Studies on improvement of diagnosis of neurosurgical lesions by magnetic resonance imaging (MRI), 2

Findings of magnetic resonance (MRI) imaging in 46 patients with sellar or parasellar mass were reviewed and compared with those of concurrently available X-ray CT. Intrasellar contents, the hypothalamic pituitary region, adjacent brain stem, optic nerves, and the surrounding cerebrospinal fluid were clearly depicted on T1-weighted images. The cavernous sinus and blood vessels, including the Willis circle, were visualized on T2-weighted images. In detecting pituitary macroadenoma, MRI seemed to be the most userful modality, because it was superior to CT in identifying abnormal changes of the infundibulum, diaphragma sellae, cavernous sinus and optic chiasm. Macroadenoma of the pituitary gland was usually isointense to the normal cerebral cortex on T1- and T2-weighted images. T1- and T2-weighted relaxation times for pituitary adenoma were slightly prolonged. The normal pituitary gland was distinguishable from adenomatous tissues. For microadenoma, MRI failed to show lesions or erosion of the sellar floor. Craniopharyngioma, meningioma of the tuberculum sellae, hypothalamic tumor, such as glioma and germinoma, and the other parasellar masses were clearly visualized on MRI. MRI was superior to CT in detecting tumor and its involvement, but inferior in detecting presence of calcification. T1-weighted imaging was useful in identifing the presence of intratumoral hemorrhage. Cysts of craniopharyngioma had various appearances on T1-weighted images. High signal cyst intensity corresponded to a high cholesterol content or the presence of methemoglobin. MRI depicted empty sella. The intrasellar content had the same appearance as that of the cerebrospinal fluid space, and the flattened pituitary gland and pituitary stalk were detected on T1-weighted images. (N.K.)