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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleHead and Neck Imaging
Open Access

MR Imaging Appearance of Ruptured Rathke Cleft Cyst and Associated Bone Marrow Enhancement

Ian T. Mark and Christine M. Glastonbury
American Journal of Neuroradiology November 2023, 44 (11) 1314-1317; DOI: https://doi.org/10.3174/ajnr.A8009
Ian T. Mark
aFrom the Department of Radiology (I.T.M.), Mayo Clinic, Rochester, Minnesota
bDepartment of Radiology and Biomedical Imaging (I.T.M., C.M.G.), University of California San Francisco, San Francisco, California
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Christine M. Glastonbury
bDepartment of Radiology and Biomedical Imaging (I.T.M., C.M.G.), University of California San Francisco, San Francisco, California
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    FIG 1.

    A 72-year-old woman who presented with fatigue and was found to have a bilobed pituitary lesion, preoperatively favored to be a pituitary adenoma. A, Precontrast T1-weighted imaging shows focal hypointense signal in the posterior basisphenoid bone marrow (arrows). Postcontrast imaging shows corresponding enhancement (B and C). Pathology confirmed an rRCC.

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    FIG 2.

    A 38-year-old woman presented with headaches for 6 months. MR imaging shows a sellar/suprasellar mass with a septated cystic lesion in the posterior aspect of the sella, preoperatively favored to represent a pituitary adenoma. Postcontrast MR imaging shows basisphenoid bone marrow (arrows) enhancement (B and C) with corresponding edema (D). There was no intrinsic basisphenoid T1-hyperintense signal on the precontrast imaging (A). Pathology confirmed the cystic lesion to be an rRCC. The enlarged suprasellar lesion was biopsied and found to be mixed inflammatory infiltrate and fibrosis, thought to represent inflammatory hypophysitis secondary to the rRCC.

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    FIG 3.

    A 39-year-old woman with a history of gamma knife therapy to the sella for an undiagnosed lesion at another institution presented with an enlarging cystic pituitary lesion. T2-weighted imaging (A) shows a hypointense nodule and edema of the basisphenoid bone marrow (arrows). This area has corresponding T1-hypointense signal on precontrast imaging (B) and enhancement (C). Pathology confirmed an rRCC.

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    FIG 4.

    Example of a pathology-proved nonruptured RCC. The precontrast T1-weighted (left) images show normal signal of the basisphenoid bone marrow edema below the T1-hyperintense RCC. The fat-saturated postcontrasted image (right) shows normal basisphenoid bone marrow without abnormal enhancement.

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    Table 1:

    Demographic information of the patients with rRCC proved at surgical resection

    PatientAge (yr)SexProlactin (μg/L)Presenting SymptomPreop DiagnosisFollow-Up
    151Female33.2HAAdenomaNo recurrence at 6 mo
    247Femalen/aHA, panhypopituitaryRCCRecurrence at 3 yr
    338Female2.7HAAdenomaNo recurrence at 4 yr
    439Female22.4Enlarging lesionRCCNo recurrence at 1 mo
    530Female36.5Diabetes insipidus, vision changesAdenomaNo recurrence at 2 mo
    672Female42.4FatigueAdenomaNo recurrence at 2 mo
    733Female113.2HyperprolactinemiaAdenomaNo recurrence at 2 mo
    • Note:—HA indicates headache; Preop, preoperative; n/a, not available.

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    Table 2.

    MR Imaging characteristics of patients with pathologic rRCCs

    PatientMax Dimension (mm)Bone Marrow EnhancementT2 SignalT2 Dark NoduleT1 Hyperintense SignalLocation
    111.5FocalHyperintenseNoNoMidline
    214.0FocalHypointenseNoYesMidline
    310.8DiffuseHeterogeneousNoNoMidline
    410.8DiffuseHyperintenseYesYesOff-midline
    511.1DiffuseHyperintenseYesNoMidline
    68.2FocalHeterogeneousNoNoReplaces entire pituitary
    712.2DiffuseHyperintenseYesNoReplaces entire pituitary
    • Note:—Max indicates maximum.

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American Journal of Neuroradiology: 44 (11)
American Journal of Neuroradiology
Vol. 44, Issue 11
1 Nov 2023
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Third Window Dehiscence on Temporal Bone CT
Ian T. Mark, Christine M. Glastonbury
American Journal of Neuroradiology Nov 2023, 44 (11) 1314-1317; DOI: 10.3174/ajnr.A8009
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Cite this article
Ian T. Mark, Christine M. Glastonbury
MR Imaging Appearance of Ruptured Rathke Cleft Cyst and Associated Bone Marrow Enhancement
American Journal of Neuroradiology Nov 2023, 44 (11) 1314-1317; DOI: 10.3174/ajnr.A8009

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