MRI of Symptomatic Rathke's Cleft Cyst : MR Intensity of Cyst Contents and Clinical Manifestations

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  • Takeichi Yasuhiro
    Department of Neurosurgery, Soseikai General Hospital
  • Nakasu Yoko
    Department of Neurosurgery, Shiga University of Medical Science
  • Handa Jyoji
    Department of Neurosurgery, Shiga University of Medical Science

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  • 症候性ラトケ嚢胞のMRI : 嚢胞の信号強度と臨床症状との関連

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We have not known Surgical indications for incidental Rathke's cleft cysts, because of our lack of knowledge about their natural history. In this study, we investigated whether symptomatic Rathke's cleft cysts have any characteristic features in magnetic resonance (MR) signal intensities, and analyzed their relation to clinical manifestations and to patterns of suprasellar expansion. MR signal intensities on T1-weighted (T1W) and T2-weighted (T2W) images were categorized into 3 types in 78 cases including our 9 cases ; type I, low signal intensity on T1W images and hyperintensity on T2W images in 25 cases ; type II, hyperintensity on both T1W and T2W images in 20 ; and type III, low Intensity on T2W images, in other 33. Patients of type I signal intensities presented with significantly high percentage of large cysts compressing the third ventricle than patients with other types. The patients of type I signal intensities also frequently had visual disturbance. Patients in type II showed significantly less percentage of large cysts. Anterior pituitary dysfunction was observed more often in patients of type II and III than patients of type I. We conclude that Rathke's cleft cysts with MR signal intensity like cerebrospinal fluid (CSF) are slowly growing, and are frequently diagnosed as large cysts associated with visual disturbance. The patients with other types of MR signal intensities may suffer pituitary dysfunction or other symptoms before the cysts compress the hypothalamic region. The assessment of MR signal intensities may contribute in predicting clinical progression in patients with Rathke's cleft cysts.

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