Craniopharyngioma diagnostic study of choice

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.

• 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]

• 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]

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