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Research ArticleULTRA-HIGH-FIELD MRI/IMAGING OF EPILEPSY/DEMYELINATING DISEASES/INFLAMMATION/INFECTION

Prevalence of Rathke Cleft and Other Incidental Pituitary Gland Findings on Contrast-Enhanced 3D Fat-Saturated T1 MPRAGE at 7T MRI

Mikael Mir, Nathaniel P. Miller, Matthew White, Wendy Elvandahl, Ayca Ersen Danyeli and Can Özütemiz
American Journal of Neuroradiology September 2024, DOI: https://doi.org/10.3174/ajnr.A8393
Mikael Mir
aFrom the University of Minnesota Medical School (M.M., N.P.M.), Minneapolis, Minnesota
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Nathaniel P. Miller
aFrom the University of Minnesota Medical School (M.M., N.P.M.), Minneapolis, Minnesota
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Matthew White
bCenter for Magnetic Resonance Research (M.W., W.E.), University of Minnesota, Minneapolis, Minnesota
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Wendy Elvandahl
bCenter for Magnetic Resonance Research (M.W., W.E.), University of Minnesota, Minneapolis, Minnesota
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Ayca Ersen Danyeli
cDepartment of Pathology (A.E.D.), School of Medicine, Acıbadem University, Istanbul, Turkey
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Can Özütemiz
dDepartment of Radiology (C.Ö.), University of Minnesota Medical School, Minneapolis, Minnesota
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  • FIG 1.
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    FIG 1.

    A 32-year-old woman who was scanned for multiple sclerosis follow-up. A, Precontrast 3D FS T1 MPRAGE shows a very dark adenohypophysis and stalk. A posterior T1 bright spot is present (yellow arrow). B, Postcontrast image shows diffuse homogeneous enhancement of the stalk, adenohypophysis, and an incidental curved nonenhancing hypointensity (red arrow), extending from the stalk between the vicinity of adenohypophysis and neurohypophysis, presumably representing the Rathke cleft.

  • FIG 2.
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    FIG 2.

    A, A 30-year-old man with pituitary hypofunction. On a sagittal postcontrast 3D FS T1 MPRAGE at 7T, the orange arrow shows a biopsy-proved large RCC, and the red arrow shows a separate triangular hypointensity more posterior and superior to the cyst. B, A 3-month follow-up with 7T MRI after endoscopic transsphenoidal drainage of the cyst shows a decompressed RCC (orange arrow) and a more dilated and prominent appearance of the J-shaped cleftlike presumed Rathke cleft (red arrow), likely due to resolution of the mass effect. The pituitary hypofunction resolved after the surgery.

  • FIG 3.
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    FIG 3.

    A 37-year-old man with medically refractory epilepsy and prior temporal lobectomy was referred to 7T MRI for follow-up. A, Sagittal precontrast 3D-T2-SPACE image does not show any abnormality in the pituitary gland, and the lesion indicated by the red arrow in B is not visible. B, Sagittal postcontrast 3D FS T1 MPRAGE at 7T shows a string-like C-shaped hypointensity extending from the stalk all the way through the adenohypophysis (red arrow), favored as a Rathke cleft. C, Sagittal contrast-enhanced 3D T1 MPRAGE image obtained 5 months later at 3T MRI are unable to demonstrate the presumed Rathke cleft.

  • FIG 4.
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    FIG 4.

    A, The whole-slide image from a postmortem case shows the pituitary gland along with anatomically adjacent tissues. The arrow indicates a Rathke cleft remnant (stained with Luxol fast blue combined with periodic acid-Schiff, ×0.5 magnification). B, The closer view depicts a Rathke cleft remnant (arrows) (stained with H&E, ×20 magnification).

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    FIG 5.

    A 45-year-old woman with increased prolactin levels who had a transnasal endoscopic pituitary adenoma resection and underwent a follow-up with a 7T MRI due to increased prolactin levels 2 months after the operation. A, Coronal postcontrast 3D FS T1 MPRAGE shows a hypointense cystic structure mimicking a cystic adenoma located at the right ventral aspect of the adenohypophysis (orange arrows) with indistinct margins. B, When one scrolls posteriorly, the cystic mass connects with the CSF. Thus, this mass likely represents an entrapped CSF in the operation field. C, When scrolled even further in the posterior direction, there is a more hypointense focus with indistinct margins in the right aspect of the adenohypophysis, considered as a residual adenoma (green arrow).

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    FIG 6.

    A 19-year-old woman was imaged for a low-grade brain tumor at 7T. While the cleftlike presumed Rathke cleft remnant can be depicted (red arrow), pulsation artifacts from the adjacent basilar artery (blue arrow) and susceptibility artifacts associated with sphenoid sinus (blue arrowhead) limit the assessment of the ventral and inferior portions of the pituitary gland.

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    FIG 7.

