Type:
Educational Exhibit
Keywords:
Education and training, Diagnostic procedure, MR, CT, Neuroradiology brain, CNS
Authors:
T. Oliveira1, M. C. Calegari2, V. Trindade1, G. Gomes1, L. de Souza1, G. D. D. Souza3; 1Brasilia/BR, 2Brasília, DF/BR, 3Brasília, Di/BR
DOI:
10.26044/ecr2019/C-3308
Background
The suprasellar cistern is a cerebrospinal fluid-filled cistern located above the sella turcica region,
under the hypothalamus and between the uncus of the temporal lobes.
It represents a passageway for complex neurovascular structures,
such as: optic chiasm,
infundibular stalk and cerebrovascular circle of Willis.
At least 30 different lesions may occur near or in pituitary gland,
originating from the gland itself or adjacent structures,
including cavernous sinuses and its contents,
arteries,
cranial nerves,
meninges,
cerebrospinal fluid compartments and brain parenchyma.
The investigation of intrasellar and suprasellar injuries can be difficult,
due to tricky anatomy and great variety of lesions,
often with similar clinical manifestations.
A useful anatomic approach that can be used is to identify the pituitary gland and sella turcica.
After that,
determine the epicenter of the lesion (if it is in the sella,
above,
below or lateral to it).
Once in the sella,
determine if the sella is enlarged or not.
When the mass location is clear,
analyze the signal intensity patterns (cystic or solid).
Determine if there are abnormal vessels or calcifications.
Finally,
establish a differential diagnosis,
the major challenge because of the complexity of structures involved.
Although computed tomography is particularly helpful in evaluating of bony changes related to pathologic processes,
MRI may be more effective in multiplanar capacity and contrast sensitivity between brain, cerebrospinal fluid and bone.
It also has a high delineation of vascular structures and blood flow,
qualities that are essentials for the study of this zone.