Board Review 3 – Case 7

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows expansion of the sella on a noncontrast CT, suggesting a long-standing mass. The MRI shows an underlying mass which has areas of hypointensity on T2 and intrinsic hyperintensity on T1 weighted imaging. There is minimal if any enhancement on post-contrast imaging.

The diagnosis is: pituitary adenoma (with hemorrhage)

Pituitary adenomas are common masses of the sella, with about half being non-functional and half hormone secreting. The most common hormone secreted is prolactin, followed by growth hormone. Adenomas can hemorrhage, causing variable imaging appearance.

The primary differential consideration is Rathke cleft cyst, which is more commonly midline, less likely to have blood products and septations, and may have a characteristic peripheral nodule. You can read more about differentiating adenomas and Rathke cleft cysts here.