DOI: 10.1148/rg.261055045
T1 Signal Hyperintensity in the Sellar Region: Spectrum of Findings1
Fabrice Bonneville, MD,
Françoise Cattin, MD,
Kathlyn Marsot-Dupuch, MD,
Didier Dormont, MD,
Jean-François Bonneville, MD and
Jacques Chiras, MD
1 From the Department of Neuroradiology, Pitié-Salpêtrière Hospital, 74 Boulevard de l’Hôpital, 75013 Paris, France (F.B., D.D., J.C.); Department of Neuroradiology, Jean Minjoz Hospital, Besançon, France (F.C., J.F.B.); and Department of Neuroradiology, Bicêtre Hospital, Le Kremlin-Bicêtre, France (K.M.). Recipient of an Excellence in Design award for an education exhibit at the 2004 RSNA Annual Meeting. Received March 7, 2005; revision requested April 12 and received May 4; accepted May 5. All authors have no financial relationships to disclose.
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Figure 1. Normal T1 signal hyperintensity of the posterior pituitary lobe in a young healthy volunteer. Axial T1-weighted MR image clearly depicts a bright spot in a depression slightly lateral to the midline (long arrow), immediately anterior to the thin linear area of signal hypointensity in the anterior cortex of the dorsum sellae (arrowhead). Note the asymmetric appearance of the marrow fat within the dorsum sellae (short arrow) and the irregular but normal margins of the posterior lobe.
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Figure 2. Giant macroadenoma in a 65-year-old man with bitemporal superior quadrantanopia. Coronal T1-weighted image depicts an ectopic but functional location of vasopressin storage, displaced from the midline, at the dome of the lesion (arrow).
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Figure 3. Normal MR signal intensity pattern of the sellar region in a 3-week-old newborn examined for hypotonia. Sagittal T1-weighted image shows the homogeneous and marked signal hyperintensity of the adenohypophysis that is usually observed at this age (arrow).
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Figure 4. Meningioma of the tuberculum sellae in a 33-year-old woman. Sagittal T1-weighted image depicts the common hyperostotic reaction adjacent to the tumor, which, in this patient, is located at the planum sphenoidale (arrowheads). The thickened bone contains fatty marrow, which accounts for the T1 signal hyperintensity.
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Figure 5. Juvenile angiofibroma in an 18-year-old man with epistaxis and nasal obstruction. Sagittal T1-weighted image depicts a mass that fills the sphenoid sinus, with a classic vascular pattern that includes numerous serpentine flow voids (arrowheads). Note the unusual hyperostotic reaction of the planum sphenoidale, which outlines the upper aspect of the mass (arrow), and the signal intensity pattern of normal red bone marrow in the clivus and C2 vertebra.
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Figure 6a. Microadenoma in a 37-year-old woman with hyperprolactinemia. Sagittal T1-weighted images acquired before (a) and 12 months after (b) surgery with a transsphenoidal approach show a postoperative increase in signal intensity in the jugum (arrowheads), a finding that is related to bone remodeling after surgery.
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Figure 6b. Microadenoma in a 37-year-old woman with hyperprolactinemia. Sagittal T1-weighted images acquired before (a) and 12 months after (b) surgery with a transsphenoidal approach show a postoperative increase in signal intensity in the jugum (arrowheads), a finding that is related to bone remodeling after surgery.
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Figure 7. Incidental finding of a sellar spine in a 17-year-old male patient with head trauma. Three-dimensional reformatted head computed tomographic (CT) image depicts a midline spur (long arrow) anterior to the dorsum sellae (short arrow).
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Figure 8. Coronal T1-weighted image in a 25-year-old woman with mild hyperprolactinemia shows a subtle magnetic susceptibility effect at the sphenoid sinus–sellar floor interface (arrowheads), which is interrupted by the bony nasal septum (short arrow), and high-signal-intensity flow artifacts in the arteries of the circle of Willis (long arrows).
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Figure 9a. Silent hemorrhagic pituitary adenoma in a 32-year-old woman with hyperprolactinemia. Coronal T1-weighted image (a) and T2-weighted image (b) show a pituitary microadenoma with a lateral location in the left part of the gland. The heterogeneous circumferential signal intensity on the T2-weighted image is highly suggestive of bleeding (arrow).
