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Cited by 18Pituitary Gland Disorders and TreatmentsFetal and Pediatric Neurological DisordersHead and Neck Surgical Oncology

The DOI matches its Crossref record; 83 of the 85 references it cites were found in a registry or an index; none of the 100 sources its claims cite is checked for support yet.

Magnetic resonance imaging of sellar and juxtasellar abnormalities in the paediatric population: an imaging review

Open access
Shields, Rachel, Mangla, Rajiv, Almast, Jeevak, Meyers, Steven·2015·Insights into Imaging
DOI 10.1007/s13244-015-0401-5PMC PMC4376809
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Abstract

The sellar and juxtasellar regions in the paediatric population are complex both anatomically and pathologically, with magnetic resonance imaging (MRI) being the "gold standard" imaging modality due to the high contrast of detail. Assessment requires a detailed understanding of the anatomy, embryology, pathophysiology and normal signal characteristics of the pituitary gland and surrounding structures in order to appropriately characterise abnormalities. This article aims to provide an overview of the imaging characteristics of developmental/congenital and acquired disease processes which affect the sellar and juxtasellar region in the paediatric population. Main Messages • The sellar region is anatomically complex and covers a wide pathology spectrum. • MRI is the key imaging modality to assess sellar and juxtasellar pathology. • Numerous developmental anomalies may not be discovered until adulthood. • Knowledge of pathology alerts and guides the clinician towards appropriate management.

Overview

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TL;DR

This narrative imaging review summarises the MRI features of congenital/developmental and acquired sellar and juxtasellar abnormalities in children, framing MRI as the "gold standard" modality because of its high contrast resolution. It provides entity-by-entity imaging descriptions (signal characteristics, enhancement, location) alongside brief clinical, embryological and epidemiological context.

Key findings

  • Normal paediatric pituitary imaging evolves: both lobes are T1-hyperintense at birth, with the anterior lobe dropping to near isointensity with the posterior pons by 6 weeks of age, while the posterior lobe retains T1 hyperintensity throughout adulthood. Normal pituitary height is typically 2–6 mm during childhood and up to 10 mm or slightly higher at puberty; preterm infants have taller glands than term infants.
  • Developmental anomalies covered include adenohypophyseal agenesis and hypoplasia, ectopic posterior pituitary, pituitary duplication, hypothalamic hamartoma, persistent craniopharyngeal canal, Rathke's cleft cyst, cephaloceles, epidermoid/dermoid, arachnoid cyst, lipoma and empty sella. Reported frequencies include Rathke's cleft cysts on MRI in childhood at 1.2%, arachnoid cysts in 0.16% of all newborns with 9–15% in the sellar region, and trans-sphenoidal meningoencephaloceles at 1 per 700,000 live births.
  • Neoplastic and inflammatory entities reviewed include pituitary adenoma (≈2.7% of all supratentorial tumours in children; only 3–6% non-functioning versus one-third in adults), craniopharyngioma (3% of all intracranial tumours), optic pathway glioma (4–6% of paediatric brain tumours, median diagnosis 5–9 years, ~half with NF1), pilomyxoid astrocytoma, germinoma and teratoma, tuberculous meningitis, osteosarcoma, Ewing sarcoma, esthesioneuroblastoma, fibrous dysplasia/McCune-Albright, Langerhans' cell histiocytosis (2 per 100,000 children under 15), lymphocytic hypophysitis, Rosai-Dorfman disease, leptomeningeal lymphoma and vascular malformations.
  • Several discriminating features are highlighted: non-enhancing T2-hyperintense lesions suggest hypothalamic hamartoma or Rathke's cleft cyst; restricted diffusion distinguishes epidermoid from arachnoid cyst; intra-tumoural haemorrhage favours pilomyxoid over pilocytic astrocytoma (25% vs 8%); a parasellar T2 dark sign helps separate lymphocytic hypophysitis from adenoma; stalk thickness >3 mm with loss of posterior pituitary T1 bright spot suggests LCH.

