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Case Studies | Radiology and Medical Imaging Sciences | India | Volume 14 Issue 4, April 2025 | Rating: 5.1 / 10
Role of Magnetic Resonance Imaging in Evaluation of Sellar and Parasellar Lesions
Dr. Shashi Prakash Verma, Dr. Jagruti Sutaria, Dr Anjana Trivedi
Abstract: Introduction: The sellar and parasellar region is a complex anatomical area that represents a crucial crossroad of important adjacent structures, e.g. orbits, cavernous sinus and its content, suprasellar cistern and its contents, circle of Willis, hypothalamus through the pituitary stalk and dural reflections forming the diaphragm sellae and the walls of the cavernous sinuses. The cavernous sinus represents the most relevant parasellar structure; however, from the practical and clinical point of view, all the structures that surround the sella turcica can be included in the parasellar region. Various types of tumours, cysts, vascular lesions, inflammatory processes, infections and congenital lesions are found in and around the sella. The clinical presentation of the sellar and parasellar lesions is also very variable. Pituitary axis dysfunction, visual field defects, hydrocephalus, intracranial mass effect and other neurologic deficits are some of the most common features. MRI is now accepted as the imaging procedure of choice in the evaluation of sellar and parasellar pathology. Use of I.V. gadolinium is very helpful in defining sellar and parasellar pathologies. The advent of dynamic contrast study has proved very useful in the detection of pituitary microadenoma. Aims & Objectives: To study the characteristics of various pathologies of the sellar and parasellar region on MRI. To differentiate between the imaging characteristics of benign and malignant lesions of the sellar and parasellar region. Materials and Methods: Study design: An observational prospective study. Study period: October 2023 to March 2025. Subject selection: The Study included 50 patients from the inpatient and outpatient department, having clinical features raising suspicion of sellar and parasellar lesions and also the patients who have been diagnosed as having sellar and parasellar lesions on CT SCAN and need further evaluation with MRI. Results: Although a number of pathologies occur in the sellar and parasellar region, the 4 major groups cover almost 3/4th of the total pathologies in this region. Our study has shown that the pituitary adenoma is the most common lesion in the sellar region. The largest age group was the 3rd and 4th decades, with a slight female predominance. Craniopharyngioma most frequently occur in children and young adults. Headache and visual problems were the most common chief complaints. MRI is highly sensitive in detecting tissue extension and involvement, clearly showing sphenoid sinus extension, clivus involvement, ICA encasement, cavernous sinus invasion, intracranial infiltration, and distinguishing dural infiltration from brain parenchyma involvement, especially on post-contrast studies. Conclusion: With my study I was able to conclude that the MRI is the modality of choice for evaluating sellar and parasellar lesions due to its high sensitivity and accuracy in identifying lesion characteristics, extent, and involvement of surrounding structures with and added advantage of excellent soft tissue contrast, multiplanner imaging and not exposing patients to ionizing radiation. In my study, I found that the advanced MRI sequences, like Diffusion Weighted Imaging (DWI), dynamic post-contrast sequences, along with the routine conventional MRI sequences (T1, T2 and FLAIR), have significantly enhanced the diagnostic accuracy.
Keywords: Pituitary, Sellar, Parasellar, Pituitary Macroadenoma, Meningioma, Craniopharyngioma, Cavernous Sinus
Edition: Volume 14 Issue 4, April 2025,
Pages: 1924 - 1934