Craniopharyngioma MRI: Difference between revisions

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{{Craniopharyngioma}}
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==Overview==
==Overview==
The [[Diagnosis|diagnostic evaluation]] of craniopharyngioma includes [[Radiology|high-definition brain imaging]]. [[Magnetic resonance imaging|Brain MRI]] [[Magnetic resonance imaging|with and without contrast is the gold standard]]. [[Computed tomography|Computed tomography (CT)]] scan is optional and may show some [[Calcification|calcifications]] that can be seen in these [[Tumor|tumors]]. [[Computed tomography|CT i]]<nowiki/>s not specific enough as a stand alone [[diagnostic test]]. [[Magnetic resonance angiography|Vascular imaging]] studies such as [[Magnetic resonance angiography|MR angiography (MRA]]) or [[CT angiography|CTA]], is decided on a case-by-case basis.


==MRI==
==MRI==
{| align="right"
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[[File:MRI CarioGIF1.gif|thumb|200px|Coronal section of brain showing craniopharyngioma [https://upload.wikimedia.org/wikipedia/commons/c/c6/Craniopharyngioma-t1corkm-001.jpg Source:Wikimedia Commons] ]]
|-
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[[File:MRICranioGIff.gif|thumb|200px|MRI showing transverse section of craniopharyngioma [https://upload.wikimedia.org/wikipedia/commons/e/e3/Craniopharyngioma-t2ax-003.jpg Source:Wikimedia Commons] ]]
|-
|
[[File:CraniMRIGIF.gif|thumb|200px|MRI showing cystic craniopharyngioma [https://upload.wikimedia.org/wikipedia/commons/e/ed/Craniopharyngioma-t1corkm-003.jpg Source:Wikimedia Commons] ]]
|}
The MRI findings depend on the type of craniopharyngioma.<ref>MRI findings of Craniopharyngioma. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/craniopharyngioma</ref>
===Adamantinomatous===
* Adamantinomatous type is the most common form (90%).
* [[Solid|Solid components]] are present, but usually form a relatively minor component of the mass.
* The [[calcification]] is very common.
* [[Tumor]] have a predilection to be large, extending [[Superior|superiorly]] into the [[third ventricle]], and [[Vessels|encasing vessels]].<ref name="pmid13883661">{{cite journal |vauthors=DATI T |title=[Radiology of craniopharyngiomas with special reference to pneumoencephalography. II] |language=Italian |journal=Rass Fisiopatol Clin Ter |volume=33 |issue= |pages=955–67 |date=October 1961 |pmid=13883661 |doi= |url=}}</ref>


*Cranial magnetic resonance imaging (MRI): An MRI uses magnetic fields but it is a different type of image than what is produced by computed tomography (CT). It can produce very detailed images of the brain to help diagnose craniopharyngioma. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture.
*'''Cysts'''
*Cranial computed tomography (CT) scan: CT scans are also used to diagnose craniopharyngioma. It can confirm the location of the tumor and show the organs nearby.
**Variable but 80% are mostly or partly [[Magnetic resonance imaging|T2 hyperintense]]
*Endocrine hormone tests
**[[Magnetic resonance imaging|T1: iso- to hyperintense]] to brain (due to high protein content machinery oil [[Cyst|cysts]])
*'''Solid component'''
**T1 C+ (Gd): [[Magnetic resonance imaging|vivid enhancement]]
**T2: variable or mixed
*'''[[Calcification]]'''
*Difficult to appreciate on [[X ray|conventional imaging]]
*Susceptible sequences may better demonstrate [[calcification]]


'''Adamantinomatous craniopharyngioma in a pediatric patient'''
'''MR angiography''': It may demonstrate displacement of the A1 segment of the [[anterior cerebral artery]] (ACA).<ref name="pmid29877209">{{cite journal |vauthors=Nishioka H, Nagata Y, Fukuhara N, Yamaguchi-Okada M, Yamada S |title=Endoscopic Endonasal Surgery for Subdiaphragmatic Type Craniopharyngiomas |journal=Neurol. Med. Chir. (Tokyo) |volume=58 |issue=6 |pages=260–265 |date=June 2018 |pmid=29877209 |pmc=6002681 |doi=10.2176/nmc.oa.2018-0028 |url=}}</ref>


([http://www.radswiki.net Images courtesy of RadsWiki])
'''MR spectroscopy''': [[Cyst]] contents may show a broad lipid spectrum, with an otherwise flat baseline.


