 Hello everyone, I am Putsavi Modi, first-year resident at D.Y. Patil Hospital, Kulapur. I would like to thank IRIA for giving me this opportunity to present at 21st MRI conference. I would also like to thank my mentor, Dr. Niranjan Patil Sir, who is a professor and Pramod Nagore Sir, who is senior resident in the Department of Radio Diagnosis at D.Y. Patil Hospital, Kulapur. My topic is cellar and supracelar masses mastering the master gland. So, we'll start with the introduction. The cellar, the supracelar space, contains a vast area of pathologies, including the neoplastic, congenital, vascular, inflammatory and infectious etiologies. It usually presents as a combination of headache, eye pain, ophthalmoplegia, usual field defects, cranial neuropathy and endocrine manifestations. So, first, what we have to do is identify the pituitary gland and the cellar tersica and determine the epicenter of the lesion, whether it is above, below or towards the lateral to the cellar. Analyze the lesion, whether the lesion shows signals, whether it is cystic, solid, showing flow voids or calcifications and then give the differential diagnosis. So, there's some common cellar and supracelar masses. We have divided into three, that is congenital, neoplasms and miscellaneous. The congenital, pituitary anomalies, that is, maybe hypoplasm, duplication, hypothalamic hematomone and rathclis cleft cyst. Under neoplasms, we will see pituitary edinoma, craniopharyngeoma and venangeoma and miscellaneous hypofysitis, a pituitary hyperplasium and internal carotid artery and uresins. So now, we'll start with the cellar and the supracelar masses individually. The pituitary micro edinoma, these are defined as tumors which are less than 10 mm in diameter. The intracelar mass is typical location and dynamic contrast enhanced T1 weighted MRI is the best technique. The tumor enhances slowly than the adjacent normal pituitary. In this case, there's a sequential coronant dynamic contrast enhanced T1 weighted images of the pituitary shows a small lesion with delayed enhancement compared to the background pituitary. The pituitary macro edinoma, these are defined as tumors more than 10 mm in diameter. They commonly extend upwards and appear as supracelar mass and usually shows the snowman appearance is due to the narrowing at the level of the diaphragm cellar. Now in this case, we have taken the sagittal T2 weighted images and the post-contrast T1 weighted images which shows a large homogeneously enhancing mass replacing the pituitary gland and a small T2 hyper intense foci noted within the mass and these are suggestive of cystic degeneration. The extension of the mass is in the left cavernous sinus encasement of the left internal carotid artery which is demonstrated over here. The next, the Rathke's cleft cyst. This is a non-neoplastic cyst arising from remnants of embryonic Rathke cleft and the signal intensity varies according to the cyst contained. In this case, on the T1 weighted images, we can see a round intracellar lesion which is hyper intense on T1 and hyper intense on T2 with no obvious enhancement on the post-contrast T1 weighted images. The meningioma, meningiomas in the cellar and paraselar region may arise from any point along the dural skull base including the tuberculum cellar, flannum, spinoid allele and anterior or clinoid processes, the spinoid wing, cavernous sinuses and petroclival region, the diaphragmatic cellar or the clevis. The height attenuation of the lesion on the plain CT enhancing the dural tail and the epicenter of the lesion in the supracellar region are the clinching points. In our case, on the axial T1 weighted images on the sagittal and the post-contrast T1 weighted images reveal a large lesion in the cellar region extending into the right paraselar region along the spinoid on the axial and the coronal post-contrast T1 weighted images shows a lesion to enhance avid leave with a linear dural enhancement along the spinoid sinus. Then the cranioferringioma, this is a benign tumor derived from the radcae pouch epithelium. There are two types, the adenomanto-matis cystic mass in the children and the papillary which is a solid mass in adults. The signal intensity of cystic component varies according to the content. So in this case, we have a well-nobulated lesion which is iso-intense on the T1 weighted images and in the T2 weighted images, we can see the fluid-fluid level in the supracellar region and the normal pituitary gland is compromised posteriorly by the lesion. Then on the post-contrast images, the lesion demonstrates subtle peripheral enhancement. Here we can see the subtle peripheral enhancement. Then the internal carotid artery aneurysm. Aneurysm of the intracavernous segment of the internal carotid artery can mimic pituitary lesion clinically as well as radiologically. So the off midline location of the lesion on plain CT should raise the suspicious of a pathology other than the primary pituitary lesion. In this case, on the coronal reformation of the CT angiography of the brain, reveals a sacular aneurysm in the right cavernous internal carotid artery and the anterior communicating artery aneurysm in the parascellar and the supracellar locations respectively. Then the lymphocytic hypophysitis. This is the idiopathic inflammation of the pituitary gland or stalk. The sagittal T1 weighted images and the coronal T2 weighted images shows enlarged thickened pituitary stalk with the loss of normal tapering. And on the post-contrast T1 weighted images, the gland stalk shows the avid enhancement. The pituitary duplication with teratoma, very rare developmental anomaly, it is usually associated with other anomalies. On the coronal and the sagittal T1 weighted images reveals a duplication of the pituitary gland with the solitary stalk and multiple T1 hyper intense areas of fat with interspaced dark areas of calcification. This is seen just beneath the gland and this is suggestive of a teratoma. The mass is seen invading into the spinoid sinus. The hypothalamic hamartoma, it is also known as tuber-sinarium hamartomas which is located between the mammillary body and the optic chasm. In this, the actual T2 weighted image, there is a hyper intense lesion predominantly on the right side in the supracelar system where there is a compression of the pons, the sagittal directly. And in the sagittal, they are directly arising from the hypothalamic area in the pre-pontine system and the supracelar system extending into the intrepidicular system comprising the pons. And then the coronal, the lesion is aberting and there is minimal displacement. The hypothalamic glioma, the gliomas of the hypothalamus and optic chasm account for 10-15% of the supratentorial tumours of the children. Large lesions are heterogeneous whereas the smaller ones tend to be homogenous. In this figure, the T1 weighted image shows a bulky hypothalamus which is iso intense to grey matter and in the post-contrast images are well-defined homogeneously enhancing lesions in the hypothalamus. Well-defined homogeneously lesions in the hypothalamus we can see. The hypothalamic tuberculosis, the infections of the hypothalamus particularly access is rare. Tuberculosis hypofisitis or supracelar tuberculomas are rare manifestations of the CNS tuberculosis. Usually occurs as an extension of tuberculosis meningitis. So in this case, in our coronal, T1 weighted image shows a thickened tuber sinadium and on post-contrast T1 weighted images reveals an avid enhancement of the hypothalamus. Then the optic nerve sheet, dural ectasy. It refers to the sacular dilatation of the optic nerve sheet and it is most commonly associated with neurofibromatosis type 1. In this figure are the sagittal T2 weighted images and the actual T1 weighted images of the brain of the child reveals a cystic dilatation of the dural sheet around the intracranial optic nerve, cystic dilatation of intracranial optic nerve on the right side and this is presenting as a cellar lesions. Now, the conclusion. So again, in order to analyze a cellar or paracelar masses on MRI we use the following anatomic approach. First, what we have to do is identify the pituitary gland and the cellar tersica. Then, determine the epicenter of the lesion and whether it is in the cellar or above, below or lateral to the cellar. If it is in the cellar, determine whether or not the cellar is enlarged. Once the location of the mass is clear, the signal intensity patterns is the lesion cystic or solid and does it contain any abnormal vessels? Are there any calcifications and so on and finally established a differential diagnosis? Here are my references for the study of the cellar and the supra cellar masses. Thank you everyone.