 Hello, everyone. I'm Dr. Sneha Santoshrati and my topic of presentation is Multiplanar and Dynamic Contrast Enhanced MRI Evaluation of Mixed Cystic and Solid Cellar Masses. AIMS and Introduction. AIM is to re-emphasize and evaluate MRI findings in mixed cystic and solid cellar mass by Dynamic Contrast Enhanced Study. The cellar region is one of the most anatomically complex areas in the brain. It encompasses the bony cellar tersica and pituitary gland plus all the normal structures that surround it. Advances and imaging techniques have enabled visualization of vital neural and vascular structures involving the cellar region. Computed tomography is useful in delineation of the oasis margin of the cellar. It is particularly helpful in evaluating the bone changes related to pathologic processes. MRI provides detailed information about the contents of the cellar and paracella regions. It is a fundamental pre-operative and post-operative imaging modality. Multiplanar capability and superior tissue contrast differentiation render magnetic resonance, imaging the preferred method for examining patients with pituitary axis dysfunction. Methods. This was a retrospective study conducted at MGM Hospital, Navi, Mumbai over a span of one year. Sample size was of 70 patients. Symptomatic patients having hyperprolactin and hyperganadism and known cases of pituitary masses were subjected to MRI evaluation by using Toshiba 1.5 Tesla scanner and following sequences with small FOV targeting the cellar we're taking. T1 small FOV coronal and sagittal sequence. T2 coronal axial and sagittal sequence. T1 contrast dynamic and delayed contrast. Diffusion weighted imaging, ADC flare axial results out of the 70 suspected cases for pituitary mass. The following table shows the number of cases and the type. So solid enhancing pituitary region mass around 10 cases were seen. Mixed and cystic and solid pituitary region mass around 35 cases were seen. Cystic pituitary region mass 5 cases were seen. Purely in bracella pituitary mass 5 cases were seen. Pituitary region mass with intrinsic high T1 signal intensity 10 cases were seen and normal were around 5. So out of these 70 cases 35 cases showed mixed cystic and solid pituitary region mass. Pituitary macro adenoma were of sample size was around 20. Pituitary micro adenoma around 5. Plano pharyngeoma around 10. In our study we reviewed the imaging findings of mixed cystic and solid pituitary region mass. On MRI imaging first pituitary macro adenoma on T1 sequence typically iso intense to gray matter larger regions are often heterogeneous and varying signal due to area of cystic change necrosis and hemorrhage. On T2 flare sequence on T2 weighted imaging typically iso intense to gray matter larger regions are often heterogeneous and varying signal due to areas of cystic change necrosis hemorrhage. Hyper signal intensity can be seen along optic pathways on T2 flare in which macro adenomas compress the optic nerve. T1 on T1 contrast dynamic and delayed solid components demonstrate moderate to bright enhancement subtle neural tail is noted. On diffusion weighted ADC and GRE imaging hemorrhagic adenomas bloom on GRE. So on extension or involvement pituitary adenomas greater than 10 mm in size. Superiorly optic nerve compression laterally K1 is sign is invasion and inferiorly invades cell atusica. Following are the images of pituitary macro adenoma, T1 contrast coronal, sagittal image and T2 axial. The second is cranio pharyngeoma adenomatous type. T1 sequence signal intensity varies with cyst content. Cystic component is hypo to hypersingle intense compared with brain. T2 flare sequence is a variable hypersingle intense on T2 flare. Solid nodule is often calcified and moderately hypo intense. Hyper intensity extending along the optic tracks is common and is due to edema not tumor invasion. T1 contrast dynamic and delayed cyst walls and solid nodules typically enhance following contrast administration. Calcification if present shows blooming on GRE. So these are the images of cranio pharyngeoma coronal T2 flare axial T1 contrast coronal pituitary mass pituitary micro adenoma on T1 sequence usually iso intense to normal pituitary T2 flare sequence variable but often are a little hyper intense. T1 contrast dynamic and delayed post contrast and especially thin section dynamic contrast enhance imaging is an important part of a pituitary MRI and has significantly improved diagnostic accuracy. Dynamic sequences demonstrated around the region of delayed enhancement compared to the rest of the gland. Delayed images are variable ranging from hyper enhancement most common to iso intense to the rest of the gland to hyper intense retained contrast involvement and extension a microdenoma is less than 10 mm in size. Vulcaness of the gland on the side on the side of the micro adenoma subtle remodeling of the floor of the cellar and deviation of the pituitary infundability away from the adenoma. Following are the images of pituitary micro adenoma T1 post contrast sagittal coronal and T2 axial the cushion anatomy in the