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    RSNA Education Exhibits

    Lesions of the Hypothalamus: MR Imaging Diagnostic Features

    Published Online:Jul 1 2007https://doi.org/10.1148/rg.274065123

    Abstract

    The hypothalamus is susceptible to involvement by a variety of processes, including developmental abnormalities, primary tumors of the central nervous system (CNS), vascular tumors, systemic tumors affecting the CNS, and inflammatory and granulomatous diseases. The hypothalamus may also be involved by lesions arising from surrounding structures such as the pituitary gland. Magnetic resonance (MR) imaging is the modality of choice for evaluating the anatomy and pathologic conditions of the hypothalamus. The MR imaging differential diagnosis depends on accurate anatomic localization and tissue characterization of hypothalamic lesions through the recognition of their signal intensity and contrast material enhancement patterns. Diffusion-weighted imaging and proton MR spectroscopy can be helpful in differentiating among various types of hypothalamic lesions. Key MR imaging features, in addition to the patient’s age and clinical findings at presentation, may be helpful in developing the differential diagnosis for lesions involving the hypothalamic region.

    © RSNA, 2007

    References

    • 1 SwaabDF. Disorders of development and growth. In: Swaab DF, ed. The human hypothalamus: basic and clinical aspects. Amsterdam, the Netherlands: Elsevier Health Science, 2004; 31–36. Google Scholar
    • 2 ChristJF. Derivation and boundaries of the hypothalamus, with atlas of hypothalamic grisea. In: Haymaker W, Anderson E, Nauta WJH, eds. The hypothalamus. Springfield, Ill: Thomas, 1969; 13–60. Google Scholar
    • 3 CarpenterMC. Core text of neuroanatomy. 2nd ed. Baltimore, Md: Williams & Wilkins, 1978; 216–235. Google Scholar
    • 4 GrayH. Anatomy of the human body. Philadelphia, Pa: Lea & Febiger, 1918; Bartleby.com, 2000. Available at: http://www.bartleby.com/107/. Accessed March 15, 2006. Google Scholar
    • 5 SaekiN, Sunami K, Kubota M, et al. Heavily T2-weighted MR imaging of white matter tracts in the hypothalamus: normal and pathologic demonstrations. AJNR Am J Neuroradiol2001; 22(8): 1468–1475. Medline, Google Scholar
    • 6 MillerMJ, Mark LP, Yetkin FZ, et al. Imaging white matter tracts and nuclei of the hypothalamus: an MR-anatomic comparative study. AJNR Am J Neuroradiol1994; 15: 117–121. Medline, Google Scholar
    • 7 SaperCB, Lowey AD, Swanson LW, Cowan WM. Direct hypothalamo-autonomic connections. Brain Res1976; 117: 305–312. Crossref, Medline, Google Scholar
    • 8 FujiiY, Nakayama N, Nakada T. High-resolution T2 reversed magnetic resonance imaging on a high magnetic field system. J Neurosurg1998; 89: 492–495. Crossref, Medline, Google Scholar
    • 9 MaghnieM, Bossi G, Klersy C, Cosi G, Genovese E, Arico M. Dynamic endocrine testing and magnetic resonance imaging in the long-term follow-up of childhood Langerhans cell histiocytosis. J Clin Endocrinol Metab1998; 83: 3089–3094. Crossref, Medline, Google Scholar
    • 10 IkushimaI, Korogi Y, Hirai T, et al. MR of epidermoids with a variety of pulse sequences. AJNR Am J Neuroradiol1997; 18(7): 1359–1363. Medline, Google Scholar
    • 11 FreemanJL, Coleman LT, Wellard RM, et al. MR imaging and spectroscopic study of epileptogenic hypothalamic hamartomas: analysis of 72 cases. AJNR Am J Neuroradiol2004; 25(3): 450–462. Medline, Google Scholar
    • 12 LawsER. Brain tumors affecting growth and development. In: Charles GD, Hindmarsh PC, eds. Clinical pediatric endocrinology. Boston, Mass: Blackwell, 2001; 253–258. Google Scholar
