Expert: Claes-Gustaf Nordquist, M.D. - 9/5/2009

Question
Hi. I just had an MRI for a possible tumor related to Cushing's Disease. I will be going to a neurologist in a week, but until then I would like to ask what this could mean.

This is what the report says: (sorry for any misspellings.)

Technique: Routine mulitplanar sequences of the head and pituitary foassa were acquired without and with IV contrast.

Findings: Cerebral, brainstem and cerebellar morphology and signal intensity within the field of imaging are normal. The adenohypophysis of the pituitary gland is uniform in signal intensity and normal in size. There is no significant pituitary infundibular deviation. There is uniform enhancement of the cavernous sinus on both sides. There is a well-circumscribed 4 mm in AP dimension by 4 mm in transverse dimension by 6 mm in superior to inferior dimension of focus of T1 and T2 prolongation posterior to the adenohypophysis within the pituitary sella most consistent with a pars intermedia cyst or a pars intermedia cleft. There is a subtle 2 mm focus of relative decreased signal intensity within the neurohypophisis of the pituitary gland which is nonspecific in its imagine features. The flow voids of both internal carotid arteries are intact. The adjacent paranasal sinuses are clear.

Impression:

1. No definite pituitary adenoma is identified.

2. There is a small pars intermedia cyst measuring up to w6 mm in diamter.

3. There is a indeterminate 2 mm focus of hypoinensity within the neurohypophysis of the pituitary gland.

My doctor said that that Rathke's Cyst is fairly normal if it is asymptomatic. But how do I know if it is causing symptoms or not?

Also, what does a 2mm focus of hypointensity usually mean?

Thank you!

Answer
Well nothing that can be related to any Cushing's disease has been seen. Based on experience it is not very probable that that little cyst is causing any of your problems. The radiologist can not determine at all what that hypointensity area may be so I should refrain from any guesswork here. Because guesswork is all what it would be with not enough information available.