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Insights into Imaging
Published in: Insights into Imaging 2/2015

Open Access 01-04-2015 | Review

Magnetic resonance imaging of sellar and juxtasellar abnormalities in the paediatric population: an imaging review

Authors: Rachel Shields, Rajiv Mangla, Jeevak Almast, Steven Meyers

Published in: Insights into Imaging | Issue 2/2015

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Abstract

The sellar and juxtasellar regions in the paediatric population are complex both anatomically and pathologically, with magnetic resonance imaging (MRI) being the “gold standard” imaging modality due to the high contrast of detail. Assessment requires a detailed understanding of the anatomy, embryology, pathophysiology and normal signal characteristics of the pituitary gland and surrounding structures in order to appropriately characterise abnormalities. This article aims to provide an overview of the imaging characteristics of developmental/congenital and acquired disease processes which affect the sellar and juxtasellar region in the paediatric population.
Main Messages
• The sellar region is anatomically complex and covers a wide pathology spectrum.
• MRI is the key imaging modality to assess sellar and juxtasellar pathology.
• Numerous developmental anomalies may not be discovered until adulthood.
• Knowledge of pathology alerts and guides the clinician towards appropriate management.
Literature
1.
Delman BN (2009) Imaging of pediatric pituitary abnormalities. Endocrinol Metab Clin N Am 38:673–698CrossRef
2.
Dietrich RB, Lis LE, Greensite FS, Pitt D (1995) Normal MR appearance of the pituitary gland in the first 2 years of life. AJNR Am J Neuroradiol 16:1413–1419PubMed
3.
Fujisawa I, Asato R, Nishimura K et al (1987) Anterior and posterior lobes of the pituitary gland: assessment by 1.5 T MR imaging. J Comput Assist Tomogr 11:214–220
4.
Nishimura K, Fujisawa I, Togashi K et al (1986) Posterior lobe of the pituitary: identification by lack of chemical shift artifact in MR imaging. J Comput Assist Tomogr 10:899–902
5.
Fujisawa I, Asato R, Kawata M et al (1989) Hyperintense signal of the posterior pituitary on T1-weighted MR images: an experimental study. J Comput Assist Tomogr 13:371–377
6.
Kiortsis D, Xydis V, Drougia AG et al (2004) The height of the pituitary in preterm infants during the first 2 years of life: An MRI study. Neuroradiology 46:224–226CrossRefPubMed
7.
Takano K, Utsunomiya H, Ono H et al (1999) Normal development of the pituitary gland: assessment with three-dimensional MR volumetry. AJNR Am J Neuroradiol 20:312–315PubMed
8.
9.
Hamilton J, Blaser S, Daneman D (1998) MR imaging in idiopathic growth hormone deficiency. AJNR Am J Neuroradiol 19:1609–1615PubMed
10.
Kelly WM, Kucharczyk W, Kucharczyk J et al (1988) Posterior pituitary ectopia: An MR feature of pituitary dwarfism. Am J Neuroradiol 9:453–460PubMed
11.
Cohen LE, Radovick S (2002) Molecular basis of combined pituitary hormone deficiencies. Endocr Rev 23:431–442CrossRefPubMed
12.
Pellegrini-Bouiller I, Bélicar P, Barlier A et al (1996) A new mutation of the gene encoding the transcription factor Pit-1 is responsible for combined pituitary hormone deficiency. J Clin Endicrinol Metab 81:2790–2796
13.
Spampinato MV, Castillo M (2005) Congenital pathology of the pituitary gland and parasellar region. Top Magn Reson Imaging 16:269–276CrossRefPubMed
14.