Methods

  • Design: narrative, image-based educational review; no systematic search strategy, inclusion criteria, or evidence grading is described.
  • Data: no patient cohort or primary data; the article is illustrated with numbered figures (Figs. 1–31) of example cases and synthesises published literature, with 79 cited references.
  • Analysis: qualitative synthesis organised by anatomical/embryological background, normal paediatric imaging characteristics, developmental anomalies, pituitary lesions, and juxtasellar lesions.

Limitations

  • The paper states no limitations explicitly.
  • Evident from the text: as a narrative review there is no stated search strategy, study selection, or critical appraisal of the cited literature; epidemiological figures are quoted from heterogeneous prior series without quality assessment.
  • Also evident: illustration is via selected single-institution example images rather than systematic imaging–pathology correlation, and the review does not address diagnostic accuracy, sensitivity/specificity, or comparative performance of MRI against other modalities.

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Integrity signals

Registry

Crossref · 10.1007/s13244-015-0401-5

Cites

83 of 83 references verified0 citation errors · 0 not checkable

Statistics

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Figures

Fig. 1 Normal pituitary anatomy
Fig. 1 Normal pituitary anatomyCC BY · PubMed Central
Fig. 2 Normal development of the pituitary gland
Fig. 2 Normal development of the pituitary glandCC BY · PubMed Central
Fig. 3 Normal physiological T1 sagittal (a) and axial (b) hyperintensity of the anterior pituitary in a 1-month-old baby
Fig. 3 Normal physiological T1 sagittal (a) and axial (b) hyperintensity of the anterior pituitary in a 1-month-old babyCC BY · PubMed Central
Fig. 4 Agenesis of the anterior pituitary gland (adenohypophysis) in an infant with hypopituitarism. Sagittal T1-weighted imaging (T1WI) shows absence of the adenohypophisis. The stalk terminates into a bulbous neurohypophysis with high signal in the dorsal portion of the sella
Fig. 4 Agenesis of the anterior pituitary gland (adenohypophysis) in an infant with hypopituitarism. Sagittal T1-weighted imaging (T1WI) shows absence of the adenohypophisis. The stalk terminates into a bulbous neurohypophysis with high signal in the dorsal portion of the sellaCC BY · PubMed Central
Fig. 5 Severe hypoplasia of the anterior pituitary gland. Pre-contrast (a) and post-contrast (b) MR images show severe hypoplasia of the anterior pituitary gland which shows only minimal contrast enhancement along the floor of the sella. The ectopic posterior pituitary is located adjacent to the optic chiasm
Fig. 5 Severe hypoplasia of the anterior pituitary gland. Pre-contrast (a) and post-contrast (b) MR images show severe hypoplasia of the anterior pituitary gland which shows only minimal contrast enhancement along the floor of the sella. The ectopic posterior pituitary is located adjacent to the optic chiasmCC BY · PubMed Central
Fig. 6 Ectopic posterior pituitary gland. Pre-contrast (a) and post-contrast (b) MR images show a normal anterior pituitary gland with contrast enhancement and an ectopic posterior pituitary located adjacent to the optic chiasm
Fig. 6 Ectopic posterior pituitary gland. Pre-contrast (a) and post-contrast (b) MR images show a normal anterior pituitary gland with contrast enhancement and an ectopic posterior pituitary located adjacent to the optic chiasmCC BY · PubMed Central
Fig. 7 Pituitary duplication. Coronal post-contrast images (a and b) show two pituitary stalks which extend inferiorly into separate duplicated pituitary glands. Sagittal T1WI (c) shows marked thickening of the hypothalamus, referred to as a pseudohamartoma, which has intermediate signal. The pseudohamartoma showed no contrast enhancement (not shown)