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Figure 9b. Silent hemorrhagic pituitary adenoma in a 32-year-old woman with hyperprolactinemia. Coronal T1-weighted image (a) and T2-weighted image (b) show a pituitary microadenoma with a lateral location in the left part of the gland. The heterogeneous circumferential signal intensity on the T2-weighted image is highly suggestive of bleeding (arrow).
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Figure 10a. Pituitary apoplexy in a 54-year-old man with acute headache and ophthalmoplegia. Sagittal T1-weighted (a) and T2-weighted (b) images depict a lesion with heterogeneous signal intensity inside an enlarged sella, a distinctive feature of subacute hemorrhage. Note the inflammatory reaction in the sphenoid sinus (*).
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Figure 10b. Pituitary apoplexy in a 54-year-old man with acute headache and ophthalmoplegia. Sagittal T1-weighted (a) and T2-weighted (b) images depict a lesion with heterogeneous signal intensity inside an enlarged sella, a distinctive feature of subacute hemorrhage. Note the inflammatory reaction in the sphenoid sinus (*).
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Figure 11. Hemorrhagic pituitary macroadenoma in a 43-year-old man. Sagittal T1-weighted image shows a fluid-fluid level that represents the sedimentation of blood products (arrow) in the sellar region, a finding that is observed mainly in hemorrhagic pituitary adenomas.
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Figure 12a. Aneurysms in the carotid and ophthalmic arteries in a 47-year-old woman with visual impairment. Coronal T1-weighted image (a) and T2-weighted image (b) show bilateral suprasellar round lesions that impinge on the optic chiasm. The heterogeneous signal intensity observed in the left-sided lesion (* in a) on both images is a distinctive feature of an aneurysm with a thrombosed component, whereas the flow void in the right-sided lesion (arrow in a) indicates a patent aneurysm.
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Figure 12b. Aneurysms in the carotid and ophthalmic arteries in a 47-year-old woman with visual impairment. Coronal T1-weighted image (a) and T2-weighted image (b) show bilateral suprasellar round lesions that impinge on the optic chiasm. The heterogeneous signal intensity observed in the left-sided lesion (* in a) on both images is a distinctive feature of an aneurysm with a thrombosed component, whereas the flow void in the right-sided lesion (arrow in a) indicates a patent aneurysm.
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Figure 13a. Giant partially thrombosed left carotid artery aneurysm in a 67-year-old man with headache. (a) Unenhanced axial CT scan reveals a giant noncalcified lesion that has destroyed the central skull base. (b) Coronal T1-weighted image depicts a heterogeneous lesion, with peripheral signal hyperintensity consistent with methemoglobin, in the sella turcica and the sphenoid sinus. The rounded component with no signal (arrow), adjacent to the intracavernous segment of the left internal carotid artery, is highly suggestive of residual circulation in an aneurysm, a finding confirmed by the digital subtraction angiogram (c).
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Figure 13b. Giant partially thrombosed left carotid artery aneurysm in a 67-year-old man with headache. (a) Unenhanced axial CT scan reveals a giant noncalcified lesion that has destroyed the central skull base. (b) Coronal T1-weighted image depicts a heterogeneous lesion, with peripheral signal hyperintensity consistent with methemoglobin, in the sella turcica and the sphenoid sinus. The rounded component with no signal (arrow), adjacent to the intracavernous segment of the left internal carotid artery, is highly suggestive of residual circulation in an aneurysm, a finding confirmed by the digital subtraction angiogram (c).
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Figure 13c. Giant partially thrombosed left carotid artery aneurysm in a 67-year-old man with headache. (a) Unenhanced axial CT scan reveals a giant noncalcified lesion that has destroyed the central skull base. (b) Coronal T1-weighted image depicts a heterogeneous lesion, with peripheral signal hyperintensity consistent with methemoglobin, in the sella turcica and the sphenoid sinus. The rounded component with no signal (arrow), adjacent to the intracavernous segment of the left internal carotid artery, is highly suggestive of residual circulation in an aneurysm, a finding confirmed by the digital subtraction angiogram (c).
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Figure 14a. Intrasellar Rathke cleft cyst in a 22-year-old patient with headache. (a) Axial T2-weighted image clearly shows the location of a kidney-shaped Rathke cleft cyst (long arrow) exactly on the imaginary midline that divides the anterior (arrowhead) and posterior (short arrow) pituitary lobes. (b, c) Sagittal unenhanced T1-weighted (b) and T2-weighted (c) images show a rounded homogeneous intrasellar lesion with T1 signal hyperintensity and T2 signal hypointensity (arrow in c). The homogeneity of the signal on images obtained with both sequences, especially on c, is inconsistent with a hemorrhagic lesion.