Hamilton BE, Salzman KL, Osborn AG (2007) Anatomic and pathologic spectrum of pituitary infundibulum lesions. AJR Am J Roentgenol 188:W223–W232CrossRefPubMed
15.
Di Iorgi N, Iorgi ND, Allegri AEM et al (2012) The use of neuroimaging for assessing disorders of pituitary development. Clin Endocrinol (Oxf) 76:161–176CrossRef
16.
Slavotinek A, Parisi M, Heike C et al (2005) Craniofacial defects of blastogenesis: duplication of pituitary with cleft palate and orophgaryngeal tumors. Am J Med Genet A 135:13–20CrossRefPubMed
17.
Kollias SS, Ball WS, Prenger EC (1995) Review of the embryologic development of the pituitary gland and report of a case of hypophyseal duplication detected by MRI. Neuroradiology 37:3–12CrossRefPubMed
18.
Manjila S, Miller EA, Vadera S et al (2012) Duplication of the pituitary gland associated with multiple blastogenesis defects: duplication of the pituitary gland (DPG)-plus syndrome. Case report and review of literature. Surg Neurol Int 3:23CrossRefPubMedCentralPubMed
19.
20.
Boyko OB, Curnes JT, Oakes WJ, Burger PC Hamartomas of the tuber cinereum: CT, MR, and pathologic findings. AJNR Am J Neuroradiol 12:309–314
21.
Saleem SN, Said A-HM, Lee DH (2007) Lesions of the hypothalamus: MR imaging diagnostic features. Radiographics 27:1087–1108
22.
Freeman JL, Coleman LT, Wellard RM et al (2004) MR imaging and spectroscopic study of epileptogenic hypothalamic hamartomas: analysis of 72 cases. AJNR Am J Neuroradiol 25:450–462PubMed
23.
Chen CJ (2001) Suprasellar and infrasellar craniopharyngioma with a persistent craniopharyngeal canal: case report and review of the literature. Neuroradiology 43:760–762CrossRefPubMed
24.
Kaushik C, Ramakrishnaiah R, Angtuaco EJ (2010) Ectopic pituitary adenoma in persistent craniopharyngeal canal: case report and literature review. J Comput Assist Tomogr 34:612–614CrossRefPubMed
25.
Kucharczyk W, Peck WW, Kelly WM et al (1987) Rathke cleft cysts: CT, MR imaging, and pathologic features. Radiology 165:491–495CrossRefPubMed
26.
Nemoto Y, Inoue Y, Fukuda T et al (1988) MR appearance of Rathke’s cleft cysts. Neuroradiology 30:155–159CrossRefPubMed
27.
Takanashi JI, Tada H, Barkovich AJ et al (2005) Pituitary cysts in childhood evaluated by MR imaging. Am J Neuroradiol 26:2144–2147PubMed
28.
Byun WM, Kim OL, Kim DS (2000) MR imaging findings of Rathke’s cleft cysts: significance of intracystic nodules. AJNR Am J Neuroradiol 21:485–488PubMed
29.
Binning MJ, Liu JK, Gannon J et al (2008) Hemorrhagic and nonhemorrhagic Rathke cleft cysts mimicking pituitary apoplexy. J Neurosurg 108:3–8CrossRefPubMed
30.
Brassier G, Morandi X, Tayiar E et al (1999) Rathke’s cleft cysts: surgical-MRI correlation in 16 symptomatic cases. J Neuroradiol 26:162–171PubMed
31.
Kim JE, Kim JH, Kim OL et al (2004) Surgical treatment of symptomatic Rathke cleft cysts: clinical features and results with special attention to recurrence. J Neurosurg 100:33–40CrossRefPubMed
32.
Jabre A, Tabaddor R, Samaraweera R, Hahn YS (2000) Transsphenoidal meningoencephalocele in adults. Surg Neurol 54:183–188CrossRefPubMed
33.
34.
Pisaneschi M, Kapoor G (2005) Imaging the sella and parasellar region. Neuroimaging Clin N Am 15:203–219CrossRefPubMed
35.
Gelabert-González M (1998) Intracranial epidermoid and dermoid cysts. Rev Neurol 27:777–782PubMed
36.
Smith JK (2005) Parasellar tumors: suprasellar and cavernous sinuses. Top Magn Reson Imaging 16:307–315CrossRefPubMed
37.
Venkatesh SK, Phadke RV, Trivedi P, Bannerji D (2002) Asymptomatic spontaneous rupture of suprasellar dermoid cyst: a case report. Neurol India 50:480–483PubMed
