Neuro - imaging. Sella. ssregypt.com
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1 Neuro - imaging Sella ssregypt.com
2 Bony Sella AP diameter Depth Contents 16mm 14mm Pituitary gland, part of infundibular stalk, CSF
3 CT Technique 5 mm slices Axial and coronal Contrast injection Bone and soft tissue windows
4 Axial
5 CORONAL
6 MRI Technique 3 mm thickness slices Sagittal and coronal T1 weighted images Pre and post contrast injection Axial T2 for brain
![less than 8mm] and regular contour Midline infundibular stalk Clear suprasellar](/docs-images/86/93080730/images/7-2.jpg "cistern MR shows isointense signal of the pituitary gland to the brain parenchyma in")
7 Normal CT AND MRI Normal size and shape of the sella Concave upper border of pituitary gland Homogenous enhancement of the pituitary gland showing normal height [ less than 8mm] and regular contour Midline infundibular stalk Clear suprasellar cistern MR shows isointense signal of the pituitary gland to the brain parenchyma in T1 and T2 WIs
8
9 Pituitary gland Anterior pituitary [ adenohypophysis ] 75% of the pituitary volum Growth Hormone GH Adreno Cortico-trophic Hormone ACTH Thyroid Stimulating Hormone TSH Follicle Stimulating Hormone FSH Luteinizing Hormone LH Melanophore Stimulating Hormone Prolactine
10 Pituitary gland Posterior pituitary 25% of volume Neurohypophysis = posterior pituitary + infundibular stalk + hypothalamic nuclei [ Supra optic, Para ventricular nuclei ] Hypothalamus Oxytocin + vasopressin Coupled by proteins and enveloped by phospholipids vesicles hypothalamo - hypophyseal tracks posterior pituitary high signal in T1 WIs
11 Absence of high signal of the posterior pituitary in T1 WIs is usually, but not always, associated with diabetes insipidus
12 Intrasellar Pathology Empty sella Very common variant The sella is partially filled with CSF The infundibulum is dipping in the sella The pituitary is flattened against the sellar floor Two types primary and secondary Secondary type Post operative Sheehan syndrome [post partum circulatory collapse pituitary necrosis]
13 M 26Y
14 F 73Y M 50Y Empty sella
![panhypopituitarism] Ectopic](/docs-images/86/93080730/images/15-3.jpg "neurohypophysis [suprasellar hot spot]")
15 Intrasellar lesions Small or absent gland and stalk [primary panhypopituitarism] Ectopic neurohypophysis [suprasellar hot spot] Duplicated pituitary stalk
16 Intrasellar lesions Incidentally found pituitary lesion more than 3mm should represent micro adenoma or Rathke s Cleft cyst Causes: Pituitary cyst Artifacts Pituitary micro adenoma
17 Pituitary cysts Non neoplastic pituitary cysts are found in about 20% of autopsy specimens F 22Y
![years [ 3% ] Adenomas measuring 10mm or less are called](/docs-images/86/93080730/images/18-4.jpg "microadenomas Adenomas larger than 10mm are called")
18 Pituitary adenoma The most common Intrasellar tumor in adults Pituitary adenoma is rare below the age of 18 years [ 3% ] Adenomas measuring 10mm or less are called microadenomas Adenomas larger than 10mm are called macroadenomas
19 Microadenoma 75% are functioning tumors 50% of active adenomas are prolactinomas Normal serum prolactin < 20ng/ml Serum prolactin above 150 ng/ml is diagnostic of adenoma MRI 95% of adenoma are hypointense in T1 Hyperintensity due to hemorrhage 20-30% of adenomas, these tumors are usually cystic with intracystic blood 50% of adenoma are hyperintense in T2
20 M 34Y
21 Microadenoma F 24Y Focal nonenhancing lesion within pituitary gland Surface bulge superior or inferior Convex upper border of pituitary gland Contra lateral stalk deviation NB Tilt of the pituitary stalk may be normal variant
22 F 24Y F 52Y
23 F 25Y F 28Y
24 F 30Y +C Microadenoma
25 F 23Y
26 F 52Y
27 Microadenoma Dynamic study
28
![30-60 minutes after contrast injection [enhancing adenoma after contrast washout from the normal gland] Petrosal venous](/docs-images/86/93080730/images/29-3.jpg "sampling for ACTH adenoma Locates the site of the lesion [not so accurate?")
