitary gland. Hormones (Athens) 2003; 2 (02) 98-102
• 7 Osborn A, Hedlund G, Salzman K. Osborn's Brain E-Book. Philadelphia: Elsevier Health Sciences; 2017. :771–817
• 8 Gutenberg A, Larsen J, Lupi I, Rohde V, Caturegli P. A radiologic score to distinguish autoimmune hypophysitis from nonsecreting pituitary adenoma preoperatively. AJNR Am J Neuroradiol 2009; 30 (09) 1766-1772
• 9 Cheemum L, Walter K, Walter JM, Laurence EB. The sella turcica and parasellar region. In: Magnetic Resonance Imaging of the Brain and Spine. Vol. 2. Philadelphia: WW Lippincott Co; 2002: 1283-1362
• 10 Dwyer AJ, Frank JA, Doppman JL. et al. Pituitary adenomas in patients with Cushing disease: initial experience with Gd-DTPA-enhanced MR imaging. Radiology 1987; 163 (02) 421-426
• 11 Edal AL, Skjödt K, Nepper-Rasmussen HJ. SIPAP–a new MR classification for pituitary adenomas. Suprasellar, infrasellar, parasellar, anterior and posterior. Acta Radiol 1997; 38 (01) 30-36
• 12 Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 1993; 33 (04) 610-617 , discussion 617–618
• 13 Kovacs K, Horvath E, Asa SL. Classification and pathology of pituitary tumors. In: Wilkins RH, Rengachary SS. eds. Neurosurgery. New York: McGraw-Hill; 1985: 834-842
• 14 Pierallini A, Caramia F, Falcone C. et al. Pituitary macroadenomas: preoperative evaluation of consistency with diffusion-weighted MR imaging–initial experience. Radiology 2006; 239 (01) 223-231
• 15 Park M, Lee SK, Choi J. et al. Differentiation between cystic pituitary adenomas and Rathke cleft cysts: a diagnostic model using MRI. AJNR Am J Neuroradiol 2015; 36 (10) 1866-1873
• 16 Whittle IR, Smith C, Navoo P, Collie D. Meningiomas. Lancet 2004; 363 (9420): 1535-1543
• 17 Borg A, Ekanayake J, Mair R. et al. Preoperative particle and glue embolization of meningiomas: indications, results, and lessons learned from 117 consecutive patients. Neurosurgery 2013; 73 (2, Suppl Operative): ons244-ons251 , discussion ons252
• 18 Sartoretti-Schefer S, Wichmann W, Aguzzi A, Valavanis A. MR differentiation of adamantinous and squamous-papillary craniopharyngiomas. AJNR Am J Neuroradiol 1997; 18 (01) 77-87
• 19 Santos ARSD, de Araujo DA, Altoé A, Corrêa DG. Suprasellar mature teratoma/dermoid cyst with the Poké ball sign. Can J Neurol Sci 2021; x: 1-2
• 20 Das CJ, Tahir M, Debnath J. et al. Ruptured intracranial dermoid. BMJ Case Rep 2009; 2009: bcr2006109835b
• 21 Simmons GE, Suchnicki JE, Rak KM, Damiano TR. MR imaging of the pituitary stalk: size, shape, and enhancement pattern. AJR Am J Roentgenol 1992; 159 (02) 375-377
• 22 Rupp D, Molitch M. Pituitary stalk lesions. Curr Opin Endocrinol Diabetes Obes 2008; 15 (04) 339-345
• 23 D'Ambrosio N, Soohoo S, Warshall C, Johnson A, Karimi S. Craniofacial and intracranial manifestations of Langerhans cell histiocytosis: report of findings in 100 patients. AJR Am J Roentgenol 2008; 191 (02) 589-597
• 24 Packer RJ, Cohen BH, Cooney K. Intracranial germ cell tumors. Oncologist 2000; 5 (04) 312-320
• 25 Eurorad - Brought to you by the ESR. 2022. Eurorad.org. [online]. Accessed January 16, 2022 at: https://www.eurorad.org/case/17198
• 26 Manjila S, Miller EA, Vadera S. et al. Duplication of the pituitary gland associated with multiple blastogenesis defects: duplication of the pituitary gland (DPG)-plus syndrome. Case report and review of literature. Surg Neurol Int 2012; 3 (01) 23
• 27 Kulkarni C, Moorthy S, Pullara SK, Rajeshkannan R, Unnikrishnan AG. Pituitary stalk transection syndrome: comparison of clinico-radiological features in adults and children with review of literature. Indian J Radiol Imaging 2012; 22 (03) 182-185
• 28 Donovan JL, Nesbit GM. Distinction of masses involving the sella and suprasellar space: specificity of imaging features. AJR Am J Roentgenol 1996; 167 (03) 597-603
• 29 Hanak BW, Zada G, Nayar VV. et al. Cerebral aneurysms with intrasellar extension: a systematic review of clinical, anatomical, and treatment characteristics. J Neurosurg 2012; 116 (01) 164-178
• 30 Smith MM, Strottmann JM. Imaging of the optic nerve and visual pathways. Semin Ultrasound CT MR 2001; 22 (06) 473-487
• 31 Chiang MF, Brock M, Patt S. Pituitary metastases. Neurochirurgia (Stuttg) 1990; 33 (04) 127-131
• 32 Amstutz DR, Coons SW, Kerrigan JF, Rekate HL, Heiserman JE. Hypothalamic hamartomas: correlation of MR imaging and spectroscopic findings with tumor glial content. AJNR Am J Neuroradiol 2006; 27 (04) 794-798