Fig. 7 Pituitary duplication. Coronal post-contrast images (a and b) show two pituitary stalks which extend inferiorly into separate duplicated pituitary glands. Sagittal T1WI (c) shows marked thickening of the hypothalamus, referred to as a pseudohamartoma, which has intermediate signal. The pseudohamartoma showed no contrast enhancement (not shown)CC BY · PubMed Central
Fig. 8 Hypothalamic hamartoma. Axial T2WI (a) and sagittal T1WI (b) shows a sessile type of hypothalamic hamartoma which has intermediate signal similar to grey matter. Pre-contrast (c) and post-contrast (d) sagittal T1WI in another patient shows a pedunculated hypothalamic hamartoma with intermediate signal and lacks contrast enhancement
Fig. 8 Hypothalamic hamartoma. Axial T2WI (a) and sagittal T1WI (b) shows a sessile type of hypothalamic hamartoma which has intermediate signal similar to grey matter. Pre-contrast (c) and post-contrast (d) sagittal T1WI in another patient shows a pedunculated hypothalamic hamartoma with intermediate signal and lacks contrast enhancementCC BY · PubMed Central
Fig. 9 Tuber cinerum hamartoma. Sagittal (a) and coronal (b) T1WI, and coronal post-contrast T1WI (c) show a non-enhancing bulky soft tissue mass in the region of the of the tuber cinerum
Fig. 9 Tuber cinerum hamartoma. Sagittal (a) and coronal (b) T1WI, and coronal post-contrast T1WI (c) show a non-enhancing bulky soft tissue mass in the region of the of the tuber cinerumCC BY · PubMed Central
Fig. 10 Persistent craniopharyngeal canal. Axial (a) and sagittal (b) CT shows a markedly enlarged persistent craniopharyngeal canal. Coronal fat-suppressed T1WI shows inferior extension of enhancing pituitary tissue within the abnormally enlarged craniopharyngeal canal (c)
Fig. 10 Persistent craniopharyngeal canal. Axial (a) and sagittal (b) CT shows a markedly enlarged persistent craniopharyngeal canal. Coronal fat-suppressed T1WI shows inferior extension of enhancing pituitary tissue within the abnormally enlarged craniopharyngeal canal (c)CC BY · PubMed Central
Fig. 11 Rathke’s cleft cyst. Sagittal T1WI (a) shows a lesion in the central portion of the pituitary gland which has high signal. Post-contrast sagittal fat-suppressed T1WI (b) shows lack of enhancement of the Rathke cleft cyst. The cyst has intermediate signal on T2WI (c) secondary to slightly elevated protein content
Fig. 11 Rathke’s cleft cyst. Sagittal T1WI (a) shows a lesion in the central portion of the pituitary gland which has high signal. Post-contrast sagittal fat-suppressed T1WI (b) shows lack of enhancement of the Rathke cleft cyst. The cyst has intermediate signal on T2WI (c) secondary to slightly elevated protein contentCC BY · PubMed Central
Fig. 12 Pars intermedia cyst. Sagittal T1WI (a) and axial T2WI (b) shows a small cyst between the anterior and posterior pituitary which lacks contrast enhancement on axial fat-suppressed T1WI (c)
Fig. 12 Pars intermedia cyst. Sagittal T1WI (a) and axial T2WI (b) shows a small cyst between the anterior and posterior pituitary which lacks contrast enhancement on axial fat-suppressed T1WI (c)CC BY · PubMed Central
Fig. 13 Cephalocele in a 17-year-old girl. Coronal T2WI (a) and sagittal T1WI (b) shows a meningocele extending inferiorly into the nasopharynx through an osseous defect in the sphenoid bone posterior to the pituitary gland
Fig. 13 Cephalocele in a 17-year-old girl. Coronal T2WI (a) and sagittal T1WI (b) shows a meningocele extending inferiorly into the nasopharynx through an osseous defect in the sphenoid bone posterior to the pituitary glandCC BY · PubMed Central