29 Microadenoma MR sensitivity 90% M 17Y Good clinical and biochemical evidence of adenoma Coronal non contrast T1 WIs Immediate coronal T1 WIs after contrast injection Dynamic scanning in coronal T1 WIs after contrast injection Delayed minutes after contrast injection [enhancing adenoma after contrast washout from the normal gland] Petrosal venous sampling for ACTH adenoma Locates the site of the lesion [not so accurate?!] Differentiates pituitary from adrenal cause [100% accuracy]
30 Microadenoma Dynamic study F 18Y
31 Follow up interval for microprolactinoma should not be more often than every several years [ 32 month ]
32 Macroadenoma Suprasellar extension of pituitary adenoma 30-50% of masses Homogenous or heterogeneous enhancement Calcification is rare 1-2% Hemorrhage, cyst formation, postoperative changes may change the findings
33 Macroadenoma F 54Y CT : MRI : Relatively hyper dense lesion Heterogeneous enhancement Cystic changes 5-18% T1 isointense signal T2 hyperintense signal
34
35 Macroadenoma Imaging should fulfill Suprasellar extension * filling the cistern * reaching the chiasm * reaching hypothalamus Parasellar extension into cavernous sinus Infrasellar extension into sphenoid sinus Intra tumoral hemorrhage
36 F 41Y
37 F 55Y Pituitary adenoma with supra- sellar extension
38 Macroadenoma Intratumoral hemorrhage 20-30% of adenomas High signal in T1 + variable signal in T2 DD craniopharyngioma cyst [ High signal in T1] The presence of fluid level in the lesion suggests hemorrhage
39 Macroadenoma Abnormal tissue between the lateral wall of the sinus and the carotid artery Cavernous sinus invasion Asymmetry between cavernous sinuses Serum prolactin above 1000 ng /ml Extension of the lesion to the sagittal plane of the intracavernous carotid artery is not a reliable indicator of sinus invasion
40 NB Constriction or occlusion of the carotid artery by pituitary adenoma is very rare while in meningiomas it is not uncommon
41 M 34Y
42 M 27Y
43 F 29Y Macroadenoma
44 Macroadenoma with hemorrhage M 34Y
45 Invasive adenoma M 48Y
46 M 47 Y
47 M 20Y
48 M 40Y
49 M 35Y
50 Pituitary abscess Symptoms similar to adenoma rather than infection Cystic lesion with marginal enhancement DD pituitary adenoma with cystic changes. Marginal enhancement supports the diagnosis of an abscess M 42Y
51 Pituitary abscess : This patient developed fever, headache, and diabetes insipidus following transsphenoidal resection of adenoma.
52 Choriostoma [Granular cell tumor, myoblastoma] Masses of normal tissues in aberrant site may occur intra or para-sellar o inside IAC Presents with pituitary endocrine dysfunction Intrasellar lesion similar to pituitary adenoma Differentiating points : Posteriorly located lesion Loss of the normal posterior lobe hyperintensity The lesion is very vascular [trans sphenoidal approach is hazardous]
53 Choristoma Sagittal T1 -weighted image shows a posterior pituitary mass which is hyperintense with absence of the normal thin hyperintensity, which corresponds to posterior lobe in normal glands. (B) The tumor is heterogeneous on Sagittal T2-weighted image [ Kucharczyk et al., 1996]
54 Rathke s cleft cyst Cubiodal or columnar epithelial lining A sellar lesion with suprasellar extension May occur suprasellar DD crainopharyngioms Calcification is uncommon Variable signal on MR [ colloid ] No solid component Marginal enhancement Displaces in stalk anterior The cyst is isointense relative to the cerebrospinal fluid, as shown on this coronal PD weighted image. The mass effect on the optic chiasm is well depicted.
