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

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Abstract

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.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Funding

This study has received funding from Taipei Veterans General Hospital, Taiwan [V111B-032, V112B-007 (to CHW); V110C-037, V111C-028, V112C-059, V112D67-002-MY3-1 (to FCC); V112B-005 (to STC); V112B-032 (to TML)], Veterans General Hospitals and University System of Taiwan Joint Research Program [VGHUST 109V1-5-2 and VGHUST 110-G1-5-2 (to FCC)], Ministry of Science and Technology (National Science and Technology Council) of Taiwan [MOST 110-2314-B-075-005- and 111-2314-B-075-025-MY3 (to CHW); MOST 109-2314-B-075-036 and 110-2314-B-075-032 (to FCC); MOST 110-2314-B-075-035-MY2 (to STC)], Yen Tjing Ling Medical Foundation, Taiwan [CI-109-3, CI-111-2, CI-112-2 (to CHW)], Professor Tsuen CHANG’s Scholarship Program from Medical Scholarship Foundation In Memory Of Professor Albert Ly-Young Shen (to CHW) and Vivian W. Yen Neurological Foundation (to CHW and FCC).

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Authors and Affiliations

  1. Department of Radiology, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan

    Chung-Han Yang, Chia-Hung Wu, Te-Ming Lin, Shu-Ting Chen, Wei-An Tai, Kai-Wei Yu, Chao-Bao Luo, Jiing-Feng Lirng & Feng-Chi Chang

  2. School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Chung-Han Yang, Chia-Hung Wu, Te-Ming Lin, Shu-Ting Chen, Wei-An Tai, Kai-Wei Yu, Chao-Bao Luo, Jiing-Feng Lirng & Feng-Chi Chang

  3. Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan

    Chao-Bao Luo

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  1. Chung-Han Yang
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Contributions

CHY, CHW, TML, STC, and FCC wrote the main manuscript text. CHY, WAT, prepared Table 1. CHY and KWY prepared Figs. 1, 2 and 3. All authors reviewed the manuscript.

Corresponding author

Correspondence to Feng-Chi Chang.

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The authors declare no competing interests.

Ethical approval

This study was approved by the Institutional Review Board of our hospital and followed all applicable laws, regulations, and policies for the protection of human participants.

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Yang, CH., Wu, CH., Lin, TM. et al. Clinical and imaging findings for the evaluation of large Rathke’s cleft cysts and cystic craniopharyngiomas. Pituitary 26, 393–401 (2023). https://doi.org/10.1007/s11102-023-01326-3

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