Imaging description

Tumors involving the sella and suprasellar cistern have diverse origin although their clinical presentation is very similar. Most common sellar and suprasellar tumor is pituitary macroadenoma. Suprasellar meningiomas commonly arise from diaphragma sellae or tuberculum sellae (Fig. 34.1); however, large meningiomas originating along the planum sphenoidale (Fig. 34.2) or greater wing of the sphenoidal bone (Fig. 34.3) may also extend into the suprasellar cistern or parasellar region [1].

The suprasellar meningiomas account for 10% of all the chiasmal tumors [2], and the position of the chiasm related to the tumor determines the pattern of visual loss [3]. Histologically, they consist of elongated bipolar cells with eosinophilic cytoplasm, arranged in syncytial configuration with whirls. When present, psammoma bodies (concentrically laminated calcifications) are a distinguishing feature. On CT, a suprasellar meningioma appears as iso- to mildly hyperdense, intensely enhancing, lobulated mass with or without areas of calcification. They are generally isointense to cortical gray matter on both T1-weighted and T2-weighted images, but atypical features such as cystic areas or hemorrhage are frequently seen. On post-contrast study, homogeneous and intense enhancement is seen, with frequent presence of a dural tail.