Difficulties in the differential diagnosis of chiasmal-cellular cysts
Abstract
Introduction. To date, the diagnosis of chiasmatic-sellar region (CSR) cysts continues to pose challenges for physicians in
various fields. This is attributed either to the similarity of the cysts' clinical manifestations or, conversely, to their absence, due to
normal hormonal levels and mild neurological symptoms. Among radiologists and clinicians, magnetic resonance imaging (MRI) with
dynamic contrast enhancement (CE), which provides high spatial resolution and excellent tissue contrast, is considered the primary
method for visualizing CSR pathologies. However, difficulties in differential diagnosis and diagnostic errors in determining the nature
of CSR cystic lesions continue to arise. The aim of this study was to analyze and systematize the differential diagnostic criteria for CSR
cystic lesions using MRI data. Materials and methods. A literature search was conducted in PubMed/MEDLINE, Web of Science, and
eLIBRARY using the keywords and their combinations: "chiasmal-sellar region", "cysts", "Rathke's pouch cyst", and "magnetic resonance
imaging". The study also included clinical cases obtained from the St. Petersburg State Pediatric Medical University. Results and
discussion. Twelve relevant literature sources were selected. A literature review was prepared, presenting the radiological semiotics of
various cystic lesions of the CSR and their differential diagnostic criteria based on MRI data. Rathke's pouch cysts (RPCs) are typically
located between the anterior and posterior pituitary glands and have a hypo- or isointense signal on T1-weighted imaging (WI) and
a hyperintense signal on T2-weighted imaging (TWI). Dynamic contrast agent administration (CA) typically results in the absence of
contrast agent accumulation. Epidermoid cysts (ECs) are characterized by a heterogeneous hypo- or isointense signal on T1-weighted
and T2-weighted images and accumulation of CF in a thin capsule at the periphery. Dermoid cysts (DCs) have a hyperintense signal on
T1-weighted images, a hypo- or isointense signal on T2-weighted images, and minimal or no CF accumulation. The signal characteristics
of arachnoid cysts (ACs) on MRI correspond to the cerebrospinal fluid (CSF) pattern. They do not accumulate CF on dynamic CSF
imaging. Based on our analysis, we have proposed a number of differential diagnostic criteria for CSR cysts that may be useful to
radiologist specialists in assessing this anatomical region, as well as to endocrinologists and neurosurgeons in planning treatment
strategies, including the course of surgery. Conclusions. Based on our analysis, we have proposed a number of differential diagnostic
criteria for CSR cysts that may be useful to radiologist specialists in assessing this anatomical region, as well as to endocrinologists
and neurosurgeons in planning treatment strategies, including the course of surgery.
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