    • 13 IronsideJW. Best Practice No 172: pituitary gland pathology. J Clin Pathol2003; 56(8): 561–568. Crossref, Medline, Google Scholar
    • 14 WerderK. Pituitary-hypothalamic tumor syndromes: adults. In: Grossman A, ed. Neuroendocrinology, hypothalamus, and pituitary. Available at: http://www.endotext.org/neuroendo/neuroendo11b/neuroendoframe11b.htm. Accessed August 22, 2002. Google Scholar
    • 15 La RosaC, Stanhope R. Pituitary and hypothalamic tumor syndromes in childhood. In: Grossman A, ed. Neuroendocrinology, hypothalamus, and pituitary. Available at: http://www.endotext.org/neuroendo/index.htm. Accessed August 27, 2003. Google Scholar
    • 16 MolitchME. Hypothalamic and pituitary tumors: general principles. In: Grossman A, ed. Clinical endocrinology. Boston, Mass: Blackwell, 1998; 129–137. Google Scholar
    • 17 WassermanJR, Koenigsberg RA. Craniopharyngioma. Emedicine. Available at: http://www.emedicine.com/radio/topic196.htm. Accessed February 23, 2005. Google Scholar
    • 18 KolliasSS, Barkovich AJ, Edwards MS. Magnetic resonance analysis of suprasellar tumors of childhood. Pediatr Neurosurg1991–1992; 17: 284–303. Crossref, Medline, Google Scholar
    • 19 MoothaSL, Barkovich AJ, Grumbach MM, et al. Idiopathic hypothalamic diabetes insipidus, pituitary stalk thickening, and the occult intracranial germinoma in children and adolescents. J Clin Endocrinol Metab1997; 82(5): 1362–1367. Crossref, Medline, Google Scholar
    • 20 AritaK, Ikawa F, Kurisu K, et al. The relationship between magnetic resonance imaging findings and clinical manifestations of hypothalamic hamartoma. J Neurosurg1999; 91: 212–222. Crossref, Medline, Google Scholar
    • 21 BoykoOB, Curnes JT, Oakes WJ, Burger PC. Hamartomas of the tuber cinereum: CT, MR, and pathologic findings. AJNR Am J Neuroradiol1991; 12: 309–314. Medline, Google Scholar
    • 22 BarkovichAJ. Intracranial, orbital, and neck masses of childhood. In: Barkovich AJ, ed. Pediatric neuroimaging. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005; 573–603. Google Scholar
    • 23 FriedeRL. Osteolipomas of the tuber cinereum. Arch Pathol Lab Med1977; 101(7): 369–372. Medline, Google Scholar
    • 24 BognarL, Balint K, Bardoczy Z. Symptomatic osteolipoma of the tuber cinereum: case report. J Neurosurg2002; 96(2): 361–363. Crossref, Medline, Google Scholar
    • 25 WittigH, Kasper U, Warich-Kirches M, Dietzmann K, Roessner A. Hypothalamic osteolipoma: a case report. Gen Diagn Pathol1997; 142(5–6): 361–364. Medline, Google Scholar
    • 26 CaldarelliM, Massimi L, Kondageski C, Di Rocco C. Intracranial midline dermoid and epidermoid cysts in children. J Neurosurg2004; 100(5 suppl pediatrics): 473–480. Medline, Google Scholar
    • 27 LunardiP, Missori P. Supratentorial dermoid cysts. J Neurosurg1991; 75: 262–266. Crossref, Medline, Google Scholar
    • 28 FeldmanRP, Marcovici A, LaSala PA. Intracranial lipoma of the sylvian fissure: case report and review of the literature. J Neurosurg2001; 94(3): 515–519. Crossref, Medline, Google Scholar
    • 29 AprileI, Iaiza F, Lavaroni A, et al. Analysis of cystic intracranial lesions performed with fluid-attenuated inversion recovery MR imaging. AJNR Am J Neuroradiol1999; 20: 1259–1267. Medline, Google Scholar
    • 30 VoelkerJL, Campbell RL, Muller J. Clinical, radiographic, and pathological features of symptomatic Rathke’s cleft cysts. J Neurosurg1991; 74(4): 535–544. Crossref, Medline, Google Scholar
