Craniopharyngiomas: identification of different semiological patterns with MRI

Abstract

Our objectives were to analyze different semiological patterns in craniopharyngiomas studied with CT and MR sequences. Retrospective study of 26 patients with confirmed craniopharyngiomas. All cases were examined with CT and MR imaging using a variety of pulse sequences (spin echo, inversion recovery, gradient echo in-phase and opposed-phase). The analyzed component patterns were classified as solid, calcium, proteic-like, cerebrospinal fluid (CSF)-like, hematic-like, and fatty patterns. The different patterns were related by means of contingency tables and the Fisher exact test and also to epidemiological findings and tumor size. A solid pole was detected in all patients, whereas a cystic component was present in 92.3% of the cases. Calcification was visualized in 65.3%, proteic-like in 53.8%, CSF-like in 23%, hematic-like in 19.2%, and fatty component in 15.3%. There were no statistical associations between patterns, with the exception that in no case did CSF-like and proteic-like patterns coexist ( P=0.004). Tumor size was related to components. Hematic-like (17.0+/-18.9 vs 3.9+/-2.6 mm, non-present vs present) and CSF-like (16.9+/-19.6 vs 6.5+/-4.0 mm) patterns were observed most frequently in smaller tumors, whereas larger tumors usually had proteic-like (5.9+/-5.4 vs 21.1+/-21.0 mm) and calcified (4.6+/-1.9 vs 19.1+/-19.9 mm) patterns. Computed tomography and a combination of different MR images frequently allow the detection of different semiological patterns in these tumors. Semiological patterns were correlated only to tumor size.

Kernspintomographische Diagnostik der Hypophyse und ihrer Nachbarstrukturen

“…3% aller intrakraniellen Tumoren ausmacht. Bei Kindern ist das Kraniopharyngeom nach Medulloblastom und Astrozytom der dritthäufigste intrakranielle Tumor und stellt damit in dieser Altersgruppe sogar 8-13% der intrakraniellen Neoplasien [19,31].…”

“…ausschließlich, intrasellär lokalisiert waren. Mollá et al [19] fanden bei 26 Patienten in 60% eine intra-und supraselläre und in 20% eine rein supraselläre Lokalisation. Bei Nachweis einer suprasellären Tumorausdehnung muss die MR-Untersuchung die für den Neurochirurgen wichtige Frage beantworten, ob der Tumor prä-oder retrochiasmal liegt; dies ist unter Umständen für die Wahl des operativen Zugangs entscheidend [31].…”

“…Eine Studie [33] an knapp 200 kindlichen Kraniopharyngeomen fand Zysten in 98,9% der Fälle.Die Angaben zur Häufigkeit intratumoraler Verkalkungen schwanken; in einer gemischten Serie wurden sie in 65% der Fälle gefunden, in einer großen Studie ausschließlich kindlicher Kraniopharyngeome in 93%, sodass gerade hier die (ergänzende oder sogar alleinige) Computertomographie sehr sinnvoll sein kann. Tumoranteile können außerdem auch ein fett-oder liquorisointenses Signal zeigen[19,33]. Veränderungen Die Untersuchung nach Operation und/oder Bestrahlung eines Hypophysentumors erfordert häufig Ergänzungen bzw.…”

Surgical treatment of ectopic recurrence of craniopharyngioma

“…5,9,36 These lesions arise from embryological squamous epithelial remnants of the craniopharyngeal duct, or Rathke pouch, which extends along an axis from the sella turcica, pituitary gland, and pituitary stalk to the hypothalamus and floor of the third ventricle. 39,45,46,58,60 Despite their benign histopathological characteristics, their clinical course is often rather malignant, and recurrence of craniopharyngiomas is one of the most common complications of treatment, occurring in 0-57% of patients following complete resection. 5,8,10,12,13,16,17,22,26,27,30,37,38,44,50,55,56,60,62,63 Although most recurrences occur locally-in or adjacent to the suprasellar cistern-ectopic recurrence of craniopharyngioma can occur in the presence or absence of suprasellar disease.…”

Minimal residual calcification and recurrence after gross-total resection of craniopharyngioma in children

“…They are thought to arise from embryological squamous epithelial remnants of the craniopharyngeal duct or Rathke's pouch. 45,50,52,75,78 Imaging findings of craniopharyngiomas in children characteristically include a cystic and solid suprasellar mass with contrast enhancment on MR imaging and cal cifications present on CT scans. 13,52 These calcifications, which are present in 65-100% of craniopharyngiomas, are more readily demonstrated on CT scans than on MR images.…”