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Sharifi G, Amin Darozzarbi AA, Paraandavaji E, Lotfinia M, Kazemi MA, Hajikarimloo B, Jafari A, Mohammadi E, Davoudi Z, Akbari Dilmaghani N. Vertical triband flag sign for differential diagnosis of Rathke's cleft cyst. World Neurosurg X 2024; 21:100260. [PMID: 38187505 PMCID: PMC10770743 DOI: 10.1016/j.wnsx.2023.100260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/30/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Abstract
Background The Rathke cleft cyst (RCC) is a type of cystic growth that is benign, circular, and well-defined with an incidence rate of 4 %. This study aims to identify a useful diagnostic imaging sign that can aid in the differentiation of RCC from other cystic lesions. Methods We retrospectively analyzed the records of 42 symptomatic RCC patients who were referred to our facility between 2016 and 2023. The data for the study were obtained from our electronic database. All magnetic resonance imaging (MRI) studies were performed using a 1.5-T superconducting magnetic scanner. All patients underwent endonasal transsphenoidal surgical resection. All MRIs were reviewed and evaluated by a neurosurgeon and a neuroradiologist. Results There were 8 (19 %) males and 34 (81 %) females with a mean age of 37.2-years. Our study identified a distinct imaging characteristic in 38 of the cases, which we have named the "vertical triband flag sign", due to the growth of the cyst developing a specific appearance. The flag sign was mostly observed only in the T1-images (71.5 %), while in four cases the sign was spotted only in T2-images, and in four cases it appeared in both T1 and T2. In 4 cases, the flag sign was not observed in which further investigations revealed that these cases were suprasellar or small sellar RCCs. The dot sign, which is a characteristic finding in RCCs was only observed in one of our cases. Conclusion Early diagnosis of RCCs may be facilitated by utilizing the vertical triband flag sign.
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Affiliation(s)
- Guive Sharifi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Arsalan Amin Darozzarbi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Paraandavaji
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmoud Lotfinia
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Medical Center Saarbruecken, Saarland, Germany
| | - Mohammad Ali Kazemi
- Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Bardia Hajikarimloo
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Jafari
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma, USA
| | - Zahra Davoudi
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Endocrinology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nader Akbari Dilmaghani
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Otolaryngology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zhang L, Li X, Li C, Wang Z, Zheng L, Qin G, Wang S, Xu L. Analysis of the Clinical Characteristics and Pituitary Function of Patients in Central China With Rathke's Cleft Cysts. Front Endocrinol (Lausanne) 2022; 13:800135. [PMID: 35295993 PMCID: PMC8919671 DOI: 10.3389/fendo.2022.800135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/18/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE A Rathke's cleft cyst (RCC) is a common, benign, cystic disease that often leads to hypophyseal dysfunction or head symptoms. The relationship between RCCs and pituitary gland function is not clear. We therefore carried out a study to examine this relationship in greater detail. METHODS The study was a retrospective, cohort design in patients diagnosed with a RCC between January 2019 to July 2021 at the First Affiliated Hospital of Zhengzhou University, China. RESULTS A total of 221 patients were enrolled and then divided into study cohorts according to the diameter of the RCC, clinical manifestations, and surgical treatment received. The majority of patients were symptomatic (143/221), including 83 cases of dizziness and headache, 9 of vision loss and visual field defect, and 2 of diabetes insipidus. 52 cases had abnormal pituitary function, with 8 cases interestingly showing high adrenocorticotropic-hormone (ACTH) and cortisone levels, while 8 juvenile cases had developed central precocious puberty. Patients with larger RCCs were more likely to present with headaches and dizziness, with subjects who suffered from these symptoms having high ACTH and cortisone levels. CONCLUSION Although the size of a RCC is not an important factor influencing hypopituitary function, we consider that endocrine evaluation should be carried out in all patients with a RCC.
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