PT  - JOURNAL ARTICLE
AU  - R. Prieto
AU  - J.M. Pascual
AU  - L. Barrios
TI  - Topographic Diagnosis of Craniopharyngiomas: The Accuracy of MRI Findings Observed on Conventional T1 and T2 Images
AID  - 10.3174/ajnr.A5361
DP  - 2017 Sep 21
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2017/09/21/ajnr.A5361.short
4100  - http://www.ajnr.org/content/early/2017/09/21/ajnr.A5361.full
AB  - BACKGROUND AND PURPOSE: The topography of craniopharyngiomas has proved fundamental in predicting the involvement of vital brain structures and the possibility of achieving a safe radical resection. Beyond the imprecise term “suprasellar,” indiscriminately used for craniopharyngiomas, an accurate definition of craniopharyngioma topography should be assessed by preoperative MR imaging. The objective of this study was to investigate the MRI findings that help define craniopharyngioma topography.MATERIALS AND METHODS: This study retrospectively investigated a cohort of 200 surgically treated craniopharyngiomas with their corresponding preoperative midsagittal and coronal conventional T1- and T2-weighted MR images, along with detailed descriptions of the surgical findings. Radiologic variables related to the occupation of the tumor of intracranial compartments and the distortions of anatomic structures along the sella turcica–third ventricle axis were analyzed and correlated with the definitive craniopharyngioma topography observed during the surgical procedures. A predictive model for craniopharyngioma topography was generated by multivariate analysis.RESULTS: Five major craniopharyngioma topographies can be defined according to the degree of hypothalamic distortion caused by the tumor: sellar-suprasellar, pseudointraventricular, secondary intraventricular, not strictly intraventricular, and strictly intraventricular. Seven key radiologic variables identified on preoperative MRI allowed a correct overall prediction of craniopharyngioma topography in 86% of cases: 1) third ventricle occupation, 2) pituitary stalk distortion, 3) relative level of the hypothalamus in relation to the tumor, 4) chiasmatic cistern occupation, 5) mammillary body angle, 6) type of chiasm distortion, and 7) tumor shape.CONCLUSIONS: Systematic assessment of these 7 variables on conventional preoperative T1 and T2 MRI is a useful and reliable method to ascertain individual craniopharyngioma topography.CPcraniopharyngiomaCRTClassification and Regression TreeLRlikelihood ratioMBAmammillary body anglePSpituitary stalk3Vthird ventricleTVFthird ventricle floor