38.
Indulkar S, Hsich GE (2011) Spontaneous rupture of intracranial dermoid cyst in a child. Neurology 77:2070CrossRefPubMed
39.
Güzel A, Trippel M, Ostertage CB (2007) Suprasellar arachnoid cyst: a 20-year follow-up after stereotactic internal drainage: case report and review of the literature. Turk Neurosurg 17:211–218PubMed
40.
Rengachary SS, Watanabe I (1981) Ultrastructure and pathogenesis of intracranial arachnoid cysts. J Neuropathol Exp Neurol 40:61–83CrossRefPubMed
41.
Choi JU, Kim DS (1998) Pathogenesis of arachnoid cyst: Congenital or traumatic? Pediatr Neurosurg 29:260–266CrossRefPubMed
42.
Di Pietro P, Debbia C, Paola Fondelli M (2004) Pediatric hypothalamic lipoma with hypothermia—case report. Brain Dev 26:61–62CrossRefPubMed
43.
Kurt G, Dogulu F, Kaymaz M et al (2002) Hypothalamic lipoma adjacent to mamillary bodies. Childs Nerv Syst 18:732–734CrossRefPubMed
44.
Sage MR, Blumbergs PC (2000) Primary empty sella turcica: a radiological-anatomical correlation. Australas Radiol 44:341–348CrossRefPubMed
45.
Cacciari E, Zucchini S, Ambrosetto P et al (1994) Empty sella in children and adolescents with possible hypothalamic-pituitary disorders. J Clin Endocrinol Metab 78:767–771PubMed
46.
Mindermann T, Wilson CB (1995) Pediatric pituitary adenomas. Neurosurgery 36:259–268, discussion 269CrossRefPubMed
47.
Partington MD, Davis DH, Laws ER, Scheithauer BW (1994) Pituitary adenomas in childhood and adolescence. Results of transsphenoidal surgery. J Neurosurg 80:209–216CrossRefPubMed
48.
Pandey P, Ojha BK, Mahapatra AK (2005) Pediatric pituitary adenoma: a series of 42 patients. J Clin Neurosci 12:124–127CrossRefPubMed
49.
Ginat DT, Meyers SP (2012) Intracranial lesions with high signal intensity on T1-weighted MR images: differential diagnosis. Radiographics 32:499–516CrossRefPubMed
50.
51.
Linscott L, Osborn AG, Blaser S et al (2008) Pilomyxoid astrocytoma: expanding the imaging spectrum. AJNR Am J Neuroradiol 29:1861–1866CrossRefPubMed
52.
Fernandez C, Figarella-Branger D, Girard N et al (2003) Pilocytic astrocytomas in children: prognostic factors—a retrospective study of 80 cases. Neurosurgery 53:544–555CrossRefPubMed
53.
Derman A, Shields M, Davis A et al (2013) Diseases of the sella and parasellar region: an overview. Semin Roentgenol 48:35–51CrossRefPubMed
54.
Jennings MT, Gelman R, Hochberg F (1985) Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg 63:155–167CrossRefPubMed
55.
Liu Z, Lv X, Wang W et al (2014) Imaging characteristics of primary intracranial teratoma. Acta Radiol 55:874–881CrossRefPubMed
56.
Van den Bos F, Terken M, Ypma L et al (2004) Tuberculous meningitis and miliary tuberculosis in young children. Trop Med Int Health 9:309–313CrossRefPubMed
57.
Jinkins JR, Gupta R, Chang KH, Rodriguez-Carbajal J (1995) MR imaging of central nervous system tuberculosis. Radiol Clin N Am 33:771–786PubMed
58.
Janse Van Rensburg P, Andronikou S, Van Toorn R, Pienaar M (2008) Magnetic resonance imaging of miliary tuberculosis of the central nervous system in children with tuberculous meningitis. Pediatr Radiol 38:1306–1313CrossRefPubMed
59.
Bernaerts A, Vanhoenacker FM, Parizel PM et al (2003) Tuberculosis of the central nervous system: Overview of neuroradiological findings. Eur Radiol 13:1876–1890CrossRefPubMed
60.