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Figure 14b. Intrasellar Rathke cleft cyst in a 22-year-old patient with headache. (a) Axial T2-weighted image clearly shows the location of a kidney-shaped Rathke cleft cyst (long arrow) exactly on the imaginary midline that divides the anterior (arrowhead) and posterior (short arrow) pituitary lobes. (b, c) Sagittal unenhanced T1-weighted (b) and T2-weighted (c) images show a rounded homogeneous intrasellar lesion with T1 signal hyperintensity and T2 signal hypointensity (arrow in c). The homogeneity of the signal on images obtained with both sequences, especially on c, is inconsistent with a hemorrhagic lesion.
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Figure 14c. Intrasellar Rathke cleft cyst in a 22-year-old patient with headache. (a) Axial T2-weighted image clearly shows the location of a kidney-shaped Rathke cleft cyst (long arrow) exactly on the imaginary midline that divides the anterior (arrowhead) and posterior (short arrow) pituitary lobes. (b, c) Sagittal unenhanced T1-weighted (b) and T2-weighted (c) images show a rounded homogeneous intrasellar lesion with T1 signal hyperintensity and T2 signal hypointensity (arrow in c). The homogeneity of the signal on images obtained with both sequences, especially on c, is inconsistent with a hemorrhagic lesion.
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Figure 15a. Axial T1-weighted images show a hemorrhagic pituitary microadenoma (arrow in a) and a Rathke cleft cyst (arrow in b). At initial comparison, the features of the two different lesion types may appear similar: high T1 signal intensity, rounded shape, and intrasellar location exactly on the midline between the pituitary lobes. However, the distinctive hemorrhagic fluid-debris level visible in the pituitary adenoma is absent in the Rathke cleft cyst.
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Figure 15b. Axial T1-weighted images show a hemorrhagic pituitary microadenoma (arrow in a) and a Rathke cleft cyst (arrow in b). At initial comparison, the features of the two different lesion types may appear similar: high T1 signal intensity, rounded shape, and intrasellar location exactly on the midline between the pituitary lobes. However, the distinctive hemorrhagic fluid-debris level visible in the pituitary adenoma is absent in the Rathke cleft cyst.
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Figure 16. Rathke cleft cyst in a 32-year-old woman with mild hyperprolactinemia. Coronal T2-weighted image shows features that are highly suggestive of a Rathke cleft cyst: tiny hypointense dots (arrowheads), which are believed to correspond to proteinaceous concretions floating inside a midline cyst.
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Figure 17. Suprasellar Rathke cleft cyst in a 28-year-old woman with mild hyperprolactinemia. Sagittal T1-weighted image shows a round and homogeneously hyperintense midline Rathke cleft cyst (arrow) in the typical suprasellar location, immediately above the sellar diaphragm and anterior to the stalk, as well as the normal area of signal hyperintensity at the posterior aspect of the sella (arrowhead).
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Figure 18. Recurrent craniopharyngioma in a 23-year-old man with visual impairment and diabetes insipidus. Sagittal T1-weighted image depicts an enormous heterogeneous suprasellar lesion with hyperintense cystic components (arrowheads), findings that are consistent with high concentrations of protein. Note the normal pituitary gland (arrow) beneath the lesion.
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Figure 19a. Hemorrhagic pituitary macroadenoma (a) and craniopharyngioma (b). At an initial comparison of the sagittal T2-weighted image (a) and the T1-weighted image (b), these two different lesions may appear to have similar features: a sellar-suprasellar location, enlargement of the sella turcica, and mixed signal intensities. However, the distinctive hemorrhagic fluid-debris level visible on a (arrowheads) is more frequently observed in macroadenomas than in craniopharyngiomas, in which a proteinaceous pseudo–fluid-fluid level (arrow in b) may be depicted.
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Figure 19b. Hemorrhagic pituitary macroadenoma (a) and craniopharyngioma (b). At an initial comparison of the sagittal T2-weighted image (a) and the T1-weighted image (b), these two different lesions may appear to have similar features: a sellar-suprasellar location, enlargement of the sella turcica, and mixed signal intensities. However, the distinctive hemorrhagic fluid-debris level visible on a (arrowheads) is more frequently observed in macroadenomas than in craniopharyngiomas, in which a proteinaceous pseudo–fluid-fluid level (arrow in b) may be depicted.
