Comparison of MRI findings of hypothalamic-optic chiasmatic gliomas and craniopharyngiomas

• DOI: 10.1177/02841851241241527
• Publication Date: 2024-04-13T09:09:45Z
• Authors: Ahmet Kursat Karaman; Kerime Hatun Özgen; Bora Korkmazer; Rauf Hamid; Hatice Kübra Yıld...; Rahşan Kemerdere; Nil Çomunoğlu; Necmettin Tanrıöver; Serdar Arslan; Osman Kızılkılıç
• Keywords: Male; Adult; Adolescent; Contrast Media; Glioma; Middle Aged; Magnetic Resonance Imaging; Diagnosis, Differential; Craniopharyngioma; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Optic Chiasm; Child, Preschool; Humans; Female; Pituitary Neoplasms; Hypothalamic Neoplasms; Child; Retrospective Studies; Aged

Background Differential diagnosis of hypothalamic-optic chiasmatic gliomas (HOCGs) and craniopharyngiomas on magnetic resonance imaging (MRI) can be quite challenging. Purpose To compare the MRI features of HOCGs and cranipharyngiomas. Material and Methods Patients diagnosed with HOCG or craniopharyngioma in histopathological evaluation between 2012 and 2022 and who underwent preoperative contrast-enhanced brain MRI were included. Various MRI features were retrospectively evaluated for each lesion: T2-weighted imaging and fluid attenuation inversion recovery hyperintensity, calcification, cystic change, T1-weighted (T1W) imaging hyperintensity of the cystic component, hemorrhage, involvement of sellar, suprasellar or other adjacent structures, lobulated appearance, presence of hydrocephalus, and contrast enhancement pattern. Apparent diffusion coefficient (ADC) values were also evaluated and compared. Results Among 38 patients included, 13 (34%) had HOCG and 25 (66%) had craniopharyngioma. Craniopharyngiomas had a significantly higher rate of cystic changes, calcification, and T1W imaging hyperintensity of the cystic component than HOCGs ( P <0.05). Of HOCGs, 92% had chiasm involvement, 23% had optic nerve involvement, and 31% had brain stem involvement. On the other hand, chiasm involvement was observed in 8% of craniopharyngiomas, but none had optic nerve and/or brain stem involvement ( P <0.05). While 62% (8/13) of HOCGs had diffuse homogeneous enhancement, 80% (20/25) of craniopharyngiomas had a diffuse heterogeneous enhancement pattern. Mean ADC values were significantly higher in craniopharyngiomas compared to HOCGs (2.1 vs. 1.6 ×10−3mm2/s, P <0.05). Conclusion Although some neuroimaging findings may overlap, features such as presence of cyst and calcification, brain stem and optic pathway involvement, different enhancement patterns, and ADC values may be helpful in the differential diagnosis of HOCGs and craniopharyngiomas.