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320

CT Metrizamide Cisternography lntrasellar Cistern S. Pinto,1’ K. Sadhu1

Richard Vijay

and

Computed (CTC)

Stanley

2

been

metnizamide

used

to document

cisternography

normal

and

arachnoidal

abnormal

communication of an arachnoid intrasellar cistern (empty sella) tary

with

visualization

radiologic

of a posteriorly

displaced

an is

plete

pitui-

full.

any

A skull

gular

neurologic series

metry,

or erosion

of the

tomography

revealed

fluid

density

within

mass

lesion,

sellar series,

using

intrathecal 1 90

mg

and

CTC

with

via

of

metnizamide.

placed

prone

any

in the

seizure

contrast

activity.

Received

2

AJR

Busch

anatomic

normal

media

overlapping gauge

of

Trendelenbung

the

patient

did

the

need

etiology

of sella

for

[5]

introduced

changes

of sella

December

14,

1978;

accepted

of Radiology,

Section

Department

of Radiology,

New

August

1979;

the

term

‘

‘empty

after

revision

York

University

10,

University Medical

0361-803X/79/1332-0320

seen

after

[1 4-1

in the

pituitary

range

fossa;

of cerebrospiand

administration

of

no

contrast

intravenous

6]. However, differentiation by CT of an intrasellar arachnoid cyst, a cystic craniopharyngioma, or a cystic piof

the

safely

cisterns

with

CT scanning

little

after

of

the

brain

or no morbidity

intrathecal

may to the

injection

of me-

alus

‘

for

and cyst

to determine [4].

definitely

demonstrate

nate the exception

possibility of a small

metnizamide

with

ing

is best

filling

We

the

are

noncommunication

reporting

the

use

560

$00.00;

First

Medical Ave.,

© American

School New

York,

Roentgen

CTC

to

‘

an intrasellar

appreciated

at Houston, NY

of an of

‘empty sella’ ‘ and thereby elimiof an intrasellar mass lesion, with the microadenoma. Our case demonstrated an

on

coronal

arachnoid cistern. This CT scans, although

1979. of Texas

Center,

[1 , 2];

arachnoid

sella’

April

rhinorrhea

nor did she

associated

of Neuroradiology,

fluid

may co1 1 ]. An

pneumoen-

the of

enlargement.

enlargement

the

sella’ ‘ from intrasellar

using

[1 0,

trizamide [1 -4, 1 7, 1 8]. The reported uses of metnizamide CT cisternography (CTC) include visualization of small lesions in the suprasellar and cerebellopontine angle cisterns [2, 3]; to document communicating obstructive hydroceph-

not complain

or nausea;

eliminated

patient

(fig.

gland

cistern

values

within

be accomplished

now

CT scans. cistern

material

empty

lesions

pressure been re-

(CT), a presumptive diagmade if the sella turcica is

be

may

tuitary adenoma is difficult. Excellent visualization

the

(30#{176})for

immediate

an intrasellar

‘ ‘

noncalcified

lumbar and

position

for

an

of 6 ml of

removed

attenuation is

pituitary

cerebrospinal

tomography

seen

intracramass

[1 2, 1 3].

low are

contrast

7800

after

fluid

and

sella

sella

enhancement

an intra-

needle

was

nal

of the

reported

associated

increased

intracranial

arachnoidal

empty

enlarged;

limits.

remod-

pulsations an incom-

increased intracranial [6-9]. Recently it has

intrasellar

computed

and

with

microadenomas an

been

of

fossa

fluid through

enlargement

sella

herniation

reported

of empty

has

Using

administra-

cuts,

that

pituitary

sella.

was

with

nosis

of cerebrospinal

spinal

needle

the

was also observed indenting cistern (fig. 2). At completion

the

Department

133:320-321,

pressure

also

asym-

1 ). To exclude

filling

CTC

of

on a GE CT scanner,

such as headaches

to determine

In 1 951

nial

the

cerebrospinal herniation

arachnoid

association

fossa.

