Craniopharyngioma diagnostic study of choice: Difference between revisions
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{{Craniopharyngioma}} | {{Craniopharyngioma}} | ||
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== Overview == | == Overview == | ||
The diagnostic evaluation of craniopharyngioma includes high-definition brain imaging. Brain MRI with and without contrast is the gold standard. Computed tomography (CT) scan is optional and may show some calcifications that can be seen in these tumors. However CT is not specific enough as a | The [[Diagnosis|diagnostic evaluation]] of craniopharyngioma includes [[MRI|high-definition brain imaging]]. [[Magnetic resonance imaging|Brain MRI]] [[Magnetic resonance imaging|with and without contrast]] is the [[Gold standard (test)|gold standard]]. [[Computed tomography|Computed tomography (CT) scan]] is optional and may show some [[Calcification|calcifications]] that can be seen in these [[Tumor|tumors]]. However [[Computed tomography|CT]] is not specific enough as a stand alone [[diagnostic test]]. [[Magnetic resonance angiography|Vascular imaging]] studies such as [[Magnetic resonance angiography|MR angiography (MRA)]] or [[CT angiography|CTA]] is decided on a case-by-case basis typically for [[Surgery|surgical planning]] or if a possible [[vascular malformation]] is suspected. | ||
== Diagnostic Study of Choice == | == Diagnostic Study of Choice == | ||
*Craniopharyngiomas have the most [[Craniopharyngioma CT|heterogeneous radiologic appearance]] of any [[Pituitary gland|suprasellar neoplasm]].<ref name="pmid28155902">{{cite journal |vauthors=Müller HL, Merchant TE, Puget S, Martinez-Barbera JP |title=New outlook on the diagnosis, treatment and follow-up of childhood-onset craniopharyngioma |journal=Nat Rev Endocrinol |volume=13 |issue=5 |pages=299–312 |date=May 2017 |pmid=28155902 |doi=10.1038/nrendo.2016.217 |url=}}</ref> | |||
*Craniopharyngioma can offer a challenge in arriving at the correct [[diagnosis]]. | |||
*The [[Rathke's pouch|radiologic characteristics of Rathke cleft cyst]] can overlap that of adamantinomatous craniopharyngioma.<ref name="pmid27258775">{{cite journal |vauthors=Cohen LE |title=Update on childhood craniopharyngiomas |journal=Curr Opin Endocrinol Diabetes Obes |volume=23 |issue=4 |pages=339–44 |date=August 2016 |pmid=27258775 |doi=10.1097/MED.0000000000000264 |url=}}</ref> | |||
* | |||
=== Study of choice === | === Study of choice === | ||
*[[Magnetic resonance imaging|Pre and post contrast enhanced MR imaging]] with attention to the [[Sella turcica|sellar region]] is the [[Modality|modality of choice]] when evaluating craniopharyngioma.<ref name="pmid27903124">{{cite journal |vauthors=Martinez-Gutierrez JC, D'Andrea MR, Cahill DP, Santagata S, Barker FG, Brastianos PK |title=Diagnosis and management of craniopharyngiomas in the era of genomics and targeted therapy |journal=Neurosurg Focus |volume=41 |issue=6 |pages=E2 |date=December 2016 |pmid=27903124 |doi=10.3171/2016.9.FOCUS16325 |url=}}</ref> | |||
*The [[Magnetic resonance imaging|superior resolution and tissue characterization]], as well as the [[Magnetic resonance imaging|multiplanar capability of MRI]] make it the [[Radiology|radiologist’s]] indispensable tool. | |||
*[[Computed tomography|High-resolution]], [[Craniopharyngioma MRI|thin-section, T1-weighted imaging of the sellar region]] in the [[Anatomical terms of location|sagittal and coronal planes]] is mandatory, and should be obtained both [[Magnetic resonance imaging|pre- and post-contrast administration]].<ref name="pmid28838874">{{cite journal |vauthors=Patel VS, Thamboo A, Quon J, Nayak JV, Hwang PH, Edwards M, Patel ZM |title=Outcomes After Endoscopic Endonasal Resection of Craniopharyngiomas in the Pediatric Population |journal=World Neurosurg |volume=108 |issue= |pages=6–14 |date=December 2017 |pmid=28838874 |doi=10.1016/j.wneu.2017.08.058 |url=}}</ref> | |||
