Differential diagnosis of intrasellar tumors by computed tomography.

Abstract

The specificity of the computed tomography (CT) diagnosis of intrasellar adenoma has not been studied. We compared the CT findings in intrasellar meningiomas, craniopharyngiomas, aneurysms, and metastases with those of pituitary adenomas. Calcification was a features of intrasellar meningiomas, aneurysms, and craniopharyngioma,s but not a typical feature of adenomas. Low-density regions representing necrosis or cyst were found in most types of intrasellar tumors. Eccentricity, hyperostosis, and bone destruction were useful signs of aneurysm, meningioma, and metastasis, respectively. Since adenoma cannot always be distinguished from another intrasellar mass, angiography to demonstrate tumor angioarchitecture may be needed to characterize some neoplasms or to confirm an intrasellar aneurysm.

Supraclinoid Internal Carotid Arterial Aneurysm Presenting as a Suprasellar Mass-Like Lesion in a Child

“…Although craniopharyngiomas are known to exhibit three basic characteristics i.e. calcification, cyst(s), and contrast enhancement on CT 10 , such findings can also be seen in aneurysms 11 . MR is superior to CT for delineating distortions of the optic chiasm and other suprasellar structures, for demonstrating the status of the carotid artery, and for differentiating them from aneurysms by flow void and heterogeneous increased signal intensity in areas of slower turbulent flow 12. Traumatic ongm is common in this age group although there was no history of trauma in our patient 2 , Traumatic aneurysms typically arise at the skull base or from distal anterior, middle or posterior cerebral arteries resulting from direct mural injury or acceleration-induced shear.…”

Aneurisma gigante parasselar simulando tumor de hipófise

“…Os argumentos diagnósticos para aneurismas intrasselares, segundo Guiot 5, seriam a ocorrência súbita de defeito visual, com freqüente cegueira unilateral, cefaléia intensa e uma lesão hiperdensa à TC. Daniels e col. 4 acrescentam que à TC um aro de calcificação é mais consistente com aneurisma, enquanto uma calcificação focal sugere craniofaringioma ou meningioma e que os aneurismas são mais excêntricos que outras massas selares. Em nossa casuística (Tabela 1) a cefaléia, o comprometimento de nervos cranianos envolvidos na oculomotricidade (III, IV e VI) e na sensibilidade facial (V) e a dor no globo ocular foram as manifestações clínicas mais importantes.…”

“…A TC tem grande valor para diagnosticar e demonstrar a extensão de processo parasselar, entretanto, a identificação de anormalidades vasculares dentro da fossa hipofisária e cisterna suprasselar apresenta dificuldade e o diagnóstico diferencial entre um aneurisma parasselar e um tumor permanece problemático 3 . A demonstração de calcificações pelo TC sugere meningioma, craniofaringioma ou aneurisma; geralmente, os adenomas hipofisários não as apresentam 4 .…”

Further data favouring hormonal dependency of cerebral meningiomas: evidence from a patient treated with cabergoline

“…They form around 15% of all intracranial tumours and approximately a third is found at the base of the skull [1]. Although meningioma often occurs in parasellar regions such as the tuberculum sellae, olfactory groove, and sphenoid wing, pure intrasellar meningiomas are exceedingly rare [2][3][4][5][6][7][8][9]. All the intrasellar meningiomas in the literature present symptoms caused by compression of the optic nerve or the pituitary gland.…”