Fig. 14 Epidermoid. Sagittal T1WI (a) shows an extra-axial lesion along the endocranial surface which has heterogeneous mostly low-intermdiate signal, and on T2WI has high signal (b). Diffusion-weighted imaging (DWI) (c) shows restricted diffusion
Fig. 14 Epidermoid. Sagittal T1WI (a) shows an extra-axial lesion along the endocranial surface which has heterogeneous mostly low-intermdiate signal, and on T2WI has high signal (b). Diffusion-weighted imaging (DWI) (c) shows restricted diffusionCC BY · PubMed Central
Fig. 15 Dermoid. Sagittal (a) and axial (b) T1WI shows an extra-axial lesion in the suprasellar cistern which has high signal. Multiple small foci with high signal are seen in the sulci and within the left lateral ventricle representing ruptured dermoid contents in the leptomeninges
Fig. 15 Dermoid. Sagittal (a) and axial (b) T1WI shows an extra-axial lesion in the suprasellar cistern which has high signal. Multiple small foci with high signal are seen in the sulci and within the left lateral ventricle representing ruptured dermoid contents in the leptomeningesCC BY · PubMed Central
Fig. 16 Arachnoid cyst. Sagittal T1WI (a) and coronal T2WI (b) show a well defined cystic mass with low T1 and high T2 signal intensity with sellar and suprasellar components
Fig. 16 Arachnoid cyst. Sagittal T1WI (a) and coronal T2WI (b) show a well defined cystic mass with low T1 and high T2 signal intensity with sellar and suprasellar componentsCC BY · PubMed Central
Fig. 17 Lipoma. Sagittal T1WI (a) shows a lipoma with high signal along the inferior surface of the hypothalamus. The signal on the lipoma is nulled on coronal fat-suppressed T2WI (b)
Fig. 17 Lipoma. Sagittal T1WI (a) shows a lipoma with high signal along the inferior surface of the hypothalamus. The signal on the lipoma is nulled on coronal fat-suppressed T2WI (b)CC BY · PubMed Central
Fig. 18 Empty sella. Sagittal post-contrast T1WI with fat-suppression show an enlarged sella mostly filled with CSF. The enhancing flattened pituitary tissue is located along the floor of the sella
Fig. 18 Empty sella. Sagittal post-contrast T1WI with fat-suppression show an enlarged sella mostly filled with CSF. The enhancing flattened pituitary tissue is located along the floor of the sellaCC BY · PubMed Central
Fig. 19 Pituitary adenomas. Sagittal post-contrast fat-suppressed T1WI (a) shows an heterogenously enhancing pituitary macroadenoma which contains a non-enhancing portion with high signal on T2WI (b). secondary to cystic degeneration. Coronal post-contrast fat-suppressed T1WI (c) shows a pituitary microadenoma which shows less early contrast enhancement than the normal pituitary tissue
Fig. 19 Pituitary adenomas. Sagittal post-contrast fat-suppressed T1WI (a) shows an heterogenously enhancing pituitary macroadenoma which contains a non-enhancing portion with high signal on T2WI (b). secondary to cystic degeneration. Coronal post-contrast fat-suppressed T1WI (c) shows a pituitary microadenoma which shows less early contrast enhancement than the normal pituitary tissueCC BY · PubMed Central
Fig. 20 Craniopharyngioma. Sagittal T1WI (a) shows a lobulated lesion filling the suprasellar cistern which contains zones of low, intermediate and high signal. Sagittal post-contrast T1WI (b) shows the lesion to have heterogeneous contrast enhancement
Fig. 20 Craniopharyngioma. Sagittal T1WI (a) shows a lobulated lesion filling the suprasellar cistern which contains zones of low, intermediate and high signal. Sagittal post-contrast T1WI (b) shows the lesion to have heterogeneous contrast enhancementCC BY · PubMed Central
Fig. 21 Glioma in a 2-year-old girl with neurofibromatosis type 1. Sagittal (a) and axial (b) post contrast T1WI shows a partially enhancing lesion enlarging the optic chiasm and proximal optic nerves
