CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSISEISENBERG

1. 8Sellar and Juxtasellar Masses
on Magnetic Resonance Imaging

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • SK 8-1 Pituitary microadenoma. Coronal T1-weighted image demonstrates a
prolactin-secreting microadenoma (open arrow) as a focal area of decreased signal
in the pituitary gland. Associated findings include displacement of the pituitary
stalk contralaterally (curved arrow) and elevation of the upper border of the gland
(straight solid arrow).15

4. • Fig SK 8-2 Pituitary macroadenoma. (A) Sagittal and (B) coronal MR scans demonstrate a large mass
(m) that arises from the sella turcica and extends upward to fill the suprasellar cistern. (C) In
another patient, an axial scan shows tumor involvement of the right cavernous sinus with
encasement of the ipsilateral carotid artery (arrow).

5. • Fig SK 8-3 Craniopharyngioma. Sagittal MR
image demonstrates a large, multiloculated,
suprasellar mass with cystic (C) and lipid (L)
components. (c, cerebellum; p, pons.)

6. • Fig SK 8-4 Rathke's cleft cyst. (A) Sagittal and
(B) coronal T1-weighted images show an ovoid
lesion of high intensity (arrow) in the middle
to posterior portion of the pituitary fossa.16

7. • Fig SK 8-5 Planum sphenoidale meningioma growing
over the diaphragma sellae. (A) Sagittal T1-weighted
scan shows a soft-tissue mass isointense to brain that
elevates the anterior cerebral artery (arrowhead) and
produces hyperostosis of the planum sphenoidale
(arrow). (B) Coronal T1-weighted image shows a mass
in the suprasellar space sitting on the diaphragma
sellae, lying above the pituitary gland, elevating the
two anterior cerebral arteries (arrowheads), and
displacing both optic nerves (arrows).16

8. • Fig SK 8-6 Optic chiasm glioma. A suprasellar
mass is seen on the left (arrowhead).

9. • Fig SK 8-7 Clival chordoma. (A) Sagittal MR scan
shows a low-intensity multilobulated mass
deforming and displacing the brainstem,
destroying the clivus, and extending into the sella
turcica (upper arrowhead) and nasopharynx
(lower two arrowheads). (B) Axial T2-weighted
scan shows that the hyperintense mass with
peripheral vessels invaginates into the brainstem
and also occupies the region of the sella turcica
and left cavernous sinus.17

10. • Fig SK 8-8 Metastasis. Coronal T1-weighted
image shows an enhanced mass (arrows) in
the sella, suprasellar space, and left parasellar
cavernous sinus.16

11. • Fig SK 8-9 Epidermoid tumor. (A) Coronal T1-
weighted image shows a hypointense suprasellar
mass (arrowheads) that extends into the fissure
of the right middle cerebral artery. (B) Axial
proton-density image shows the suprasellar mass
to have slightly increased signal intensity
(arrowheads) and to extend into the inferior right
frontal region.16

12. • Fig SK 8-10 Trigeminal schwannoma of the
right gasserian ganglion. (A) T1-weighted
coronal image shows the mass to be of
relatively low signal intensity and to involve
the mandibular division (arrow). (B) On the
T2-weighted scan, the lesion has high
homogeneous signal intensity.18

13. • Fig SK 8-11 Distal left carotid artery aneurysm. On
this coronal T2-weighted scan, the predominantly
flow-void mass (A) extends into the suprasellar
cistern and displaces the pituitary stalk.15

14. • Fig SK 8-12 Ectopia of the posterior pituitary lobe.
(A) Sagittal and (B) coronal T1-weighted images in
a patient with diabetes insipidus that developed
after an automobile accident. Hyperintensity in
the region of the tuber cinereum (arrows)
indicates transection of the pituitary stalk. Note
the separate hyperintense area of fat in the
dorsum sellae (arrowhead, A).19