Specific Imaging Findings

The appearance of pediatric craniopharyngiomas is typical: they occupy the suprasellar cistern, have a cystic component and are partially calcified in 90% of cases. Multiple cysts with varying signal intensities are characteristic. Cystic components are typically hyperintense and less commonly isointense to the CSF on T1- weighted images. Fluid-debris levels may be present within the cysts. Solid components have variable signal intensities and they usually enhance with contrast. Enhancement may be minimal and limited to the cyst wall. Compression on the third ventricle is a common feature, which may be accompanied by obstructive hydrocephalus. Optic tract edema is commonly seen in craniopharyngiomas; however, it may occasionally be present in other parasellar tumors. Solid craniopharyngiomas are more common in adults and less frequently contain calcifications.

Pertinent Clinical Information

Patients commonly present with symptoms of increased intracranial pressure, including headache, nausea, vomiting, and symptoms of optic chiasm compression. The most common endocrine abnormality in children consists of growth disturbance, in about 80% of cases. Patients may also present with global hypopituitarism, hyperprolactinemia, or diabetes insipidus.

Differential Diagnosis

Pituitary Macroadenoma (41)

1. • originates from the sella

2. • usually isointense with brain and shows solid, frequently delayed, enhancement

3. • calcifications are rare

Rathke's cleft cyst (38)

1. • a single ovoid cyst without enhancing nodules, wall enhancement absent to minimal

2. • calcifications are uncommon, thin and peripheral

3. • intracystic nodules of low T2 signal may be present