![fetal life] Coronal T1-weighted contrast-enhanced image shows a](/docs-images/86/93080730/images/55-1.jpg "nonenhancing hypointense Rathke s cleft cyst within the homogeneously")
55 Rathke s cleft arise from the craniopharyngeal duct [an epithelial structure connects the nasopharynx with 3 rd ventricle, involutes during fetal life] Coronal T1-weighted contrast-enhanced image shows a nonenhancing hypointense Rathke s cleft cyst within the homogeneously enhancing pituitary gland
56 T1-weighted sagittal image obtained before contrast enhancement demonstrates a well-defined Rathke s cleft cyst in the sella that is isointense relative to the CSF. Note the normal high signal intensity in the posterior pituitary, which is draped over the dorsal aspect of the cyst.
57 M 12Y Rathke s cleft cyst
![extra cranial primaries [pituitary carcinoma is rare ] Symptoms include diabetes insipidus](/docs-images/86/93080730/images/58-2.jpg "(rare with adenomas), panhypopituitarism, cranial nerve palsy III, IV, VI ( common with")
58 Metastases 1% - 5% cancer patients Mostly occur suprasellar, parasellar, infrasellar Intrasellar deposits are uncommon Most of malignant pituitary lesions are metastases from extra cranial primaries [pituitary carcinoma is rare ] Symptoms include diabetes insipidus (rare with adenomas), panhypopituitarism, cranial nerve palsy III, IV, VI ( common with deposits) M 72Y
59 M 67 Y Sellar and Infrasellar deposits
60 Suprasellar anatomy &pathology
61 Suprasellar Structures Diaphragma sellae Suprasellar cistern and circle of Willis Optic nerves and chiasm Upper part of infundibular stalk Hypothalamus Anterior 3 rd ventricle and its recesses Mammellary bodies Tuber cenerium
62 Optic chiasm Hypothalamus Mammellary bodies Tuber cenerium
63 Hypothalamus
64 Suprasellar lesions Adult Child Extension of pituitary adenoma Suprasellar meningioma Craniopharyngioma Hypothalamic glioma Aneurysms 80% of the lesions
65 Craniopharyngioma 1.2-3% of intracranial tumors Occurs only in the region of the sella Epithelial origin [adamantinomatous, squamous- papillary, mixed] Two peaks Children 6-10 years Adults 50 years 50% of suprasellar tumors in children are craniopharyngiomas Symptoms of increased intracranial pressure
66 Craniopharyngioma Item Incidence Calcium Cyst Shape Age Vascular encasement Recurrence Adamantinomatous More common Common Always present Lobulated Common in children Positive Usually Squamous - papillary Less common Less likely Usually solid Rounded Common in adults Negative Rare
![Craniopharyngioma M 16Y Lobulated suprasellar mass with cystic component The cystic component is hyperintense in T1 [protinacious contents] In T2 WIs the cyst may](/docs-images/86/93080730/images/67-2.jpg "be hyper or hypointense The solid component shows strong enhancement Calcification is common Vascular encasement in the adamantinomatous type not seen in other")
67 Craniopharyngioma M 16Y Lobulated suprasellar mass with cystic component The cystic component is hyperintense in T1 [protinacious contents] In T2 WIs the cyst may be hyper or hypointense The solid component shows strong enhancement Calcification is common Vascular encasement in the adamantinomatous type not seen in other types
68 M 5Y
69 Craniopharyngioma M 18Y 421 HU
70 Craniopharyngioma, MRI M 13Y
71 Craniopharyngioma, MRI
