Brain Tumor Res Treat.  2023 Jan;11(1):59-65. 10.14791/btrt.2022.0036.

MRI-Based Classification of Rathke’s Cleft Cyst and Its Clinical Implication

• Kim G
• Moon JH
• Kim SH
• Kim EH

• KMID: 2539330
• DOI: http://doi.org/10.14791/btrt.2022.0036

Abstract

Background
Rathke’s cleft cysts (RCCs) are benign tumors of the pituitary gland. Small, asymptomatic RCCs do not require surgical treatment, whereas surgical treatment is required for symptomatic RCCs.
Methods
We retrospectively reviewed medical records of patients with an RCC who were diagnosed and managed in our institution between April 2004 and April 2020 and generated two different cohorts: the observation (n=114) and the surgical group (n=99). Their initial MRI signal characteristics were analyzed. The natural course focusing on cyst size was observed in the observation group and postoperative visual and endocrine outcomes were evaluated in the surgical group.
Results
The characterization of MRI signals of cyst contents in both T1-weighted (T1W) and T2-weighted (T2W) images revealed nine combinations for our 213 patients. Among 115 patients with a high T2W signal, the cysts showed hypo-, iso-, and hyper-intensity on T1W images in 72, 39, and 44 patients, respectively; Type S-low, Type S-iso, and Type S-high. One more major group of 35 patients showed RCCs with hyperintensity on the T1W images and hypointensity on the T2W images named as Type M. In the comparison between observation and surgical groups, we identified only two major groups in which the number of patients in the surgical and observation groups was statistically different: more Type S-low in a surgical group (p<0.001) and more Type M in an observation group (p=0.007). In subgroup analysis, the range of change in the cyst size was the highest in Type S-high in the observation group (p=0.028), and intergroup differences in visual and endocrine outcomes were not evident in the surgical group.
Conclusion
MRI characteristics help to predict the natural course of RCCs. We identified subgroups of RCCs which are more or less likely to require surgical intervention.

Keyword

Magnetic resonance imaging; Rathke’s cleft cyst

Figure

• 

  Fig. 1 The characterization of magnetic resonance imaging (MRI) signals of cyst contents in both T1W and T2W images. Among possible nine combinations, we identified four major groups based on MRI signal characteristics; Type S-high, Type S-iso, Type S-low and Type M.

• 

  Fig. 2 Magnetic resonance images (MRI) of four representative cases of Rathke’s cleft cyst (RCC). A and B: Type S-high. A 44-year-old female patient with RCC underwent transsphenoidal surgery for visual disturbance. The MRI shows a hyperintense signals both in T1-weighted (T1W) and T2-weighted (T2W) sagittal images. C and D: Type S-iso. A 45-year-old male patient was just followed-up without surgical intervention for 5 years. MRI revealed Rathke’s cleft cyst with hypointensity in T1W and hyperintensity in T2W. E and F: Type S-hypo. A 44-year-old female patient with RCC was followed-up for 7 years without surgical treatment as the size of the cyst did not change. The MRI revealed hypointense signal in T1W and hyperintense signal in T2W image. G and H: Type M. A 32-year-old female patient underwent surgery for relieving intractable headache. Preoperative MRI revealed hyperintensity in T1W and hypointensity in T2W images.

• 

  Fig. 3 Comparison between observation (A) and surgical (B) groups. Comparative analysis revealed that only two major groups in which the number of patients in the surgical and observation groups was statistically different: more Type S-low in the surgical group and more Type M in the observation group. *p-value<0.001; †p-value=0.007.

• 

  Fig. 4 Visual and endocrine outcomes in the surgical group. A: In the surgical group, the main indications of surgery were visual deterioration in 41 patients, endocrine hormone deficiency in 29 patients, and other reasons such as uncontrolled headache in 22 patients. The Type S-low group included more patients who underwent surgery for visual compromise. B and C: Visual improvement was achieved in 26 patients (83.9%), whereas visual function did not change in 2 patients and worsened in 3 patients while endocrine function was improved in 16 patients (72.8%), worsened in 5 patients (22.7%), and did not change in 1 patient after surgery. However, the intergroup differences in visual and endocrine outcomes were not evident. *p-value=0.034.

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