Headaches for 4 weeks mainly in the evenings and during the night, no visual disturbances.
MRI pituitary region
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A suprasellar nodular mass with cystic components. The solid component is located above the pituitary gland. The post-contrast acquisition demonstrates enhancement of the solid nodule and walls of the cystic component.
A craniopharyngioma typically involves the sella and suprasellar space (see images). Some craniopharyingiomas can be both intrasellar and suprasellar, having a "snowman" appearance.
The adamantinomatous subtype appears as a predominately cystic suprasellar mass with a solid component (as in this case).
Description of MRI findings:
- cystic area which is hyperintense on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images with heterogeneous isointense to hypointense solid components in the caudal part.
- signal intensity varies on T1-weighted images. The cystic contents can appear hyperintense if they have a high protein, blood product, and/or cholesterol content. In this case the cystic component is T1-isointense.
- contrast enhancement is seen, which is characteristic.
- compression of the third ventricle may occur and hydrocephalus may be present. Such compression helps in distinguishing craniopharyingioma from Rathke's cleft cyst or pituitary adenoma.