    • 31 WengerM, Simko M, Markwalder R, Taub E. An entirely suprasellar Rathke’s cleft cyst: case report and review of the literature. J Clin Neurosci2001; 8(6): 564–567. Crossref, Medline, Google Scholar
    • 32 NomikosP, Buchfelder M, Fahlbusch R. Intra-and suprasellar colloid cysts. Pituitary1999; 2(2): 123–126. Crossref, Medline, Google Scholar
    • 33 WagnerAL. Brain, colloid cyst. Emedicine. Available at: http://www.emedicine.com/radio/topic96.htm. Accessed February 15, 2005. Google Scholar
    • 34 AllenJC. Initial management of children with hypothalamic and thalamic tumors and the modifying role of neurofibromatosis-1. Pediatr Neurosurg2000; 32(3): 154–162. Crossref, Medline, Google Scholar
    • 35 ShuangshotiS, Kirsch E, Bannan P, Fabian VA. Ganglioglioma of the optic chiasm: case report and review of the literature. AJNR Am J Neuroradiol2000; 21(8): 1486–1489. Medline, Google Scholar
    • 36 LeeCC, Liu CH, Wei CP, How SW. Symptomatic granular cell tumor of the neurohypophysis. J Formos Med Assoc2004; 103(1): 58–62. Medline, Google Scholar
    • 37 Cohen-GadolAA, Pichelmann MA, Link MJ, et al. Granular cell tumor of the sellar and suprasellar region: clinicopathologic study of 11 cases and literature review. Mayo Clin Proc2003; 78(5): 567–573. Crossref, Medline, Google Scholar
    • 38 UlmAJ, Yachnis AT, Brat DJ, Rhoton AL Jr. Pituicytoma: report of two cases and clues regarding histogenesis. Neurosurgery2004; 54(3): 753–757. Crossref, Medline, Google Scholar
    • 39 TakeiH, Goodman JC, Tanaka S, Bhattacharjee MB, Bahrami A, Powell SZ. Pituicytoma incidentally found at autopsy. Pathol Int2005; 55(11): 745–749. Crossref, Medline, Google Scholar
    • 40 KowalskiRJ, Prayson RA, Mayberg MR. Pituicytoma. Ann Diagn Pathol2004; 8(5): 290–294. Crossref, Medline, Google Scholar
    • 41 ChenKT. Crush cytology of pituicytoma. Diagn Cytopathol2005; 33(4): 255–257. Crossref, Medline, Google Scholar
    • 42 ChoykePL, Glenn GM, Walther MM, Patronas NJ, Linehan WM, Zbar B. von Hippel–Lindau disease: genetic, clinical, and imaging features. Radiology1995; 194(3): 629–642. Link, Google Scholar
    • 43 ConwayJE, Chou D, Clatterbuck RE, et al. Hemangioblastomas of the central nervous system in von Hippel-Lindau syndrome and sporadic disease. Neurosurgery2001; 48(1): 55–62. Crossref, Medline, Google Scholar
    • 44 WasenkoJJ, Rodziewicz GS. Suprasellar hemangioblastoma in Von Hippel-Lindau disease: a case report. Clin Imaging2003; 27(1): 18–22. Crossref, Medline, Google Scholar
    • 45 PorterPJ, Willinsky RA, Harper W, Wallace MC. Cerebral cavernous malformations: natural history and prognosis after clinical deterioration with or without hemorrhage. J Neurosurg1997; 87(2): 190–197. Crossref, Medline, Google Scholar
    • 46 KurokawaY, Abiko S, Ikeda N, Ideguchi M, Okamura T. Surgical strategy for cavernous angioma in hypothalamus. J Clin Neurosci2001; 8(suppl 1): 106–108. Google Scholar
    • 47 JohnsenDE, Woodruff WW, Allen IS, Cera PJ, Funkhouser GR, Coleman LL. MR imaging of the sellar and juxtasellar regions. RadioGraphics1991; 11: 727–758. Link, Google Scholar
    • 48 SchubigerO, Haller D. Metastases to the pituitary-hypothalamic axis: an MR study of 7 symptomatic patients. Neuroradiology1992; 34: 131–134. Crossref, Medline, Google Scholar
    • 49 KastrupO, Wanke I, Maschke M. Neuroimaging of infections. NeuroRx2005; 2(2): 324–332. Crossref, Medline, Google Scholar
    • 50 IshikawaS, Aoki H, Akahane C, et al. Hypothalamic encephalitis with bradycardia. Intern Med2001; 40(8): 805–807. Crossref, Medline, Google Scholar
