Abstract
Cystic pituitary adenomas may mimic Rathke cleft cysts when there is no solid enhancing component found on MR imaging, and preoperative differentiation may enable a more appropriate selection of treatment strategies. We investigated the diagnostic potential of MR imaging features to differentiate cystic pituitary adenomas from Rathke cleft cysts and to develop a diagnostic model. This retrospective study included 54 patients with a cystic pituitary adenoma (40 women; mean age, 37.7 years) and 28 with a Rathke cleft cyst (18 women; mean age, 31.5 years) who underwent MR imaging followed by surgery. The following imaging features were assessed: the presence or absence of a fluid-fluid level, a hypointense rim on T2-weighted images, septation, an off-midline location, the presence or absence of an intracystic nodule, size change, and signal change. On the basis of the results of logistic regression analysis, a diagnostic tree model was developed to differentiate between cystic pituitary adenomas and Rathke cleft cysts. External validation was performed for an additional 16 patients with a cystic pituitary adenoma and 8 patients with a Rathke cleft cyst. The presence of a fluid-fluid level, a hypointense rim on T2-weighted images, septation, and an off-midline location were more common with pituitary adenomas, whereas the presence of an intracystic nodule was more common with Rathke cleft cysts. Multiple logistic regression analysis showed that cystic pituitary adenomas and Rathke cleft cysts can be distinguished on the basis of the presence of a fluid-fluid level, septation, an off-midline location, and the presence of an intracystic nodule (P = .006, .032, .001, and .023, respectively). Among 24 patients in the external validation population, 22 were classified correctly on the basis of the diagnostic tree model used in this study. A systematic approach using this diagnostic tree model can be helpful in distinguishing cystic pituitary adenomas from Rathke cleft cysts.
Highlights
MATERIALS AND METHODSThis retrospective study included 54 patients with a cystic pituitary adenoma (40 women; mean age, 37.7 years) and 28 with a Rathke cleft cyst (18 women; mean age, 31.5 years) who underwent MR imaging followed by surgery
BACKGROUND AND PURPOSECystic pituitary adenomas may mimic Rathke cleft cysts when there is no solid enhancing component found on MR imaging, and preoperative differentiation may enable a more appropriate selection of treatment strategies
The presence of a fluid-fluid level, a hypointense rim on T2-weighted images, septation, and an off-midline location were more common with pituitary adenomas, whereas the presence of an intracystic nodule was more common with Rathke cleft cysts
Summary
Study Population This retrospective study was approved by the Yonsei University Health System institutional review board, and the requirement for informed consent was waived. Craniopharyngioma was not included for analysis, because only 3 patients presented with a cystic mass without a solid enhancing portion during the same period, and 2 of them had typical imaging findings of craniopharyngioma Those 54 patients with a pituitary adenoma underwent surgery because of medication treatment failure (n ϭ 10), local mass effect (n ϭ 11), hormonal symptoms (n ϭ 18), headache (n ϭ 14), or rapid size increase (n ϭ 1). The contribution of each imaging feature was evaluated by univariate logistic regression and a multivariable logistic regression model after a stepwise procedure was performed to differentiate cystic pituitary adenomas and RCCs. On the basis of the results of logistic regression analysis, a recursivepartitioning-tree classification algorithm was used to suggest a diagnostic tree model. A P value of Ͻ.05 was considered statistically significant
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