Matsushita Shu, Shimono Taro, Maeda Hiroyuki, Tsukamoto Taro, Horiuchi Daisuke, Oura Tatsushi, Ishibashi Kenichi, Takita Hirotaka, Tatekawa Hiroyuki, Atsukawa Natsuko, Goto Takeo, Miki Yukio
Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
Department of Neurosurgery, Osaka City General Hospital, 2-13-22, Miyakojima-Honndori, Miyakojima-ku, Osaka, 534-0021, Japan.
Jpn J Radiol. 2025 Jan;43(1):32-42. doi: 10.1007/s11604-024-01641-0. Epub 2024 Aug 20.
Rathke cleft cysts are commonly encountered sellar lesions, and their inflammation induces symptoms and recurrence. Cyst wall enhancement is related to inflammation; however, its range and frequency have not yet been investigated. This study aimed to investigate the clinical and radiological differences between inflammatory and non-inflammatory Rathke cleft cysts.
Forty-one patients who underwent cyst decompression surgery for Rathke's cleft cysts between January 2008 and July 2022 were retrospectively analyzed. Based on the pathological reports, patients were divided into inflammatory and non-inflammatory groups. Clinical assessments, endocrinological evaluations, cyst content analysis, and imaging metrics (mean computed tomographic value, maximum diameter, mean apparent diffusion coefficient [ADC] value, and qualitative features) were analyzed. Receiver operating characteristic curve analysis was performed, to determine ADC cutoff values, for differentiating inflammatory group from non-inflammatory group.
Totally, 21 and 20 cases were categorized into the inflammatory and non-inflammatory groups, respectively. The inflammatory group displayed a higher incidence of central diabetes insipidus (arginine vasopressin deficiency) (p = 0.04), turbid cyst content (p = 0.03), significantly lower mean ADC values (p = 0.04), and more extensive circumferential wall enhancement on magnetic resonance imaging (MRI) (p < 0.001). In the inflammatory group, all cases revealed circumferential wall enhancement, with some exhibiting thick wall enhancement. There were no significant differences in other radiological features. The ADC cutoff value for differentiating the two groups was 1.57 × 10 mm/s, showing a sensitivity of 81.3% and specificity of 66.7% CONCLUSION: Inflammatory Rathke cleft cysts tended to show a higher incidence of central diabetes insipidus and turbid cyst content. Radiologically, they exhibited lower mean ADC values and greater circumferential wall enhancement on MRI.
拉克氏裂囊肿是常见的鞍区病变，其炎症可引发症状及复发。囊肿壁强化与炎症相关，但其范围和频率尚未得到研究。本研究旨在探讨炎性和非炎性拉克氏裂囊肿的临床及影像学差异。
回顾性分析2008年1月至2022年7月间因拉克氏裂囊肿接受囊肿减压手术的41例患者。根据病理报告，将患者分为炎性组和非炎性组。分析临床评估、内分泌学评价、囊肿内容物分析及影像学指标（平均计算机断层扫描值、最大直径、平均表观扩散系数[ADC]值及定性特征）。进行受试者操作特征曲线分析，以确定区分炎性组和非炎性组的ADC临界值。
炎性组和非炎性组分别有21例和20例。炎性组中枢性尿崩症（精氨酸加压素缺乏）发生率更高（p = 0.04），囊肿内容物浑浊（p = 0.03），平均ADC值显著更低（p = 0.04），且在磁共振成像（MRI）上囊肿壁环形强化更广泛（p < 0.001）。在炎性组中，所有病例均显示囊肿壁环形强化，部分病例表现为厚壁强化。其他影像学特征无显著差异。区分两组的ADC临界值为1.57×10⁻³mm²/s，敏感性为81.3%，特异性为66.7%。结论：炎性拉克氏裂囊肿往往中枢性尿崩症发生率更高，囊肿内容物更浑浊。在影像学上，它们在MRI上表现出更低的平均ADC值和更广泛的囊肿壁环形强化。
