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65 y/o female with Hx of HTN, DM, CAD, ESRD, and hypothyroidism. MRI was done as part of a workup for "endocrine problems". What does the MRI show?

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Sagittal (image 1) and axial (image 2) T2-weighted MRI show a Rathke cleft cyst (arrow) extending into the sella turcica. Rathke cleft cysts arise from epithelial remnants between the anterior and posterior lobes of the pituitary gland. While most are small and asymptomatic, larger cysts may compress adjacent structures causing headaches, endocrine dysfunction, and visual disturbances.

Lateral Radiographs Description

• Lateral radiographs of the skull allow visualization of superficial and deep landmarks concurrently.
• First, identify the coronal suture, which separates the frontal and parietal bones of the skull. The lambdoid suture is visible posteriorly, dividing the parietal from the occipital bones. Posterior and superficial to the lambdoid suture, note the external occipital protuberance on the occipital bone.
• Note that pneumatized bones, such as the maxilla (containing maxillary sinus), frontal bone (containing frontal sinus), sphenoid bone (containing sphenoid sinus), and mastoid process (containing mastoid air cells), appear radiolucent, or darker, than surrounding areas of the skull.
• Superior to the sphenoid sinus, the bony sella turcica houses the pituitary gland. Anterior to the sella turcica, the greater wing of the sphenoid bone is visible.
• Note the components of the mandible, including the more anteriorly positioned coronoid process and the more posteriorly located condyle. The cervical spine is also apparent, with the anterior arch of atlas (C1) and dens of axis (C2) clearly delineated.

Source: Atlas of Human Anatomy, 7th edition. ISBN: 9780323393225. Copyright ©2019 Elsevier, Inc.

Dynamic sella MR of an adult with galactorrhea showing a prolactinoma (from early to late images).

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