*[[Craniopharyngioma MRI|Dynamic enhanced imaging of the sellar region]] can be performed if diagnostic considerations include [[Pituitary adenoma|pituitary microadenoma]] or the rare [[Hemangioma|parasellar cavernous hemangioma]]. | |||
*[[Computed tomography|CT]] is also sensitive in the detection of fat density which is valuable in the [[Sella turcica|suprasellar region]] when the differential include [[Rathke's pouch|Rathke cleft cyst]].<ref name="pmid24467716">{{cite journal |vauthors=Müller HL |title=Craniopharyngioma |journal=Endocr. Rev. |volume=35 |issue=3 |pages=513–43 |date=June 2014 |pmid=24467716 |doi=10.1210/er.2013-1115 |url=}}</ref> | |||
==References== | ==References== | ||
Latest revision as of 15:26, 26 February 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Marjan Khan M.B.B.S.[2]
Overview
The diagnostic evaluation of craniopharyngioma includes high-definition brain imaging. Brain MRI with and without contrast is the gold standard. Computed tomography (CT) scan is optional and may show some calcifications that can be seen in these tumors. However CT is not specific enough as a stand alone diagnostic test. Vascular imaging studies such as MR angiography (MRA) or CTA is decided on a case-by-case basis typically for surgical planning or if a possible vascular malformation is suspected.
Diagnostic Study of Choice
- Craniopharyngiomas have the most heterogeneous radiologic appearance of any suprasellar neoplasm.[1]
- Craniopharyngioma can offer a challenge in arriving at the correct diagnosis.
- The radiologic characteristics of Rathke cleft cyst can overlap that of adamantinomatous craniopharyngioma.[2]
Study of choice
- Pre and post contrast enhanced MR imaging with attention to the sellar region is the modality of choice when evaluating craniopharyngioma.[3]
- The superior resolution and tissue characterization, as well as the multiplanar capability of MRI make it the radiologist’s indispensable tool.
- High-resolution, thin-section, T1-weighted imaging of the sellar region in the sagittal and coronal planes is mandatory, and should be obtained both pre- and post-contrast administration.[4]
- Dynamic enhanced imaging of the sellar region can be performed if diagnostic considerations include pituitary microadenoma or the rare parasellar cavernous hemangioma.
- CT is also sensitive in the detection of fat density which is valuable in the suprasellar region when the differential include Rathke cleft cyst.[5]
References
- ↑ Müller HL, Merchant TE, Puget S, Martinez-Barbera JP (May 2017). "New outlook on the diagnosis, treatment and follow-up of childhood-onset craniopharyngioma". Nat Rev Endocrinol. 13 (5): 299–312. doi:10.1038/nrendo.2016.217. PMID 28155902.
- ↑ Cohen LE (August 2016). "Update on childhood craniopharyngiomas". Curr Opin Endocrinol Diabetes Obes. 23 (4): 339–44. doi:10.1097/MED.0000000000000264. PMID 27258775.
- ↑ Martinez-Gutierrez JC, D'Andrea MR, Cahill DP, Santagata S, Barker FG, Brastianos PK (December 2016). "Diagnosis and management of craniopharyngiomas in the era of genomics and targeted therapy". Neurosurg Focus. 41 (6): E2. doi:10.3171/2016.9.FOCUS16325. PMID 27903124.
- ↑ Patel VS, Thamboo A, Quon J, Nayak JV, Hwang PH, Edwards M, Patel ZM (December 2017). "Outcomes After Endoscopic Endonasal Resection of Craniopharyngiomas in the Pediatric Population". World Neurosurg. 108: 6–14. doi:10.1016/j.wneu.2017.08.058. PMID 28838874.
- ↑ Müller HL (June 2014). "Craniopharyngioma". Endocr. Rev. 35 (3): 513–43. doi:10.1210/er.2013-1115. PMID 24467716.