Clinical and imaging findings for the evaluation of large Rathke’s cleft cysts and cystic craniopharyngiomas

Purpose: Large Rathke’s cleft cysts (LRCCs) and cystic craniopharyngiomas (CCPs) arise from the same embryological origin and may have similar MR presentations. However, the two tumors have different management strategies and outcomes. This study was designed to evaluate the clinical and imaging findings of LRCCs and CCPs, aiming to evaluate their pretreatment diagnosis and outcomes. Methods: We retrospectively enrolled 20 patients with LRCCs and 25 patients with CCPs. Both tumors had a maximal diameter of more than 20 mm. We evaluated the patients’ clinical and MR imaging findings, including symptoms, management strategies, outcomes, anatomic growth patterns and signal changes. Results: The age of onset for LRCCs versus CCPs was 49.0 ± 16.8 versus 34.2 ± 22.2 years (p =.022); the following outcomes were observed for LRCCs versus CCPs: (1) postoperative diabetes insipidus: 6/20 (30%) versus 17/25 (68%) (p =.006); and (2) posttreatment recurrence: 2/20 (10%) versus 10/25 (40%) (p =.025). The following MR findings were observed for LRCCs versus CCPs: (1) solid component: 7/20 (35%) versus 21/25 (84%) (p =.001); (2) thick cyst wall: 2/20 (10%) versus 12/25 (48%) (p =.009); (3) intracystic septation: 1/20 (5%) versus 8/25 (32%) (p =.030); (4) snowman shape: 18/20 (90%) versus 1/25 (4%) (p <.001); (5) off-midline extension: 0/0 (0%) versus 10/25 (40%) (p =.001); and (6) oblique angle of the sagittal long axis of the tumor: 89.9° versus 107.1° (p =.001). Conclusions: LRCCs can be differentiated from CCPs based on their clinical and imaging findings, especially their specific anatomical growth patterns. We suggest using the pretreatment diagnosis to select the appropriate surgical approach and thus improve the clinical outcome.Keywords: Rathke’s cleft cyst, craniopharyngioma, sellar mass, magnetic resonance imaging.