<gallery>
===Papillary===
Image:Craniopharyngioma-001.jpg|Craniopharyngioma
* Papillary craniopharyngioma tend to be more [[Spherical aberration|spherical]] in outline.
Image:Craniopharyngioma-002.jpg|Craniopharyngioma
* [[Calcification]] is uncommon or even rare in the papillary subtype.
Image:Craniopharyngioma-003.jpg|Craniopharyngioma
* Papillary tumors tend to displace adjacent structures.<ref name="pmid17825241">{{cite journal |vauthors=Van Effenterre R, Boch AL |title=[Craniopharyngiomas] |language=French |journal=Ann. Endocrinol. (Paris) |volume=68 |issue=6 |pages=412–21 |date=December 2007 |pmid=17825241 |doi=10.1016/j.ando.2007.08.001 |url=}}</ref>
Image:Craniopharyngioma-004.jpg|Craniopharyngioma
Image:Craniopharyngioma-005.jpg|Craniopharyngioma
</gallery>


*Adamantinomatous subtype appears as a predominately cystic suprasellar mass with a solid component.
*'''Cysts'''
*Characteristic calcifications may not be discernible, though gradient-echo (GRE) images may show susceptibility effects from calcified components.
**When present they are variable in signal.<ref name="pmid14095868">{{cite journal |vauthors=MATSON DD |title=CRANIOPHARYNGIOMA |journal=Clin Neurosurg |volume=10 |issue= |pages=116–29 |date=1964 |pmid=14095868 |doi= |url=}}</ref> <ref name="pmid27846921">{{cite journal |vauthors=Burrell S, Hebb AL, Imran SA, Mishra A, Mawko G, Clarke DB |title=Visualization of 90Yttrium Colloid Within a Cystic Craniopharyngioma Using PET/CT/MRI Fusion |journal=Can J Neurol Sci |volume=44 |issue=2 |pages=192–193 |date=March 2017 |pmid=27846921 |doi=10.1017/cjn.2016.410 |url=}}</ref>
*Cystic areas appear hyperintense on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images with heterogeneous isointense-to-hypointense solid components.
**85% [[Magnetic resonance imaging|T1 hypointense]]
*The cystic areas may be iso-, hyper-, or hypointense relative to brain tissue with T1-weighted sequences.
*'''Solid component'''
**T1: [[Magnetic resonance imaging|iso- to lightly hypointense]] to brain
**T1 C+: [[Magnetic resonance imaging|vivid enhancement]]
**T2: variable/mixed
 
<br><br><br><br>


==References==
==References==
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Latest revision as of 17:22, 25 February 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Marjan Khan M.B.B.S.[2]

Overview

The diagnostic evaluation of craniopharyngioma includes high-definition brain imaging. Brain MRI with and without contrast is the gold standard. Computed tomography (CT) scan is optional and may show some calcifications that can be seen in these tumors. CT is not specific enough as a stand alone diagnostic test. Vascular imaging studies such as MR angiography (MRA) or CTA, is decided on a case-by-case basis.

MRI

Coronal section of brain showing craniopharyngioma Source:Wikimedia Commons
MRI showing transverse section of craniopharyngioma Source:Wikimedia Commons
MRI showing cystic craniopharyngioma Source:Wikimedia Commons

The MRI findings depend on the type of craniopharyngioma.[1]

Adamantinomatous

MR angiography: It may demonstrate displacement of the A1 segment of the anterior cerebral artery (ACA).[3]

MR spectroscopy: Cyst contents may show a broad lipid spectrum, with an otherwise flat baseline.

Papillary

  • Papillary craniopharyngioma tend to be more spherical in outline.
  • Calcification is uncommon or even rare in the papillary subtype.
  • Papillary tumors tend to displace adjacent structures.[4]





References

  1. ↑ MRI findings of Craniopharyngioma. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/craniopharyngioma
  2. ↑ DATI T (October 1961). "[Radiology of craniopharyngiomas with special reference to pneumoencephalography. II]". Rass Fisiopatol Clin Ter (in Italian). 33: 955–67. PMID 13883661.
  3. ↑ Nishioka H, Nagata Y, Fukuhara N, Yamaguchi-Okada M, Yamada S (June 2018). "Endoscopic Endonasal Surgery for Subdiaphragmatic Type Craniopharyngiomas". Neurol. Med. Chir. (Tokyo). 58 (6): 260–265. doi:10.2176/nmc.oa.2018-0028. PMC 6002681. PMID 29877209.
  4. ↑ Van Effenterre R, Boch AL (December 2007). "[Craniopharyngiomas]". Ann. Endocrinol. (Paris) (in French). 68 (6): 412–21. doi:10.1016/j.ando.2007.08.001. PMID 17825241.
  5. ↑ MATSON DD (1964). "CRANIOPHARYNGIOMA". Clin Neurosurg. 10: 116–29. PMID 14095868.
  6. ↑ Burrell S, Hebb AL, Imran SA, Mishra A, Mawko G, Clarke DB (March 2017). "Visualization of 90Yttrium Colloid Within a Cystic Craniopharyngioma Using PET/CT/MRI Fusion". Can J Neurol Sci. 44 (2): 192–193. doi:10.1017/cjn.2016.410. PMID 27846921.


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