    • 51 GroisN, Prayer D, Prosch H, Lassmann H. CNS LCH Cooperative Group. Neuropathology of CNS disease in Langerhans cell histiocytosis. Brain2005; 128(4): 829–838. Crossref, Medline, Google Scholar
    • 52 PrayerD, Grois N, Prosch H, Gadner H, Barkovich AJ. MR imaging presentation of intracranial disease associated with Langerhans cell histiocytosis. AJNR Am J Neuroradiol2004; 25(5): 880–891. Medline, Google Scholar
    • 53 HoneggerJ, Fahlbusch R, Bornemann A, et al. Lymphocytic and granulomatous hypophysitis: experience with nine cases. Neurosurgery1997; 40: 713–723. Crossref, Medline, Google Scholar
    • 54 LukKH, Lam KS, Kung AW, Fung CF, Leung SY. Suprasellar ectopic pituitary adenoma presenting as cranial diabetes insipidus. Postgrad Med J1992; 68(800): 467–469. Crossref, Medline, Google Scholar
    • 55 Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 1999; 160(2): 736–755. Crossref, Medline, Google Scholar
    • 56 ManaJ. Magnetic resonance imaging and nuclear imaging in sarcoidosis. Curr Opin Pulm Med2002; 8(5): 457–463. Crossref, Medline, Google Scholar
    • 57 BakshiR, Fenstermaker RA, Bates VE, Ravichandran TP, Goodloe S Jr, Kinkel WR. Neurosarcoidosis presenting as a large suprasellar mass: magnetic resonance imaging findings. Clin Imaging1998; 22(5): 323–326. Crossref, Medline, Google Scholar
    • 58 HorvathE, Kovacs K, Smyth HS, et al. A novel type of pituitary adenoma: morphological features and clinical correlations. J Clin Endocrinol Metab1988; 66: 1111–1118. Crossref, Medline, Google Scholar
    • 59 PoussaintTY, Barnes PD, Anthony DC, Spack N, Scott RM, Tarbell NJ. Hemorrhagic pituitary adenomas of adolescence. AJNR Am J Neuroradiol1996; 17(10): 1907–1912. Medline, Google Scholar
    • 60 BonnevilleJF. Pituitary adenomas: value of MR imaging. J Radiol2000; 81(9): 939–942. Medline, Google Scholar
    • 61 UltmannMC, Seigel SF, Hirsch WL. Pituitary stalk and ectopic hyperintense T1 signal on magnetic resonance imaging. Am J Dis Child1993; 147: 647–652. Crossref, Medline, Google Scholar
    • 62 BonnevilleF, Cattin F, Marsot-Dupuch K, Dormont D, Bonneville JF, Chiras J. T1 signal hyperintensity in the sellar region: spectrum of findings. RadioGraphics2006; 26(1): 93–113. Link, Google Scholar
    • 63 LipscombeL, Asa S, Ezzat S. Management of lesions of the pituitary stalk and hypothalamus. Endocrinologist2003; 13(1): 38–51. Crossref, Google Scholar
    • 64 LegerJ, Velasquez A, Garel C, Hassan M, Czernichow P. Thickened pituitary stalk on magnetic resonance imaging in children with central diabetes insipidus. J Clin Endocrinol Metab1999; 84(6): 1954–1960. Crossref, Medline, Google Scholar
    • 65 LeeBC, Deck MD. Sellar and juxtasellar lesion detection with MR. Radiology1985; 157(1): 143–147. Link, Google Scholar
    • 66 LiangL, Korogi Y, Sugahara T, et al. Dynamic MR imaging of neurohypophyseal germ cell tumors for differential diagnosis of infundibular diseases. Acta Radiol2000; 41(6): 562–566. Crossref, Medline, Google Scholar
    • 67 HuaF, Asato R, Miki Y, et al. Differentiation of suprasellar nonneoplastic cysts from cystic neoplasms by Gd-DTPA MRI. J Comput Assist Tomogr1992; 16(5): 744–749. Crossref, Medline, Google Scholar
    • 68 SuttonLN, Wang ZJ, Wehrli SL, et al. Proton spectroscopy of suprasellar tumors in pediatric patients. Neurosurgery1997; 41(2): 388–394. Crossref, Medline, Google Scholar
    • 69 KendiTK, Caglar S, Huvaj S, Bademci G, Kendi M, Alparslan S. Suprasellar germ cell tumor with subarachnoid seeding MRI and MR spectroscopy findings. Clin Imaging2004; 28(6): 404–407. Crossref, Medline, Google Scholar

    Article History

    Published in print: July 2007