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Prevalence of pituitary cysts in children using modern magnetic resonance imaging techniques

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Abstract

Background

Pituitary pars intermedia/Rathke cleft cysts or cyst-like structures are commonly encountered in children undergoing brain magnetic resonance imaging (MRI), especially when examinations include thin-section, high-resolution sequences.

Objective

To determine the prevalence of pituitary cystic lesions in children at our institution using modern MRI technique, to assess for associated endocrinopathy and to address the need for follow-up.

Materials and methods

We retrospectively reviewed 232 consecutive 1.5- and 3-T brain MRIs in children ages 0–18 years (mean: 8.3±5.3 years). We evaluated 3-D volumetric T1 spoiled gradient echo (SPGR) and axial T2-weighted sequences. Pituitary glands were evaluated for the presence, size and signal characteristics of cysts. Cyst volumes were measured in three orthogonal planes. Endocrine abnormalities were documented from the medical record.

Results

Pituitary cysts were present in 57.7% of children (n=134), with a mean linear measurement of 3.6±1.17 mm (range: 0.4 to 12.3 mm). The overwhelming majority of cysts were hyopointense on T1-W images (n=121, 90%) and isointense on T2-W images relative to the adenohypophysis (n=106, 79%). T1 hyperintense and T2 hypointense signals were present in a minority, 6.7% and 8%, respectively. Most cysts were occult on post-contrast T1-W images (n=24, 77%). Endocrine abnormalities were present in 2/134 (1.5%) of children with cysts (these were unrelated to the pituitary gland) versus 1/98 (1%) children without cysts (P=0.7).

Conclusion

More often than not, pituitary cysts/cyst-like structures can be found incidentally in children using modern MRI techniques. Follow-up is not typically required if there are no associated symptoms or excessive size.

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Authors and Affiliations

  1. Department of Diagnostic Imaging and Radiology, University of Missouri Hospital/Women’s and Children’s Hospital, One Hospital Drive, Columbia, MO, 65212, USA

    Eman S. Mahdi

  2. Department of Diagnostic Imaging and Radiology, Staten Island University Hospital, Staten Island, NY, USA

    Ryan Logan Webb

  3. Department of Diagnostic Imaging and Radiology, Children’s National Medical Center, Washington, DC, USA

    Matthew T. Whitehead

  4. George Washington University Hospital, Washington, DC, USA

    Matthew T. Whitehead

Authors
  1. Eman S. Mahdi
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  2. Ryan Logan Webb
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  3. Matthew T. Whitehead
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Correspondence to Eman S. Mahdi.

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Mahdi, E.S., Webb, R.L. & Whitehead, M.T. Prevalence of pituitary cysts in children using modern magnetic resonance imaging techniques. Pediatr Radiol 49, 1781–1787 (2019). https://doi.org/10.1007/s00247-019-04479-1

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  • DOI: https://doi.org/10.1007/s00247-019-04479-1

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