Article Figures & Data
Figures
- 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.
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.
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.
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).
- 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).
- 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.
- 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
Parameter Value Plane Sagittal Slice thickness (mm) 0.6 Matrix 224 × 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.
Indication (No.) (%) Epilepsy 10 (10%) Headache 10 (10%) Multiple Sclerosis 8 (8%) Pituitary adenoma 8 (8%) Seizure 6 (6%) Pituitary lesion 5 (5%) Assess for CAA 4 (4%) Brain lesion 4 (4%) Radiation therapy planning 4 (4%) Cushing disease 3 (3%) Gait disorder 3 (3%) Radiation therapy planning for glioblastoma 3 (3%) Glioblastoma 3 (3%) Memory changes 3 (3%) Stroke/TIA 3 (3%) Vision changes 3 (3%) Dizziness 2 (2%) Note:—CAA indicates Cerebral Amyloid Angiopathy.
Mass Type Total (No.) (%) Cleftlike Present (No.) (%) Cleftlike Absent (No.) (%) RCC 7 (25.9%) 7 (31.8%) 0 RCC vs entrapped CSF 7 (25.9%) 6 (27.3%) 1 (20%) RCC vs entrapped CSF vs adenoma 2 (7.4%) 2 (9.1%) 0 Entrapped CSF 3 (11.1%) 1 (4.5%) 2 (40%) Adenoma 6 (22.2%) 4 (18.2%) 2 (40%) Drained RCC without mass effect 1 (3.7%) 1 (4.5%) 0 Adenoma vs artifacts 1 (3.7%) 1 (4.5%) 0 Total (frequency) 27 22 5 Artifact Total (No.) (%) Cleftlike Present (No.) (%) Cleftlike Absent (No.) (%) Present 57 (58.8%) 34 (51.5%) 23 (74.2%) Absent 40 (41.2%) 32 (48.5%) 8 (25.8%) Total (patients) 97 66 31 Artifact type Motion 30 (41.1%) 19 (44.2%) 11 (36.7%) Susceptibility 43 (58.9%) 24 (55.8%) 19 (63.3%) Total 73 43 30 ↵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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