72 Rathke s cleft cyst Craniopharyngioma Cubiodal or columnar lining Not a pure suprasellar lesion Calcification is uncommon CSF signal on MR No solid component Marginal enhancement Displaces in stalk anterior Squamous or basal cell lining Usually occur suprasellar Common Hyperintense in T1 Solid component is present Enhancement of solid part Displaces the stalk posterior
73 Suprasellar lesions Adult Child Extension of pituitary adenoma Suprasellar meningioma Craniopharyngioma Hypothalamic glioma Aneurysms 80% of the lesions
74 Optic and hypothalamic glioma 25% of pediatric suprasellar neoplasms 75% of tumors occur in 1 st decade M=F 20-50% of patients with neurofibromatosis type I will develop hypothalamic glioma The tumors are often large at presentation (slow growth) May infiltrate the thalamus and brain stem
75 Optic and hypothalamic glioma CT calcification MRI Isodense suprasellar mass no Strong enhancement T1 isointense T2 hyperintense No hemorrhage Enhancement similar to CT
76 Hypothalamic glioma F 8Y
77 Hypothalamic glioma M 10Y
78 Hypothalamic glioma M 10Y
79 Hypothalamic glioma Solid lesion No Calcification Low signal on T1 Heterogeneous / Homogenous enhancement Infiltrates the visual tracts, brainstem and thalami 20-50% associated with NF1 Craniopharyngioma A cystic part is present Calcification is common Hyperintense in T1 Intense enhancement of the solid part NO NO
80 Neurofibromatosis Type I Autosomal dominant disorder About 50% of patients had family history 1:2500 births More than 50% of patients with NFI have abnormal neuroimaging The main lesions include hamartomas and gliomas in the orbit and brain Multifocal lesions in the optic nerves, brain stem, basal ganglia, dentate nuclei and periventricular white matter [Low T1, high T2 signals] To differentiate hamartomas from gliomas No edema No mass effect = Hamartomas No enhancement
81 Neurofibromatosis Type I
82 Infiltrating glioma of the optic nerve in NFI
83 Infiltrating glioma of the optic nerve in NFI
84 Optic chiasm glioma Coronal T1-weighted MR images before and after contrast enhancement showing marked enlargement of the right side of the optic chiasm with a clear plane of separation between the chiasm and the hypothalamus [Kucharczyk et al., 1996]
85 Optic neuritis
86 Small chiasmatic glioma versus optic neuritis Neuritis is painful while tumor is not Neuritis regress in follow up studies
87 Suprasellar lesions Adult Child Extension of pituitary adenoma Suprasellar meningioma Craniopharyngioma Hypothalamic glioma Aneurysms 80% of the lesions
88
89 Supra- sellar extension of pituitary adenoma M 30Y
90 M 26Y
91 Suprasellar meningioma 15-25% of meningiomas The 2 nd common Suprasellar tumor in adults Origin: Sphenoid ridge, diaphragma sellae, tuberculum sellae Usually present in middle aged females Shows lobulated outlines, strong enhancement Calcification 20 % and hyperostosis are seen Dural tail enhancement? Not specific Vascular encasement
92 Tuberculum sellae meningioma F 45Y
93 Suprasellar meningioma F 55Y F 51Y
94 F 53Y Suprasellar meningioma
95 F 51Y Suprasellar meningioma
96 M 30Y
97 Adenoma versus Meningioma Meningioma is separate from the pituitary Phosphorus MRS can differentiates adenomas which have a higher phosphate monoester peak than meningiomas
98 Suprasellar lesions Adult Child Extension of pituitary adenoma Suprasellar meningioma Craniopharyngioma Hypothalamic glioma Aneurysms 80% of the lesions
99 Suprasellar aneurysm The circle of Willis is present in the suprasellar cistern usually clinically silent until rapture subarachnoid hemorrhage CT: Hyper dense rounded lesion with marginal calcification usually off the midline Homogenous enhancement [large aneurysm may contain thrombus] Bilateral internal carotid aneurysms