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Figure 20a. Cholesterol granuloma of the sphenoid sinus in a 45-year-old woman with headache. (a) Sagittal T1-weighted image shows a homogeneous hyperintense infrasellar lesion that has filled the sphenoid sinus and displaced the pituitary gland upward. (b) Axial T2-weighted image shows high signal intensity in the lesion. The thin rim of signal hypointensity (arrowheads) visible on both images suggests the diagnosis. (Courtesy of Gul Moonis, MD.)
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Figure 20b. Cholesterol granuloma of the sphenoid sinus in a 45-year-old woman with headache. (a) Sagittal T1-weighted image shows a homogeneous hyperintense infrasellar lesion that has filled the sphenoid sinus and displaced the pituitary gland upward. (b) Axial T2-weighted image shows high signal intensity in the lesion. The thin rim of signal hypointensity (arrowheads) visible on both images suggests the diagnosis. (Courtesy of Gul Moonis, MD.)
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Figure 21a. Trigeminal lipoma in a 34-year-old woman with right-sided facial neuralgia. (a) Coronal T1-weighted image depicts a right laterosellar hyperintense lesion that occupies the posterior aspect of the cavernous sinus and emerges through the foramen ovale (arrowheads). (b) Axial CT scan demonstrates the pure fatty nature of the lesion, which parallels the trigeminal nerve and its branches.
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Figure 21b. Trigeminal lipoma in a 34-year-old woman with right-sided facial neuralgia. (a) Coronal T1-weighted image depicts a right laterosellar hyperintense lesion that occupies the posterior aspect of the cavernous sinus and emerges through the foramen ovale (arrowheads). (b) Axial CT scan demonstrates the pure fatty nature of the lesion, which parallels the trigeminal nerve and its branches.
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Figure 22. Ruptured dermoid cyst in a 50-year-old man with sudden headache. Sagittal T1-weighted image depicts a large heterogeneously hyperintense suprasellar dermoid cyst (arrow) and multiple subarachnoid foci of high signal intensity consistent with fat accumulations (arrowheads).
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Figure 23. Subarachnoid remnants of contrast material in a 72-year-old woman with a history of intrathecal injection of an iodinated lipid-containing contrast agent for better visualization of a meningioma (arrow) in the foramen magnum. Sagittal T1-weighted image shows multiple hyperintense nodules trapped in the chiasmatic cistern (arrowheads).
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Figure 24. Lipomatous meningioma in the tuberculum sellae in a 29-year-old woman with mild hyperprolactinemia. Sagittal unenhanced T1-weighted image depicts an extraaxial suprasellar mass with high signal intensity, in the same location and with the same shape as other commonly observed meningiomas but with an atypical, fat signal intensity. (Courtesy of Jean-Luc Sarrazin, MD.)
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Figure 25a. Chordoma in a 73-year-old man. (a) Unenhanced CT scan shows, midline, a destructive mass of the clivus, with posterior peripheral calcification and with a fluid-fluid level in a hemorrhagic cystic component (arrow). (b) Sagittal T1-weighted image depicts a heterogeneous chordoma that impinges on the pons (arrow) and that contains high-signal-intensity foci with various origins. Note the typical speckled pattern of mixed isointense and hyperintense signals.
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Figure 25b. Chordoma in a 73-year-old man. (a) Unenhanced CT scan shows, midline, a destructive mass of the clivus, with posterior peripheral calcification and with a fluid-fluid level in a hemorrhagic cystic component (arrow). (b) Sagittal T1-weighted image depicts a heterogeneous chordoma that impinges on the pons (arrow) and that contains high-signal-intensity foci with various origins. Note the typical speckled pattern of mixed isointense and hyperintense signals.
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Figure 26a. Chondrosarcoma in a 37-year-old man with intracranial hypertension. (a) Sagittal T1-weighted image depicts a suprasellar lesion with high signal intensity at its anterior aspect (arrow). (b) Axial T1-weighted image shows more foci of high signal intensity (arrowheads), as well as areas of low signal intensity, and shows that the lesion center is not at the midline. (c) CT scan shows massive calcification, a finding that is highly suggestive of a chondromatous tumor.
