Imaging of Craniopharyngiomas and Radiologic Differential Diagnosis

Abstract Craniopharyngiomas have the most heterogeneous radiologic appearance of any suprasellar neoplasm. Two distinct pathologic types exist (adamantinomatous and papillary). Although a suprasellar location is most common, these neoplasms can also arise primarily in the sella; rarely, they can arise in unusual locations such as the third ventricle or nasopharynx. Since the suprasellar cistern is home to a large number of other neoplasms, as well as developmental, vascular, and inflammatory lesions, the multitude of potential appearances of craniopharyngioma can offer a formidable challenge in arriving at the correct diagnosis. In particular, the radiologic characteristics of Rathke cleft cyst can overlap that of adamantinomatous craniopharyngioma. Fortunately, knowledge of the appearances of craniopharyngiomas on radiologic studies, along with the complementary roles played by CT and MR imaging in the evaluation of intrasellar and suprasellar lesions, enable the interpreting physician to arrive at an accurate and relatively short differential diagnosis in most cases.