100
101 Suprasellar aneurysm
102 Ruptured suprasellar aneurysm Subarachnoid hemorrhage and communicating hydrocephalus
![MRI aneurysm] Suprasellar aneurysm - Signal void in all](/docs-images/86/93080730/images/103-0.jpg "pulse sequences [patent - Signal misregistration")
103 MRI aneurysm] Suprasellar aneurysm - Signal void in all pulse sequences [patent - Signal misregistration artifacts in the phase encoding direction due to pulsitile flow - Laminated internal architecture of thrombosed aneurysm [T2]
![void] Thrombosed](/docs-images/86/93080730/images/104-4.jpg "lumen [Laminated")
104 MR I Well defined lesion with mixed signal intensities Patent lumen [ signal void] Thrombosed lumen [Laminated thrombus of mixed stages] Perianeurysmal hemorrhage and edema
105 Thrombosed aneurysm Multiple laminae of variable signals representing the blood products in the thrombus, the most recent thrombus is present centrally After contrast the patent lumen may enhance (slow flow), part of the thrombus and aneurysm wall may also enhance MR angiography
106 Suprasellar dermoid cyst % of intracranial tumors Inclusion of epithelium during embryogenesis Suprasellar is more common than vermian Benign, slowly growing, cystic midline lesion CT: Fat density + calcification MR: Fat signal [ Fat saturation technique] Assess for rupture into ventricles or CSF M 39Y
107 Dermoid tumor. The high signal intensity areas in the subarachnoid space of the Sylvian fissures and ambient cisterns represent lipid material from the tumor that has contaminated the CSF (Haughton and Peebles, 2002)
108 Suprasellar epidermiod cyst Located away from the midline CSF like contents on CT, MRI DD arachnoid cyst FLAIR intermediate signal of epidermoid cyst Diffusion WIs Free diffusion of water molecules in CSF Low signal in arachnoid cyst while restricted diffusion by protein macro moelecules in epidermoid cyst high signal Calcification is uncommon. No enhancement % of intracranial tumors
109
110 Tuber cinereum hamartoma Slowly growing non neoplastic lesion Boys > Girls Presents with precocious puberty, Seizures or both CT: Small (2cm) isodense lesion No calcification MR: Isointense in T1, Hyper intense in T2 No enhancement Mammellary bodies Tuber cenerium
111 Tuber cinereum hamartoma
112 Hypothalamic hamartoma M 16Y
113 Suprasellar arachnoid cyst 15% of arachnoid cysts occur in the sellar region CT: well defined, cystic, CSF containing suprasellar lesion No calcification No enhancement MRI: CSF signal in all pulse sequences Suprasellar arachnoid cyst compressing the third ventricle and displacing the brainstem posteriorly [Haughton and Peebles, 2002]
114 Colloid cyst 2% of all glial neoplasms Characteristic site anterior 3 rd ventricle Characteristic contents dense viscid mucoid material (old blood, cholesterol crystals, CSF, various ions) CT: hyper dense midline lesion no enhancement F 31Y
115 Colloid cyst 2% of all glial neoplasms MRI any signal depending on the contents T1 hyperintense or hypo intense T2 hyperintense or hypo intense No enhancement [CT, MRI] Solid enhancement should suspect other lesion Intermittent herniation into the foramina of Monro causes hydrocephalus
116 Colloid cyst
117 Colloid cyst
118 F 45Y Colloid cyst
