Abstract
The sellar/juxtasellar region comprises the bone component of the sella turcica, pituitary gland, cavernous sinus, and suprasellar cistern. Abnormalities in this region can be attributed to underproduction or overproduction of hormones or to the neurological signs and symptoms resulting from the compression of adjacent structures. Magnetic resonance imaging (MRI) is currently the imaging method of choice, having supplanted computed tomography. The aim of this study was to demonstrate the common and uncommon imaging aspects of sellar and juxtasellar changes, which could facilitate the differential diagnosis. We retrospectively evaluated the MRI scans of 70 patients with sellar/juxtasellar abnormalities from didactic files, and report those with more unusual changes, where MRI played an important role in diagnosis. All cases were confirmed histologically or clinical laboratory.
Highlights
The sellar region, albeit small, encompasses a number of important structures, including the bone component of the sella turcica, as well as the pituitary gland, cavernous sinus, and suprasellar cistern. Abnormalities in this region can be attributed to the underproduction or overproduction of hormones or to the neurological signs and symptoms resulting from the compression of adjacent structures
Study conducted at the Hospital Universitário Walter Cantídio da Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil
Pituitary adenomas are the most common lesions in the sellar/juxtasellar region, lesions originating in other structures can affect the region, complicating the diagnosis
Summary
The sellar region, albeit small, encompasses a number of important structures, including the bone component of the sella turcica, as well as the pituitary gland, cavernous sinus, and suprasellar cistern. On MRI, sellar meningiomas show an isointense signal in T1-weighted sequences and an isointense or hyperintense in T2-weighted sequences, as well as early enhancement, usually accompanied by the dural tail sign (Figure 8) When they invade the cavernous sinus, they tend constrict the carotid artery (Figure 9), which rarely occurs in cases of adenoma. Aneurysms of the sellar region typically originate from the cavernous or supraclinoid portion of the internal carotid artery, accounting for up to 10% of all cerebral aneurysms Their diagnosis is made more with MRI than with CT, because the former can reveal a flow void, due to the rapid luminal flow, and heterogeneous signal intensity in areas with slow, turbulent flow (Figure 10).
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