Magnetic resonance imaging, clinical manifestations, and management of Rathke's cleft cyst

Abstract

Objective: The management of Rathke's cleft cyst (RCC), particularly in patients with no symptoms or with only minor endocrinopathies, has not yet been established. We retrospectively analysed patients with RCC to elucidate correlations between the clinical manifestations, magnetic resonance imaging (MRI) findings, histology and therapeutic outcomes.

Methods: We retrospectively studied 37 patients with RCC, who underwent computed tomography (CT), MRI and endocrinological examinations, of whom 27 patients underwent surgical intervention.

Results: The presence of frontal headaches and anterior pituitary dysfunction was unrelated to the cyst size but was more frequent in patients with high- and isointensity cysts on T1-weighted images (WIs) than those with low-intensity cysts (P=0.0159 and P=0.0249, respectively). All three patients with posterior pituitary dysfunction had a high-intensity cyst on T1-WI (P=0.0385), whereas pituitary dysfunction was not observed in patients with a low-intensity cyst on T1-WI. In contrast to the excellent therapeutic outcomes with regard to visual disturbance and hyperprolactinaemia, recovery of pituitary dysfunction was rare; only three of nine patients with hypopituitarism showed improvement. Among six patients with histologically recognized intense chronic inflammation in the cyst wall, five patients had an RCC of T1 high intensity (P=0.0161), two patients had distinct rim enhancement on MRI (P=0.0060), all patients had frontal headaches (P=0.0130), and four patients had associated hypopituitarism (P=0.0243), none of which improved after surgical intervention.

Conclusion: RCCs of high- and isointensity on T1-weighted images, which contain mucous material within the cyst, may be associated with chronic inflammation that can potentially cause irreversible endocrine dysfunction. In asymptomatic patients with RCCs of these MR intensities, close follow-up with precise endocrinological evaluation and gadolinium-enhanced MRI is necessary to avoid occult progression of the inflammation.