Magnetic resonance imaging of sellar and juxtasellar abnormalities in the paediatric population: an imaging review

Abstract

The sellar and juxtasellar regions in the paediatric population are complex both anatomically and pathologically, with magnetic resonance imaging (MRI) being the “gold standard” imaging modality due to the high contrast of detail. Assessment requires a detailed understanding of the anatomy, embryology, pathophysiology and normal signal characteristics of the pituitary gland and surrounding structures in order to appropriately characterise abnormalities. This article aims to provide an overview of the imaging characteristics of developmental/congenital and acquired disease processes which affect the sellar and juxtasellar region in the paediatric population.Main Messages• The sellar region is anatomically complex and covers a wide pathology spectrum.• MRI is the key imaging modality to assess sellar and juxtasellar pathology.• Numerous developmental anomalies may not be discovered until adulthood.• Knowledge of pathology alerts and guides the clinician towards appropriate management.

Pediatric Sellar: Suprasellar Tumors

“…20,21 No restricted diffusion is seen on DWI. 9 The absence of growth is seen on follow-up MR examinations.…”

“…Around 75% of the HCGs occur in the first decade, with a median age of diagnosis ranging between 5 and 9 years, 9 and males and females are affected equally. 10 HCGs account for 10 to 15% of supratentorial tumors in children 4 and 25 to 30% of pediatric suprasellar neoplasms.…”

“…9 Suprasellar germinomas affect equally males and females, while in pineal location a male predominance is reported. 1,3,9 Visual disturbances caused by chiasm compression and pituitary axis dysfunction caused by hypothalamic-hypophyseal compression are the most common presenting symptoms; β-human chorionic gonadotropin or α-fetoprotein may be detected in the cerebrospinal fluid (CSF) or blood.…”

“…5,16 Craniospinal irradiation or focal field irradiation combined with chemotherapy achieve high survival rates, 17,18 with a 10-year survival rate reported to be over 85%. 9 Radical tumor resection, in combination with radiotherapy and chemotherapy, is indicated in other germ-cell tumors of intermediate or poor prognosis. 19…”

“…Generally hyperintense on T1W and T2W images, occasionally with fluid/fluid or fluid/debris levels. 9 Epidermoids are off-midline lesions, with low-to-intermediate signal intensity on T1W images and increased signal intensity on T2W images. Hyperintensity is also seen in fluid- attenuated inversion recovery and DWI, differentiating epidermoids from arachnoid cysts.…”