Fig. 21 Glioma in a 2-year-old girl with neurofibromatosis type 1. Sagittal (a) and axial (b) post contrast T1WI shows a partially enhancing lesion enlarging the optic chiasm and proximal optic nervesCC BY · PubMed Central
Fig. 22 Pilomyxoid astrocytoma in a 4-month-old baby girl. Sagittal T1WI (a) shows a large hypothalamic lesion with intermediate signal which extends superiorly into and filling the third ventricle, and inferiorly into the suparsellar cistern. The tumour has mostly high signal on axial T2WI (b)
Fig. 22 Pilomyxoid astrocytoma in a 4-month-old baby girl. Sagittal T1WI (a) shows a large hypothalamic lesion with intermediate signal which extends superiorly into and filling the third ventricle, and inferiorly into the suparsellar cistern. The tumour has mostly high signal on axial T2WI (b)CC BY · PubMed Central
Fig. 23 Germ cell tumours in two different children. Post-contrast T1WI (a) shows a large enhancing lesion in the suprasellar cistern extending superiorly into the third ventricle and posteriorly into the prepontine cistern. Sagittal post-contrast T1WI (b) in another child shows enhancing, disseminated germ-cell tumour in the suprasellar cistern, third and lateral ventricles, with involvement of the corpus callosum and optic chiasm
Fig. 23 Germ cell tumours in two different children. Post-contrast T1WI (a) shows a large enhancing lesion in the suprasellar cistern extending superiorly into the third ventricle and posteriorly into the prepontine cistern. Sagittal post-contrast T1WI (b) in another child shows enhancing, disseminated germ-cell tumour in the suprasellar cistern, third and lateral ventricles, with involvement of the corpus callosum and optic chiasmCC BY · PubMed Central
Fig. 24 Teratoma. Sagittal T1WI (a) and axial T2WI (b) show a lesion at the undersurface of the hypothalamus which has mixed low, intermediate and high signal. Axial CT image (c) shows the lesion to contain zones of calcification, fat and intermediate soft-tissue attenuation
Fig. 24 Teratoma. Sagittal T1WI (a) and axial T2WI (b) show a lesion at the undersurface of the hypothalamus which has mixed low, intermediate and high signal. Axial CT image (c) shows the lesion to contain zones of calcification, fat and intermediate soft-tissue attenuationCC BY · PubMed Central
Fig. 25 A 4-month-old baby boy with tuberculous meningitis. Axial (a, b) and coronal (c) post-contrast T1WI shows prominent extra-axial contrast-enhancement in the basal meninges, surrounding the brainstem, cerebellar sulci and Sylvian fissures. The leptomeningeal infection invades the left temporal lobe
Fig. 25 A 4-month-old baby boy with tuberculous meningitis. Axial (a, b) and coronal (c) post-contrast T1WI shows prominent extra-axial contrast-enhancement in the basal meninges, surrounding the brainstem, cerebellar sulci and Sylvian fissures. The leptomeningeal infection invades the left temporal lobeCC BY · PubMed Central
Fig. 26 Enthesioneuroblastoma. Sagittal T1WI (a) and post-contrast T1WI (b) show a destructive mass lesion involving the sphenoid bone which invades the sphenoid sinus and sella. The tumour shows prominent, mildly heterogeneous contrast enhancement
Fig. 26 Enthesioneuroblastoma. Sagittal T1WI (a) and post-contrast T1WI (b) show a destructive mass lesion involving the sphenoid bone which invades the sphenoid sinus and sella. The tumour shows prominent, mildly heterogeneous contrast enhancementCC BY · PubMed Central
Fig. 27 Fibrous dysplasia in a 5-year-old girl with McCune Albright syndrome. Axial CT (a) shows multiple expansile lesions involving the skull which have a “ground glass” appearance representing sites of polyostotic fibrous dysplasia. Sagittal T1WI shows expansion of the clivus which has diffuse low signal (b) with corresponding diffuse enhancement on sagittal post-contrast fat-suppressed T1WI (c)