119 Suprasellar germinoma Synchronous Suprasellar and pineal germ cell tumors occur in 6-12% of cases 80% of germinomas occur in the pineal body region, 20% Suprasellar Midline lesion with homogenous enhancement. Cystic changes are rare Subependymal spread enhancing nodules in the wall of the 3 rd and lateral ventricles Other germ cell carcinoma Embryonal cell carcinoma Yolk sac tumor Choriocarcinoma Teratomas
120 Pineal body and suprasellar germinomas Arise from the primitive germ cells in the suprasellar region Usually present with diabetes insipidus, hypo- pituitarism, visual changes
121 Suprasellar lipoma 0.1% of intracranial tumors Fat density (CT) or signal (MRI) No enhancement Adjacent to the mammillary bodies Fat saturation MR techniques are helpful in diagnosis
122 Suprasellar lipoma F 21Y
123 Sarcoidosis Suprasellar granuloma Chronic inflammatory disease of unknown cause 3rd 4th decades Diabetes insipidus + cranial nerve affection, mainly visual disturbance Leptomeningeal thickening and enhancement along hypothalamus, tuber cinereum, mammillary bodies Thickened enhanced infundibular stalk
124 Sarcoidosis F 34Y
125 F 23Y
126 Suprasellar Hot Spot nal focus on unenhanced T1 WIs Craniopharyngioma Subacuate hemorrhage (thrombosed vessels) Ectopic neurohypophysis Lipoma Dermoid Ectopic neurohypophysis
127 Supra and Infrasellar metastases The most common 1ry lesions are lung, breast, melanoma Multiple lesions in the sellar region affecting any anatomic structure CT usually hypodense- Hyper dense deposits [melanoma, hemorrhage] MRI signal depends on the cellularity and hemorrhage Solitary lesion is common [known primary is essential for diagnosis]
128 Suprasellar deposits of breast cancer F 60Y
129 Parasellar anatomy &pathology
130 Cavernous sinus contents Internal carotid artery Cranial nerves III, IV, V (ophthalmic, maxillary divisions), VI Dura Bones
131 Parasellar lesions Points to be assessed Anterior extension into the orbital apex Medial extension into the sella Posterior extension into the prepontine cistern Assessment of the orbit is important for: Tumor extension Proptosis Dilated veins
132 Para-sellar meningioma 10% of meningiomas occur in the Parasellar region Arise in the cavernous sinus or extend from optic nerve, sphenoid wing All features of meningiomas by CT and MRI Homogenous enhancement Dural base and Dural tail [ Dove s tail ] Calcification Bone sclerosis Vascular encasement F 40Y
133 Para-sellar meningioma M 45Y
134 Para-sellar meningioma F 50Y
135 Para-sellar meningioma F 33Y
136 Trigeminal nerve schwannoma The 2 nd common after acoustic Schwannoma Facial pain, weak muscles of mastication Follow the course of the nerve CT: Heterogeneously enhancing para-sellar mass MRI: T1 isointense T2 hyperintense Diagnostic landmarks Involvement of the Gasserian ganglion Dumble configuration with posterior fossa component
137 Trigeminal neuroma Involvement of the Gasserian ganglion
138 Trigeminal neuroma Dumble configuration with posterior fossa component M 36Y
139 Trigeminal neuroma Extension through the widened skull base foramina M 19Y
140 M 6Y
141 Para-sellar chordoma 0.2% of intracranial tumors M = F A common lesion arising from notochord remnants Infrasellar or para-sellar Benign, may be locally invasive CT: Mass with bone destruction MRI: T1 hypo, 25% isointense 75% T2 marked hyper intensity similar to fluids with septations in 70% Gd- DTPA heterogeneous enhancement Vascular enhancement without narrowing
142 Para-sellar chordoma F 26Y