zone

(fig.

at 24 hr thereafter

reaction

were

Discussion

the

intrasellar

exist

a quadran-

depression,

pituitary

to the scanner

pituitary gland of the intrasellar and

cephalography

and a 22

metnizamide

aspect

examination

fossa

The

transferred

2). A displaced

of any adverse

without

pituitary

fields

with

was within

low attenuation

collimator

then

focal

of the

CTC was performed

demonstrated

posterior

and

a 5 mm

was

1 0 mm

dura

visual

turcica

Polytomognaphy

without

of the patient

administration I/mI

patient

lamina

a nonenhancing the

the

sella

projection.

sella

evaluation

tion

Specifically,

lateral

the enlarged

Endocninologic Computed

related

documentation

with

ported

had a 2 year history of examination failed to dem-

an enlarged

on

confirmed

woman Clinical

deficits.

showed

configuration

sella

diaphragma

Further

Report

onstrate

and or increased arachnoidal

[7], as well as with benign (i.e. , pseudotumor cerebni)

A 24-year-old obese black generalized frontal headaches.

have

A case of by CTC

moencephalography eling to normal transmitted via

gland.

Case

the

cyst [4]. demonstrated

herniation secondary to an incomplete diasellae. Subsequently, Kaufman [6] reported the features of the ‘ ‘ empty sella’ ‘ as seen at pneu-

phragma

cerebrospinal fluid kinetics [1 , 2], to demonstrate small lesions in the suprasellar and cerebelbopontine cisterns [2, 3], and to show the presence or absence of subarachnoid

reported

of

F. Handel,1

tomographic

has

in the Recognition

10016.

Ray Society

6431 Address

Fannin, reprint

Houston, requests

TX

77030.

to R. S. Pinto.

findthin

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AJR:133,

August

CASE

1979

A

B

321

REPORTS

A

B Fig.

Filling Fig.

1-Noncontrast.

attenuation

(0-6

A, Axial

H) within

scan

at level of pituitary fossa. Zone of low sella turcica (arrows). B, Coronal scan at below level of posterior clinoids and top

enlarged

same level. Zone of low attenuation of dorsum sellae (arrow).

fossa

7.

zamide

8.

cistern of

indents

along

the

intrasellar

its posterior

nonopacification

border.

represents

teroinfeniorly displaced findings reported at

consideration

nologic

syndrome,

In all probability, the

cannot via

CTC,

of

our

evaluation

‘

arachnoid

compressed

this

area

and

pos-

is not unlike the in ‘ ‘empty

and eliminates

El Gammal

conclusively

although patient

clinical

does

not

CTC will eliminate in the diagnosis

as it did

in our

9. 1 0.

1 1

.

Zatz

LM,

imaging

using

serial

1 2.

Sutton

Arch

Pathol

Anat

R,

of sellar

changes

Br

J Radiol

Saur

OP:

Empty

sella

syndrome

hypertension.

J Neuro-

TH:

SO,

The

enlarged

sella

93: 1085-1091 Wilson

empty

CB:

Coexisting

sellas.

J

and

the

1969

,

pituitary

Neurosurg

ade-

48 : 23-28,

Neuro-

320:437-

JL: Co-existing

Hughes

JEO,

HH:

sella.

pituitary AJR

invagination.

Mount

LA:

fluid

31 : 538-543,

1969

cerebrospinal

21 :59-65, July 1969 NE, Naidich TP: Computerized

and intra-

0, 1974

Cerebrospinal

J Neurosurg

Nontraumatic

adenoma

1 22 : 508-51

fluid

rhinorrhea.

of sellar

and

parasellar

tomography

lesions.

Semin

in the diag-

Roentgenol

1 2:

1977 TP,

Pinto

RS,

Kushner

NE: Evaluation

MJ,

of sellar

Lin

JP,

Knicheff

II, Leeds

and parasellar masses 1 20 : 91 -99, 1976

computed

tomography.

1 6.

