NeuroradiologyRathke's cleft cyst
(Martin Heinrich Rathke, 1793 - 1860, German anatomist), benign intrasellar cyst that may reach a large size and grow in the suprasellar space. It is located between the anterior and posterior lobe, in the so called intermediate lobe and is believed to form from remnants of the Rathke's pouch.
These cysts have a wide range of histological features and are lined by epithelial cells.
They may be misdiagnosed as craniopharyngiomas or as cystic pituitary adenomas; although usually asymptomatic they may produce visual disturbances, hypothalamic dysfunction and headache when they grow in the suprasellar space.
Radiologically they appear at CT as iso-hypodense cystic mass lesions arising from the pituitary fossa, without enhancement.
MRI shows cystic lesions with long T1 and long T2 although sometimes intrinsic paramagnetic substances may produce T1 and T2 shortening resulting in hyperintense T1 and hypointense T2 lesions (Fig.1). No enhancement is usually observed.
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a, b. MR, sagittal and coronal T1-weighted images. A slightly hyperdense mass is partly intrasellar and partly suprasellar, reaching the chiasm.
c. MR, T2-weighted coronal image. The cyst is hypointense in the centre due to the presence of paramagnetic substances and hyperintense at the periphery.
d. MR, coronal T1-weighted image following gadolinium injection. The cyst remains hypointense with respect to the enhancing pituitary tissue. The cyst is well separated from the pituitary gland that is compressed and displaced laterally and towards the sellar floor.
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Rathke's cleft cyst, Fig.1 (a) | | Rathke's cleft cyst, Fig.1 (b) | | Rathke's cleft cyst, Fig.1 (c) |
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Rathke's cleft cyst, Fig.1 (d) | |