Sella Turcica and Parasellar Region(蝶鞍和鞍旁区病变影像诊断).ppt

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1、SellaTurcicaandParasellarRegionDate:September18th,2011Ⅰ.AnatomicApproachtoDifferentialDiagnosisⅡ.PituitaryMicroadenomaⅢ.PituitaryMacroadenomaⅣ.Rathke’sCleftCystⅤ.CraniopharyngiomaⅥ.MeningiomaⅦ.AneurysmAneurysmvsMeningiomaⅧ.HamartomaⅨ.HypothalamicandChiasmGliomaⅩ.GerminomaⅪ.ChordomaⅫ.Metastases1.Fir

2、stidentifythepituitaryglandandsellaturcica.2.Thendeterminetheepicenterofthelesionandwhetheritisinthesellaorabove,beloworlateraltothesella.3.Ifitisinthesella,determinewhetherornotthesellaisenlarged.4.Oncethelocationofthemassisclear,analyzethesignalintensitypatterns:isthelesioncysticorsolid?5.Doesitc

3、ontainanyabnormalvessels?6.Arethereanycalcifications?Andsoon.7.FinallyestablishaDifferentialDiagnosis.InordertoanalyzeasellarorparasellarmassonMRIweusethefollowinganatomicapproach:ⅠAnatomicApproachtoDifferentialDiagnosisOnacoronalsectionthroughthebrainthereferencestructureisthepituitaryglandwhichli

4、esinthesellaturcica.Itisusuallylargerinfemalesthaninmales-infemalesthesuperiorbordertendstobeconvex,whereasinmalesitisusuallyconcave.Themostcommonabnormalitiesthatariseinthepituitaryglandarepituitaryadenoma,Rathke'scleftcystandcraniopharyngioma.PituitaryglandThenextstructuretoidentifyisthepituitary

5、stalk.Thisisaverticallyorientedstructurewhichconnectsthepituitaryglandtothebrain.Itisthinneratthebottomandthickeratthetop.Embryologically,itisalsoderivedfromRathke'scleftepitheliumandthereforethepathologies,whichcanariseinthepituitaryglandcanalsoariseinthestalk.Thereareafewunusualthingstobeconsider

6、edinchildren,suchasgerminomasandeosinophilicgranulomas.Inadultsmetastasesandoccasionallylymphomacanariseinthepituitarystalk.PituitarystalklymphomaAnothermajorstructureinthesuprasellarcisternistheopticchiasm.Itisanextensionofthebrainandlookslikethenumber8lyingonitsside.Itisglialtissue-thereforethemo

7、stcommontumorstooriginateherearegliomas.IntheUSandEuropeanotherfrequentpathologyinthisregionisdemyelinatingdisease-particularlymultiplesclerosis.Thiscanalsobeassociatedwithsomeswellingoftheopticchiasm.Optic