143 Para sellar carotid- cavernous fistula Abnormal communication between the artery and cavernous sinus Patients present by proptosis (pulsating), motility disorders Most cases are due to trauma Spontaneous cases may be due to Arteriosclerosis Congenital defect in the media of the artery Rapture of carotid aneurysm inside the sinus The affected sinus is enlarged + dilated ophthalmic vein on CT MRI will show signal void in the sinus and ophthalmic vein and can detect thrombosis Angiography is diagnostic
144 Carotid cavernous fistula M 20Y
145 M 20Y Carotid cavernous fistula
146 F 47Y Carotid cavernous fistula
147 Aneurysms of the intra-cavernous portion of the ICA
148 Aneurysms of the intra-cavernous portion of the ICA M 30Y
149 Cavernous sinus thrombosis F 25Y A rare lesion caused by infection starting in the face, ear or sinuses specially the sphenoid Peri -orbital pain, proptosis, venous congestion and ophthalmoplegia[ cranial nerve affection] CT: Filling defect in the sinus with increased densities anterior to the globe MRI: Signal of subacute blood in the sinus with attenuated carotid artery Diagnostic landmarks Enlarged sinus with loss of normal enhancement Inflammatory orbital changes
150 Cavernous sinus thrombosis M 11Y
151 Cavernous sinus thrombosis
152 Parasellar deposits of melanoma
153 Quiz cases Colloid cyst
154 QPituitary adenoma M 40Y
155 QCraino-pharyngiomaoma F 20Y
156 QPituitary adenoma M 53Y
157 Q
158 QPituitary micro-adenoma
159 Q F 56Y Neuro - sarcoidosis
160 QCraino-pharyngiomaoma Squamous papillary type F 41Y
161 Q Tuber sinereum hamartoma F 8Y
162 Q Supra-sellar partially thrombosed aneurysm
163 Q Carotid cavernous fistula F 47 Y
164 Q Rathke s cleft cyst / adenoma
165 QSupra-sellar meningioma F 41Y
166 Q Pituitary micro-adenoma F 19Y
167 سبحانك اللهم و بحمدك نشهد ان ال اله اال انت نستغفرك و نتوب اليك ssr-eg.net Thank you Mamdouh Mahfouz MD
168 Q
169 Q
170 F 42Y?
171 ?
172 F 24Y?
173 F 34Y?
174 F 30Y?
175 ?
176 ? F 22Y
177 ?
178 M 40Y?
179 M 59Y?
180 M 36Y?
181 ?
182 F 40Y
183 F 45Y
184
185
186
187
188 M 42Y
189 Teratoma A- SagittalT1 WI showing markedly heterogonous intensity of a large suprasellar mass lesion B Axial post contrast scan showing intense heterogeneous enhancement of the lesion with central necrotic areas. (Yock, 1995)
190 Recurrent Chiasmatic glioma
191 Craniopharyngioma
192 M 36Y
193
194 F 41Y
195 Suprasellar lesions [ Granuloma ] Eosinophilic granuloma Proliferation of histeocytes Childhood disease Diabetes insipidus + lytic bony + lesions+ exophthalmos Nodular enhancement in the hypothalamus Thickened enhanced infundibular stalk Sarcoidosis Chronic inflammatory disease, unknown cause 3 rd 4 th decades Diabetes insipidus + cranial nerve affection visual disturbance Leptomeningeal thickening and enhancement along hypothalamus, tuber cinereum, mammillary bodies Thickened enhanced infundibular stalk
196 Carotid-cavernous fistula : Digital subtraction angiogram showing cortical venous drainage pathways over the right convexity to the superior sagittal sinus in a patient with a carotid-cavernous fistula
197
198 F 26Y
199 F 24Y
200 F 48Y
201 F 13Y
202 M 18Y
203 M 32Y
204
205 F 1Y
206
207 M 10Y Hypothalamic glioma
208 Hypothalamic glioma
209 M 6Y
210 Suprasellar aneurysm F 70Y
211
212 Colloid cyst
213 +C Rathke s cleft cyst, extending into the suprasellar cistern. Note that the mass has homogeneous high signal intensity in T1, intermediate T2 with no enhancement after contrast injection
214 M 59Y Infrasellar deposits
215 M 62Y Infrasellar deposits
216 F 50Y
217
218 M 30Y
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