Gadwal SR, Gannon FH, Fanburg-Smith JC et al (2001) Primary osteosarcoma of the head and neck in pediatric patients: a clinicopathologic study of 22 cases with a review of the literature. Cancer 91:598–605CrossRefPubMed
61.
Cotterill SJ, Ahrens S, Paulussen M et al (2000) Prognostic factors in Ewing’s tumor of bone: analysis of 975 patients from the European Intergroup Cooperative Ewing's Sarcoma Study Group. J Clin Oncol 18:3108–3114PubMed
62.
Broich G, Pagliari A, Ottaviani F (1997) Esthesioneuroblastoma: a general review of the cases published since the discovery of the tumour in 1924. Anticancer Res 17:2683–2706PubMed
63.
Broski SM, Hunt CH, Johnson GB et al (2012) The added value of 18F-FDG PET/CT for evaluation of patients with esthesioneuroblastoma. J Nucl Med 53:1200–1206CrossRefPubMed
64.
Moore AT, Buncic JR, Munro IR (1985) Fibrous dysplasia of the orbit in childhood. Clinical features and management. Ophthalmology 92:12–20CrossRefPubMed
65.
Shah ZK, Peh WCG, Koh WL, Shek TWH (2005) Magnetic resonance imaging appearances of fibrous dysplasia. Br J Radiol 78:1104–1115CrossRefPubMed
66.
Bousson V, Rey-Jouvin C, Laredo JD et al (2014) Fibrous dysplasia and McCune-Albright syndrome: imaging for positive and differential diagnoses, prognosis, and follow-up guidelines. Eur J Radiol 83:1828-1842CrossRefPubMed
67.
(1996) A multicentre retrospective survey of Langerhans’ cell histiocytosis: 348 cases observed between 1983 and 1993. The French Langerhans' Cell Histiocytosis Study Group. Arch Dis Child 75:17–24
68.
Prayer D, Grois N, Prosch H et al (2004) MR imaging presentation of intracranial disease associated with Langerhans cell histiocytosis. AJNR Am J Neuroradiol 25:880–891PubMed
69.
Maghnie M, Cosi G, Genovese E et al (2000) Central diabetes insipidus in children and young adults. N Engl J Med 343:998–1007CrossRefPubMed
70.
71.
Kalra AA, Riel-Romero RMS, Gonzalez-Toledo E (2011) Lymphocytic hypophysitis in children: a novel presentation and literature review. J Child Neurol 26:87–94CrossRefPubMed
72.
Nakata Y, Sato N, Masumoto T et al (2010) Parasellar T2 dark sign on MR imaging in patients with lymphocytic hypophysitis. AJNR Am J Neuroradiol 31:1944–1950CrossRefPubMed
73.
Rosai J, Dorfman RF (1972) Sinus histiocytosis with massive lymphadenopathy: a pseudolymphomatous benign disorder. Analysis of 34 cases. Cancer 30:1174–1188CrossRefPubMed
74.
Wu M, Anderson AE, Kahn LB (2001) A report of intracranial Rosai-Dorfman disease with literature review. Ann Diagn Pathol 5:96–102CrossRefPubMed
75.
Lou X, Chen Z, Wang F, Ma L (2012) MR findings of Rosai-Dorfman disease in sellar and suprasellar region. Eur J Radiol 81:1231–1237CrossRefPubMed
76.
77.
Chamberlain MC (1995) A review of leptomeningeal metastases in pediatrics. J Child Neurol 10:191–199CrossRefPubMed
78.
Acciarri N, Galassi E, Giulioni M et al (2009) Cavernous malformations of the central nervous system in the pediatric age group. Pediatr Neurosurg 45:81–104CrossRefPubMed
79.
Lena G, Ternier J, Paz-Paredes A, Scavarda D (2007) Central nervous system cavernomas in children. Neurochirurgie 53:223–237CrossRefPubMed
Metadata
Title
Magnetic resonance imaging of sellar and juxtasellar abnormalities in the paediatric population: an imaging review
Authors
Rachel Shields
Rajiv Mangla
Jeevak Almast
Steven Meyers
Publication date
01-04-2015
Publisher
Springer Berlin Heidelberg
Published in
Insights into Imaging / Issue 2/2015
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1007/s13244-015-0401-5

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