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Figure 26b. Chondrosarcoma in a 37-year-old man with intracranial hypertension. (a) Sagittal T1-weighted image depicts a suprasellar lesion with high signal intensity at its anterior aspect (arrow). (b) Axial T1-weighted image shows more foci of high signal intensity (arrowheads), as well as areas of low signal intensity, and shows that the lesion center is not at the midline. (c) CT scan shows massive calcification, a finding that is highly suggestive of a chondromatous tumor.
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Figure 26c. Chondrosarcoma in a 37-year-old man with intracranial hypertension. (a) Sagittal T1-weighted image depicts a suprasellar lesion with high signal intensity at its anterior aspect (arrow). (b) Axial T1-weighted image shows more foci of high signal intensity (arrowheads), as well as areas of low signal intensity, and shows that the lesion center is not at the midline. (c) CT scan shows massive calcification, a finding that is highly suggestive of a chondromatous tumor.
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Figure 27a. Pituitary abscess in a 28-year-old man with febrile cephalalgia. (a) Sagittal T1-weighted image depicts a heterogeneous intrasellar lesion with a hyperintense peripheral capsule. (b) Contrast-enhanced coronal T1-weighted image shows gadolinium uptake characteristic of a pituitary abscess, a finding that extends to the adjacent cavernous sinuses and left temporal dura mater.
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Figure 27b. Pituitary abscess in a 28-year-old man with febrile cephalalgia. (a) Sagittal T1-weighted image depicts a heterogeneous intrasellar lesion with a hyperintense peripheral capsule. (b) Contrast-enhanced coronal T1-weighted image shows gadolinium uptake characteristic of a pituitary abscess, a finding that extends to the adjacent cavernous sinuses and left temporal dura mater.
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Figure 28a. Hypermagnesemia in a 32-year-old woman receiving intravenous nutrition in an intensive care unit. Sagittal (a) and axial (b) T1-weighted images show homogeneously hyperintense signal in the anterior pituitary lobe and the globus pallidus (arrows), a finding suggestive of this condition.
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Figure 28b. Hypermagnesemia in a 32-year-old woman receiving intravenous nutrition in an intensive care unit. Sagittal (a) and axial (b) T1-weighted images show homogeneously hyperintense signal in the anterior pituitary lobe and the globus pallidus (arrows), a finding suggestive of this condition.
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Figure 29. Fat packing in the postoperative bed of a pituitary adenoma. Coronal T1-weighted image obtained 3 months after surgery shows a homogeneous hyperintense berrylike region of fatty material, with a characteristic dark outline that represents a chemical shift artifact (arrowheads).
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Figure 30. Blood-impregnated gelatin sponge. Coronal T1-weighted image acquired 1 week after surgical excision of a pituitary macroadenoma shows specific MR features that include a thin peripheral rim of high signal intensity, which corresponds to methemoglobin, and scattered spots of signal void, which correspond to bubbles of air trapped in the gelatin sponge.
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Figure 31. Metal artifact in the postoperative bed of a macroadenoma. Sagittal T1-weighted image obtained 4 days after surgery shows metallic artifacts along the transsphenoidal path of approach, which appear as areas of no signal, with peripheral hyperintense dots (arrowheads). Note that the space left by the adenoma has not yet decreased at early follow-up MR imaging.
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Figure 32a. Hyperactivity of residual normal pituitary gland after medical treatment of a prolactin-secreting macroadenoma in a 19-year-old woman with primary amenorrhea. Coronal T1-weighted images before (a) and 18 months after (b) therapy with oral bromocriptine for normalization of prolactinemia and menstruation show the complete posttreatment disappearance of the lesion in the right aspect of the sella. In addition, the signal intensity in the residual normal pituitary tissue in the left aspect of the sella has increased to a level exceeding that in the white matter of the temporal lobes.
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Figure 32b. Hyperactivity of residual normal pituitary gland after medical treatment of a prolactin-secreting macroadenoma in a 19-year-old woman with primary amenorrhea. Coronal T1-weighted images before (a) and 18 months after (b) therapy with oral bromocriptine for normalization of prolactinemia and menstruation show the complete posttreatment disappearance of the lesion in the right aspect of the sella. In addition, the signal intensity in the residual normal pituitary tissue in the left aspect of the sella has increased to a level exceeding that in the white matter of the temporal lobes.
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Copyright © 2006 by the Radiological Society of North America.
