Craniopharyngioma MRI: Difference between revisions

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{{Craniopharyngioma}}
{{Craniopharyngioma}}
{{CMG}}{{AE}}{{SR}}
{{CMG}}; {{AE}} {{Marjan}}
==Overview==
==Overview==
The diagnostic evaluation of craniopharyngioma includes high-definition brain imaging. Brain MRI with and without contrast is the gold standard.
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==
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>
{| align="right"
|
[[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] ]]
|-
|
[[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===
Adamantinomatous type is the most common form (90%),  and typically have a lobulated contour as a result of usually multiple cystic lesions. Solid components are present, but usually form a relatively minor component of the mass, and enhance vividly on MRI scans. The calcification is very common (90%). These tumor have a predilection to be large, extending superiorly into the [[third ventricle]], and encasing vessels, and even being adherent to adjacent structures. The findings on MRI are:
* 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>
 
*'''Cysts'''
*'''Cysts'''
**Variable but 80% are mostly or partly T2 hyperintense
**Variable but 80% are mostly or partly [[Magnetic resonance imaging|T2 hyperintense]]
**T1: iso- to hyperintense to brain (due to high protein content machinery oil cysts)
**[[Magnetic resonance imaging|T1: iso- to hyperintense]] to brain (due to high protein content machinery oil [[Cyst|cysts]])
*'''Solid component'''
*'''Solid component'''
**T1 C+ (Gd): vivid enhancement
**T1 C+ (Gd): [[Magnetic resonance imaging|vivid enhancement]]
**T2: variable or mixed
**T2: variable or mixed
*'''Calcification'''
*'''[[Calcification]]'''
*Difficult to appreciate on conventional imaging
*Difficult to appreciate on [[X ray|conventional imaging]]
*Susceptible sequences may better demonstrate calcification
*Susceptible sequences may better demonstrate [[calcification]]


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


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


===Papillary===
===Papillary===
Papillary craniopharyngioma tend to be more ''spherical'' in outline and usually lack the prominent cystic component; most are either ''solid'' or contain a few smaller cysts. Calcification is uncommon or even rare in the papillary subtype. These tumors tend to displace adjacent structures. The findings on MRI are:
* Papillary craniopharyngioma tend to be more [[Spherical aberration|spherical]] in outline.
* [[Calcification]] is uncommon or even rare in the papillary subtype.
* 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>
 
*'''Cysts'''
*'''Cysts'''
**When present they are variable in signal
**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>
**85% T1 hypointense
**85% [[Magnetic resonance imaging|T1 hypointense]]
*'''Solid component'''
*'''Solid component'''
**T1: iso- to lightly hypointense to brain
**T1: [[Magnetic resonance imaging|iso- to lightly hypointense]] to brain
**T1 C+: vivid enhancement
**T1 C+: [[Magnetic resonance imaging|vivid enhancement]]
**T2: variable/mixed
**T2: variable/mixed


'''MR spectroscopy''': Cyst contents does not show a broad lipid spectrum as they are filled with water fluid.
<br><br><br><br>
 
([http://www.radswiki.net Images courtesy of RadsWiki])
 
<gallery>
Image:Craniopharyngioma-001.jpg|Craniopharyngioma
Image:Craniopharyngioma-002.jpg|Craniopharyngioma
Image:Craniopharyngioma-003.jpg|Craniopharyngioma
Image:Craniopharyngioma-004.jpg|Craniopharyngioma
Image:Craniopharyngioma-005.jpg|Craniopharyngioma
</gallery>


==References==
==References==

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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