Rozanio

R, Hammerschlag

1 7.

I: Diagnosis of empty sella with CT scan. Neuroradiology 85-88. 1977 Roberson GH. Bnismar J, Davis KR, Taveras JM, Weiss Metnizamide preliminary

1 8.

GH,

Bnismar

Ackerman

RH,

puted

tomography.

Bajraktani

X,

graphic empty 20.

Radiology Post

Glenn Surg

intrasellar

The

empty

KR,

Taveras

enhancement RK:

cisternal 13:97-105,

sella

Jackson 13:

A:

tomography;

6 : 235-238,

Goulatia

by

1976

A, Davis

Neuro! A,

SM,

hypocycloidal

NV: CSF

Neuroradiology

OF:

Wolpert

127:965-967, J, Weiss

with

KO,

with

Grepe

changes sella).

Gabniele

SB,

cisternography results. AJR

Roberson

1 9.

rhi-

Neuro!

NE, Chase

1951

intrasellar

lesion.

pressure.

intracranial

Newton

Wing

and empty

Naidich

fluid

Orayer BP, Rosenbaum AE, Maroon JC, Bank WO, Woodford JE: Posterior fossa extraaxial cyst: diagnosis with metnizamide CT cistennography. AJR 128:431-436, 1977 5. Busch W: Die Morphologie den Sella Turcica und ihre BezieVirchows

consideration

EM,

partially

TJ, Vezina

Leeds

4.

Hypophyse.

fossa.

arachnoidal

of metrizamide-filled gland associated with opacification by metriextension into pituitary

intrasellar

intracranial

Radiology

arachnoid

PFJ,

Kaufman

JN,

Kaufman Arch

1977

zur

EA,

cistern.

norrhea 1 3.

patient.

radiology 1 3 :7-i 7, 1977 Drayen BP, Rosenbaum AE, Reigel OP, Bank WO, Oeeb ZL: Metnizamide computed tomography cisternography: pediatric applications. Radiology 1 24 : 349-357, 1977 3. Orayer BP, Rosenbaum AE, Kennerdell JS, Robinson AG, Bank WO, Deeb ZL: Computed tomographic diagnosis of suprasellar masses by intrathecal enhancement. Radiology 1 23 : 339-344,

6.

Janon

Brisman

2.

hungen

Further

of pituitary

of intrasellar

1975

and

sellar

this

the necessity of the ‘ ‘empty

AE, Higman HB: Cerebrospinal metnizamide CT cisternography.

MB: increased

of benign

43:177-180,

121-135,

BP, Rosenbaum

at level

of low attenuation

Housepian

surg

Oomingue

1 5.

458.

LA,

intrasellar

REFERENCES Orayer

scan

indicative

1972

Weisberg

nosis

.

with

as complication

1 4.

1

zone,

1978

endocni-

support

T, Allen

45:561-569,

be eliminated

the

A, Axial

lucent

possibility

associated

nomas

possibility. In all likelihood, of pneumoencephalography sella’

filled

pituitary gland. This pneumoencephabography

sella” [6-8, 19-21]. A small microadenoma from

contrast

cisternogram.

observed

extension. Concave indentation at posterior aspect cistern (arrow) probably represents displaced pituitary . empty sella’ syndrome. B. Coronal scan. Intrasellar zamide (arrow) conclusively delineates subarachnoid

section axial scans will demonstrate the metnizamide filled intrasellar extension of the suprasellar arachnoid space. The axial scan revealed a small region unfilled with metnithat

2-Metrizarnide

of previously

syndrome.

JM,

New

for com-

1976 Pneumoencephaloherniation

(primary

1977

AJR

104:168-170,

1968 B: The

‘

‘empty’

subanachnoid

‘

sella

space.

tuncica-manifestation Radiology

90 : 931 -941

of the ,

1968

21

.

Grossman

CB:

empty

syndrome.

sella

Dynamic

roentgenographic Radiology

1 16:341

changes -344,

1975

in the