Craniopharyngioma MRI

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. 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.

The MRI findings depend on the type of craniopharyngioma.^[1]

• Adamantinomatous type is the most common form (90%).
• Solid components are present, but usually form a relatively minor component of the mass.
• The calcification is very common.
• Tumor have a predilection to be large, extending superiorly into the third ventricle, and encasing vessels.^[2]

• Cysts
  • Variable but 80% are mostly or partly T2 hyperintense
  • T1: iso- to hyperintense to brain (due to high protein content machinery oil cysts)
• Solid component
  • T1 C+ (Gd): vivid enhancement
  • T2: variable or mixed
• Calcification
• Difficult to appreciate on conventional imaging
• Susceptible sequences may better demonstrate calcification

MR angiography: It may demonstrate displacement of the A1 segment of the anterior cerebral artery (ACA).^[3]

MR spectroscopy: Cyst contents may show a broad lipid spectrum, with an otherwise flat baseline.

• Papillary craniopharyngioma tend to be more spherical in outline.
• Calcification is uncommon or even rare in the papillary subtype.
• Papillary tumors tend to displace adjacent structures.^[4]

• Cysts
  • When present they are variable in signal.^{[5] [6]}
  • 85% T1 hypointense
• Solid component
  • T1: iso- to lightly hypointense to brain
  • T1 C+: vivid enhancement
  • T2: variable/mixed

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