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Sellar / suprasellar mass
NeuroMRI
A mass centred on the sella or suprasellar cistern, often presenting with visual field defects or endocrinopathy. Epicentre and patient age drive the differential.
Differential
Pituitary macroadenoma
common- •Arises from the sella, "snowman/figure-8" with diaphragma waist
- •Sella expanded/remodelled; cavernous sinus invasion
- •Adult; hormone hypersecretion or hypopituitarism
Craniopharyngioma
common- •Suprasellar, cystic + solid with calcification (adamantinomatous)
- •T1-bright "machinery oil" cyst fluid
- •Bimodal age (children and older adults)
Meningioma (tuberculum sellae)
less-common- •Dural base with dural tail, homogeneous avid enhancement
- •Normal-sized sella, hyperostosis
Rathke cleft cyst
less-common- •Non-enhancing cyst with intracystic nodule
- •No calcification; between anterior and posterior pituitary
Hypothalamic/optic pathway glioma
rare- •Child, association with neurofibromatosis type 1
- •Solid T2-bright mass expanding the optic chiasm/tracts
Germinoma
rare- •Infundibular thickening with diabetes insipidus
- •Loss of posterior pituitary bright spot; adolescent
Key discriminators
- •Epicentre: intrasellar (adenoma) vs suprasellar
- •Calcification (craniopharyngioma) vs none
- •Cystic vs solid; T1-bright cyst content
- •Patient age (bimodal for craniopharyngioma)
- •Endocrine picture (DI, hypersecretion)
Work-up / next steps
- 1.Dedicated pituitary MRI with dynamic contrast
- 2.Full pituitary hormone panel and visual field testing
- 3.Serum/CSF markers (β-hCG, AFP) if germinoma suspected
- 4.Neurosurgical/endocrine referral
References
- Radiopaedia: Sellar and suprasellar masses.
- Osborn AG. Osborn’s Brain, 2nd ed.
Educational clinical decision support only. This differential does not make a diagnosis, is not a medical device, and must never substitute for interpretation by a qualified radiologist correlated with the full clinical picture and prior imaging.