Sellar ve Parasellar Bölgede Radyolojik Değerlendirme
Özet
Sellar ve parasellar bölge lezyonlarının radyolojik değerlendirmesini, anatomik özelliklerini ve ayırıcı tanısını kapsamlı bir şekilde ele alan bu metinde, hipofiz bezinin embriyolojik gelişimi, bölümleri ve normal boyutları açıklanmaktadır. Gebelik ve pubertede gelişen fizyolojik hiperplazinin adenomlardan ayrımı vurgulanmakta; fraktür veya litik lezyonları taklit edebilen ecchordosis physaliphora, fossa navicularis ve persistan kraniofaringeal kanal gibi anatomik varyasyonlar tanımlanmaktadır. En sık izlenen tümörler olan hipofiz adenomlarının tanısında dinamik kontrastlı MRG'nin önemi belirtilmektedir. Makroadenomların kavernöz sinüs invazyonu ve karotid arter ilişkisi menengiom gibi kitlelerden ayrımında kritik rol oynar. Solid ve kistik bileşenleri farklılık gösteren kraniofaringiomlar ile patognomonik intrakistik nodüller içeren benign Rathke kleft kistlerinin ayırıcı tanı kriterleri sunulmaktadır. Ayrıca anevrizma, araknoid ve epidermoid kistler, empty sella, Langerhans hücreli histiyositozis, lenfositik hipofizit, santral diabetes insipidus ve ektopik nörohipofiz gibi patolojilerin radyolojik sinyal özellikleri ve kontrastlanma paternleri detaylandırılmaktadır. Sonuç olarak, bu bölge lezyonlarına yaklaşımda hasta yaşı, klinik bulgular ve radyolojik özellikler birlikte değerlendirilmelidir.
Focusing comprehensively on the radiological evaluation, anatomical features, and differential diagnosis of sellar and parasellar region lesions, this text explains the embryological development, parts, and normal dimensions of the pituitary gland. It emphasizes the differentiation of physiological hyperplasia during pregnancy and puberty from adenomas, and defines anatomical variations that can mimic fractures or lytic lesions, such as ecchordosis physaliphora, fossa navicularis, and persistent craniopharyngeal canal. The importance of dynamic contrast-enhanced MRI in diagnosing pituitary adenomas, the most common tumors, is highlighted. Cavernous sinus invasion and carotid artery relationship of macroadenomas play a critical role in distinguishing them from masses like meningiomas. Differential diagnosis criteria are presented for craniopharyngiomas, which differ in solid/cystic components, and benign Rathke cleft cysts containing pathognomonic intracystic nodules. Additionally, the radiological signal characteristics and enhancement patterns of pathologies such as aneurysms, arachnoid and epidermoid cysts, empty sella, Langerhans cell histiocytosis, lymphocytic hypophysitis, central diabetes insipidus, and ectopic neurohypophysis are detailed. Consequently, patient age, clinical findings, and radiological features must be evaluated together when approaching lesions in this region.
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