    An 83-year-old woman who was referred for a brain MRI for a posterior communicating artery aneurysm follow-up. Coronal C + 3D FS T1 MPRAGE shows rounded susceptibility artifacts in the base of the adenohypophysis (blue arrows), which may mimic a hypointense adenoma and limit the assessment of the base. A cystic-appearing T1 hypointense area immediately lateral to the stalk and superior to the gland (Orange arrow) is separated by a thin membrane and is continuous with adjacent CSF in other slices (not shown). This is favored to represent entrapped CSF between the gland and the diaphragm, mimicking a cystic mass.

Tables

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    Table 1:

    C + 3D FS T1 MPRAGE sequence parameters

    ParameterValue
    PlaneSagittal
    Slice thickness (mm)0.6
    Matrix224 × 224
    FOV (mm)150
    Interslice distance (%)50
    Voxel size (mm3)0.3 × 0.3 × 0.3a
    Acquisition time (min)6:32
    TR/TE (ms)3000/2.49
    • ↵a In our contrast-enhanced radiation therapy protocol, the interpolation is off to decrease geometric distortion, and therefore the voxel size is 0.6 × 0.6 × 0.6 mm3.

    • View popup
    Table 2:

    7T MRI indications

    Indication(No.) (%)
    Epilepsy10 (10%)
    Headache10 (10%)
    Multiple Sclerosis8 (8%)
    Pituitary adenoma8 (8%)
    Seizure6 (6%)
    Pituitary lesion5 (5%)
    Assess for CAA4 (4%)
    Brain lesion4 (4%)
    Radiation therapy planning4 (4%)
    Cushing disease3 (3%)
    Gait disorder3 (3%)
    Radiation therapy planning for glioblastoma3 (3%)
    Glioblastoma3 (3%)
    Memory changes3 (3%)
    Stroke/TIA3 (3%)
    Vision changes3 (3%)
    Dizziness2 (2%)
    • Note:—CAA indicates Cerebral Amyloid Angiopathy.

    • View popup
    Table 3:

    Frequency of pituitary masses

    Mass TypeTotal (No.) (%)Cleftlike Present (No.) (%)Cleftlike Absent (No.) (%)
    RCC7 (25.9%)7 (31.8%)0
    RCC vs entrapped CSF7 (25.9%)6 (27.3%)1 (20%)
    RCC vs entrapped CSF vs adenoma2 (7.4%)2 (9.1%)0
    Entrapped CSF3 (11.1%)1 (4.5%)2 (40%)
    Adenoma6 (22.2%)4 (18.2%)2 (40%)
    Drained RCC without mass effect1 (3.7%)1 (4.5%)0
    Adenoma vs artifacts1 (3.7%)1 (4.5%)0
    Total (frequency)27225
    • View popup
    Table 4:

    Prevalence of artifactsa

    ArtifactTotal (No.) (%)Cleftlike Present (No.) (%)Cleftlike Absent (No.) (%)
    Present57 (58.8%)34 (51.5%)23 (74.2%)
    Absent40 (41.2%)32 (48.5%)8 (25.8%)
    Total (patients)976631
    Artifact type
     Motion30 (41.1%)19 (44.2%)11 (36.7%)
     Susceptibility43 (58.9%)24 (55.8%)19 (63.3%)
     Total734330
    • ↵a Overall presence of artifacts across patients (n = 97, three omitted), reported in total and for Cleftlike Present and Cleftlike Absent groups. A statistically significant difference between Cleftlike Present and Cleftlike Absent groups, with a proportionately higher rate of scan artifacts in the Cleftlike Absent group [χ2(1, n = 97) = 4.48, P = . 03]. Below are subgroup frequencies of artifact types. Note that the lower rows report artifact frequencies across studies, not by the patient (some scans include both susceptibility and motion artifacts). No statistically significant difference was found in types of artifacts between Cleftlike Present and Cleftlike Absent groups [χ2(1, n = 73) = 0.41, P = .52].

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Mikael Mir, Nathaniel P. Miller, Matthew White, Wendy Elvandahl, Ayca Ersen Danyeli, Can Özütemiz
Prevalence of Rathke Cleft and Other Incidental Pituitary Gland Findings on Contrast-Enhanced 3D Fat-Saturated T1 MPRAGE at 7T MRI
American Journal of Neuroradiology Sep 2024, DOI: 10.3174/ajnr.A8393

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Prevalence of Rathke Cleft and Other Incidental Pituitary Gland Findings on Contrast-Enhanced 3D Fat-Saturated T1 MPRAGE at 7T MRI
Mikael Mir, Nathaniel P. Miller, Matthew White, Wendy Elvandahl, Ayca Ersen Danyeli, Can Özütemiz
American Journal of Neuroradiology Sep 2024, DOI: 10.3174/ajnr.A8393
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