Sagittal T1 image in a 3 year old girl with central diabetes | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Sagittal T1 image in a 3 year old girl with central diabetes insipidus shows a thickened pituitary infundibulum (red arrow) and absent T1 bright posterior pituitary (blue arrow). In children, Langerhans cell histiocytosis (LCH), as in this case, and germinoma are the primary considerations. The infundibulum is the most frequent location for intracranial LCH involvement. #NeuroWednesday

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Young child with Hurler disease shows a J-shaped sella tursica (arrow). The sella has this configuration due to enlargement of the pituitary. The differential diagnosis includes normal anatomic variation, mucopolysaccharidoses, neurofibromatosis, and a pituitary mass.


Axial (image 1), coronal (image 2), and sagittal (image 3) T1-weighted post-contrast MRI focused on the pituitary show thickening of the infundibulum (arrow) and enlargement of the pituitary (arrowhead). Langerhans cell histiocytosis rarely affects the central nervous system. When it does, patients may present with diabetes insipidus, ataxia, or hydrocephalus. Diabetes insipidus is a common manifestation when the posterior pituitary and infundibulum are infiltrated by Langerhans cells. Infundibular thickening greater than 3 mm is suggestive of involvement.


Sagittal T1-weighted MRI shows abnormal thickening of the pituitary infundibulum (arrow, image 1). There is also posteriorly inferior displacement of the posterior pituitary bright spot. This is in contradistinction to a normal-appearing infundibulum (arrow, image 2). Langerhans cell histiocytosis can affect the pituitary infundibulum and causes diabetes insipidus. On MRI, the most common findings of pituitary involvement of Langerhans cell histiocytosis includes the absence of the posterior pituitary bright spot and infundibular thickening. #NeuroWednesday


MR images in a 12 year old with headaches and diplopia shows a heterogeneously enhancing suprasellar mass. There is pituitary infundibulum thickening (blue arrow), and the posterior pituitary bright T1-focus is absent (red). The mass had diffusion restriction, and germinoma was favored. CNS germinomas are centered in the midline, usually in the pineal and suprasellar locations. Suprasellar lesions often present with diabetes insipidus or visual changes. The pineal lesions usually present with headache, precocious puberty, or Parinaud syndrome with upward gaze paralysis. #NeuroWednesday

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