Fig. 27 Fibrous dysplasia in a 5-year-old girl with McCune Albright syndrome. Axial CT (a) shows multiple expansile lesions involving the skull which have a “ground glass” appearance representing sites of polyostotic fibrous dysplasia. Sagittal T1WI shows expansion of the clivus which has diffuse low signal (b) with corresponding diffuse enhancement on sagittal post-contrast fat-suppressed T1WI (c)CC BY · PubMed Central
Fig. 28 Langerhans cell histiocytosis in a 6-year-old girl with headaches and diabetes insipidus. Coronal T1WI shows a lesion involving the upper pituitary gland and stalk which has intermediate signal (a). The lesion shows prominent enhancement on post-contrast coronal T1WI (b)
Fig. 28 Langerhans cell histiocytosis in a 6-year-old girl with headaches and diabetes insipidus. Coronal T1WI shows a lesion involving the upper pituitary gland and stalk which has intermediate signal (a). The lesion shows prominent enhancement on post-contrast coronal T1WI (b)CC BY · PubMed Central
Fig. 29 Lymphocytic hypophysitis in a 16-year-old boy who presented with frequent urination, which started when he was 9. Coronal T1WI (a) shows thickening of the pituitary stalk which has intermdiate signal. Post-contrast axial (b) and sagittal (c) T1WI shows thickening of the pituitary stalk with homogeneous enhancement
Fig. 29 Lymphocytic hypophysitis in a 16-year-old boy who presented with frequent urination, which started when he was 9. Coronal T1WI (a) shows thickening of the pituitary stalk which has intermdiate signal. Post-contrast axial (b) and sagittal (c) T1WI shows thickening of the pituitary stalk with homogeneous enhancementCC BY · PubMed Central
Fig. 30 Leptomeningeal spread of lymphoma. Sagittal post contrast T1WI demonstrates diffuse intracranial and spinal leptomeningeal enhancement in a 22-month-old infant boy with lymphoma including the sella and parasellar subarachnoid space
Fig. 30 Leptomeningeal spread of lymphoma. Sagittal post contrast T1WI demonstrates diffuse intracranial and spinal leptomeningeal enhancement in a 22-month-old infant boy with lymphoma including the sella and parasellar subarachnoid spaceCC BY · PubMed Central
Fig. 31 Cavernous malformation: coronal T2WI (a) and axial gradient echo (GRE) (b) images in a 5-year-old girl show a large suprasellar lesion with mixed low, intermediate and high signal intensity with a thin rim of low signal on T2WI and foci of low T2* signal from susceptibility effects of blood products on GRE
Fig. 31 Cavernous malformation: coronal T2WI (a) and axial gradient echo (GRE) (b) images in a 5-year-old girl show a large suprasellar lesion with mixed low, intermediate and high signal intensity with a thin rim of low signal on T2WI and foci of low T2* signal from susceptibility effects of blood products on GRECC BY · PubMed Central

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Metadata

Authors
Shields, R., Mangla, R., Almast, J., & Meyers, S.
Affiliations
University of Rochester Medicine (US)
Corresponding author
Shields, Rachel
ORCID
Venue
Insights into Imaging
Publisher
Springer Science and Business Media LLC
Published
2015-03-21
Volume
6
Issue
2
Pages
241-260
ISSN
1869-4101 (ISSN-L)
DOI
10.1007/s13244-015-0401-5
PMC
PMC4376809
OpenAlex
W2125454623
Cited by
18
References
85
Citations by year
2026: 3 · 2025: 1 · 2024: 1 · 2023: 5 · 2022: 1 · 2020: 1 · 2019: 4 · 2017: 1 · 2016: 1
FWCI
0.44
Type
journal article
Language
en
Open access
Licence
Locations
  • Insights into Imaging (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Fetal and Pediatric Neurological Disorders
  • Health Sciences › Medicine › Surgery › Head and Neck Surgical Oncology
Keywords
sellar region, congenital pituitary anomaly, developmental anomalies, MRI signal characteristics

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