Karaalioğlu Banu, Öksüz Nazlı Çakıcı, İpek Veyselkarani, Çakır Aslı, Kahraman Osman, Özbek Muhammet Arif
Department of Radiology, İstanbul Medipol University Hospital, TEM Avrupa Otoyolu, Göztepe Çıkışı No:1, 34214, Bağcılar, Istanbul, Turkey.
Department of Neurosurgery, İstanbul University of Health and Technology, Istanbul, Turkey.
Childs Nerv Syst. 2025 Sep 16;41(1):281. doi: 10.1007/s00381-025-06941-y.
Craniopharyngiomas (CP) present with both solid and cystic structures in magnetic resonance imaging (MRI) studies. Contrary to MRI appearance, components described as cysts are not infrequently found as non-fluent structures during surgery. This study aims to address the discrepancy between radiology and surgery regarding the nature of these lesions and to evaluate them for their preoperative predictability.
Preoperative MRI images of 24 CP patients were analyzed. The cystic components of the tumors were assessed in terms of quantitative and qualitative signal properties and contrast enhancement on conventional pulse sequences, and analyzed based on their macroscopic appearances.
Thirteen of 31 lesions (42%) that suggested cyst on MRI were solid during surgery, with none showing contrast uptake. MRI demonstrated 100% sensitivity and negative predictive value (NPV), 71.7% specificity, and 58% positive predictive value (PPV) in identifying true cysts. Most lesions resembling cysts were hyperintense on FLAIR and T1WI and isointense on ADC maps, suggesting high protein content. However, surgically confirmed fluid-filled cysts exhibited similar signal characteristics in a comparable proportion. The only significant imaging indicator was a hypointense appearance on T2WI, with a mean intensity ratio close to that of the basal ganglia.
Accurate identification of solid and cystic components in craniopharyngiomas is critical for effective treatment planning. Although MRI is traditionally considered reliable for this purpose, 42% of lesions that appeared cystic without contrast enhancement were ultimately confirmed as non-fluid or solid during surgery. This study was unable to establish definitive MRI characteristics to reliably differentiate between cystic and solid components. Further research with larger cohorts is warranted to validate potential imaging markers and improve diagnostic accuracy.
颅咽管瘤（CP）在磁共振成像（MRI）研究中呈现出实性和囊性结构。与MRI表现相反，在手术中被描述为囊肿的成分常常被发现为非液性结构。本研究旨在解决放射学和手术学在这些病变性质方面的差异，并评估其术前可预测性。
分析24例CP患者的术前MRI图像。根据常规脉冲序列上的定量和定性信号特性及对比增强情况评估肿瘤的囊性成分，并基于其宏观外观进行分析。
在MRI上提示为囊肿的31个病变中，有13个（42%）在手术中为实性，均未显示对比剂摄取。MRI在识别真正囊肿方面显示出100%的敏感性和阴性预测值（NPV）、71.7%的特异性以及58%的阳性预测值（PPV）。大多数类似囊肿的病变在液体衰减反转恢复序列（FLAIR）和T1加权成像（T1WI）上呈高信号，在表观扩散系数（ADC）图上呈等信号，提示高蛋白含量。然而，手术证实的液性囊肿在相当比例中也表现出类似的信号特征。唯一显著的影像学指标是在T2加权成像（T2WI）上呈低信号，平均强度比接近基底节。
准确识别颅咽管瘤中的实性和囊性成分对于有效的治疗计划至关重要。尽管传统上认为MRI在此方面可靠，但在手术中，42%无对比剂增强而表现为囊性的病变最终被证实为非液性或实性。本研究未能确定可靠区分囊性和实性成分的明确MRI特征。有必要进行更大样本量的进一步研究以验证潜在的影像学标志物并提高诊断准确性。
