High-resolution metrizamide CT cisternography in sellar and suprasellar abnormalities

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✓ Metrizamide computerized tomographic cisternography was performed with a small dose and low concentration of intrathecal metrizamide using a newer generation of computerized tomography scanner for the evaluation of sellar and suprasellar abnormalities. The examination was performed with thin sections in axial, direct coronal, and (when feasible) direct sagittal projections in a high-resolution technique. The relationship of the lesions with carotid arteries, optic chiasms, and hypothalamic structures was accurately defined.

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Address reprint requests to: Kalyanmay Ghoshhajra, M.D., Division of Neuroradiology, Presbyterian-University Hospital, DeSoto at O'Hara Street, Pittsburgh, Pennsylvania 15213.

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Figures

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    Normal anatomy of the sellar and parasellar region on metrizamide computerized tomographic cisternography. Upper Left: Axial section through the midsella (arrow) showing no concentration of metrizamide within the sella turcica. Upper Center: On a section through the diaphragma sellae, the infundibulum is seen as a central defect (arrow). Upper Right: Suprasellar cistern showing a transverse impression (arrows) anterior to the infundibulum that represents the optic chiasm. Lower Left: Cut just above the previous section demonstrates the A1 and M1 segments of the carotid arteries (arrows). Lower Right: Direct sagittal section reveals the optic recess of the third ventricle (arrow).

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    Normal metrizamide computerized tomographic cisternography, coronal sections, through the sellar and parasellar regions show the chiasmatic, infundibular, and vascular anatomy.

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    Case 1. Metrizamide computerized tomographic cisternography of the sellar and parasellar region. Upper Left: Axial section through the center of the sella turcica showing a concentration of metrizamide within the sella, which represents an empty sella. The pituitary gland could not be located. Upper Right: Section through the suprasellar region showing unusually long prechiasmatic nerves (arrows). Lower Left: Direct coronal section demonstrating both optic nerves (arrows), and a metrizamide-filled sella turcica. Lower Right: Section through the optic chiasm (arrows) demonstrating a slight depression.

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    Case 2. Metrizamide computerized tomographic cisternography scans. Left: Axial section through the sella turcica showing a small pituitary gland located posteroinferiorly (arrow) with concentration of metrizamide within the sella representing an intrasellar cisternal herniation. Right: Direct sagittal section showing an infantile type of sella turcica with intrasellar cisternal herniation. A small pituitary gland is clearly seen in the posteroinferior part of the sella turcica (arrow).

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    Case 3. Metrizamide computerized tomographic cisternography scans. Left: Axial section showing a filling defect in the suprasellar region (arrows). Right: Coronal section showing slight elevation of the optic chiasm with suprasellar extension of the neoplasm (arrows).

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    Case 4. Metrizamide computerized tomographic cisternography scans. Upper Left: Axial section through the midsella showing the sella turcica (arrow) asymmetrically enlarged by the intrasellar mass. Upper Right: Section through the suprasellar region showing a rounded defect in the suprasellar cistern caused by the suprasellar extension of the neoplasm. Lower Left: Coronal section showing the asymmetrical suprasellar extension of the neoplasm (arrow). Lower Right: Direct sagittal section showing anteroposterior and superior extension of the chromophobe adenoma.

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    Case 5. Metrizamide computerized tomographic cisternography scans. Upper: Axial sections through the suprasellar region showing a large filling defect caused by a suprasellar mass (arrows). Lower Left: Direct coronal section showing superior extension of the mass by elevation of the A1 segments of the carotid arteries (arrows). There was also bilateral parasellar extension present. Lower Right: Direct sagittal section outlining the anteroposterior and superior extension of the mass (arrows). The sella turcica is normal in size.

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