sagittal plane the cellar tosica is a midline shallow depression in the posterior spinae bone that contains the pituitary gland. The floor of the cellar tosica is variable in appearance depending largely on the degree of aeration of the underlying spinae sinus. The cortical bone and AFL sinus may merge imperceptibly on MR images the dorsal most aspect of the spinae bone descends to from the clivis the roof of the cellar tosica is formed by neural reflection the diaphragm cell this thin membrane is inconsistently visualized on MR images but is best seen on long tia short t-emages the two lobes of the pituitary gland are embryologically physiologically and anatomically distinct the adenohypophysis is iso intense relative to gray matter on T1 weighted images the neurosecretary material in neurohypophysis produces the high senile intensity evident on most even weighted images with normal findings adenomas are often classified by size microdenomas are 10 mm or less in diameter and macrodenomas are greater than 10 mm in diameter pituitary macrodenoma originate within the pituitary gland and result in expansion of the cellar they are soft tumors with a propensity to erode bone and typically showed mild heterogeneous enhancement density significant density and enhancement features are not distinctive but cellar enlargement and erosion cavernous sinus in region and liberated margins are reliable indicators of an adenoma most commonly such tumors extend the cephala toward the optic plasma and hypothalamus or laterally into the cavernous sinus pituitary macrodenomas can expand the cellar and extend into the supracella region they may also show hemorrhagic or protonaceous cystic changes with even hyper intensity mimicking craniopharyngeomas but they rarely classify the solid portions typically enhance uniformly whereas the necrotic cystic or hemorrhagic portions do not macrodenomas can expand laterally and invade the cavernous sinus when hemorrhage or apoplexy occurs in supracella adenomas susceptibility weighted sequences are helpful to identify blood products which can be markedly hyper influenced on T2 weighted images pituitary apoplexy is an emergency that can result in permanent visual loss if not immediately addressed craniopharyngeomas are benign epithelial tumors known to arise from squamous breasts along the remnants of hyperfysal rathic duct they are most commonly supracella in location that can also be mixed intra supracella or rarely purely intra cellar wearing locations occur because they can arise anywhere along the pituitary stroke from the third ventricle to the pituitary gland a small number of craniopharyngeomas can be ectopic located in the third ventricle nasopharyngeal spinite sinus giant craniopharyngeomas are known to extend into anterior middle or posterior craniophosa craniopharyngeoma is the most common non-glial pediatric intra cranial tumor and comprises over half of all pediatric supracella tumors the peak incidence is between 10 to 14 years of age with second peak in the fourth to sixth decade the most common symptoms at presentation are headache visual field effects or anterior pituitary dysfunction craniopharyngeoma vary in size with larger tumors being predominantly cystic and complex with a multilubilated appearance nearly 90 percent of the adventuromatous variant of craniopharyngeoma have calcification in cysts and demonstrate enhancement of the wall or solid portions which are distinguishing imaging features the cystic areas can be of varying signal intensity on t1 weighted images depending on the protein of protein or cholesterol content the solid portion can also be heterogeneous and t1 and t2 sequences the detection of pituitary micro adenomas on mr images strongly depends on the image contrast between the micro adenoma and normal pituitary tissue contrast enhance mr imaging has been extensively used to improve image contrast and hence improve the detection of micro adenomas post contrast and especially thin section dynamic contrast enhance imaging is an important part of a pituitary mr right and has significantly improved diagnostic accuracy dynamic sequence demonstrated around the region of delayed enhancement compared to the rest of the gland delayed images are variable ranging from hyper enhancement to iso intense to the rest of the gland to hyper intense retained contrast conclusion we assess the mr imaging characteristic of 70 pathologically or clinically proved cell allegiance adenoma and craniopharyngeoma constituted major legions in our series the mr imaging characteristics of the most common legions are sufficiently distinct to allow them to be differentiated from each other and from most other entities other characteristics such as extra cell versus intracellar location nature of contrast material enhancement the presence of cystic components and clinical findings permit further differentiation among the various other abnormalities the superior resolution and multiple planar capacity of mr imaging best depicts the extent of cellar and juxtasella legions these are my references thank you