A 27-year-old female presented with complaints of headache

A 27-year-old female presented with complaints of headache

  • A 27-year-old female presented with complaints of headache

1. Sagittal and Coronal T1 weighted images of sella
Shows a well-defined intrasellar T1 hyperintense lesion

2. Sagittal and coronal T2 weighted images of sella
Shows a T2 hyperintense intrasellar cystic lesion with a peripheral T2 hypointense intra-cystic nodule within


Rathke’s cleft cyst


Rathke pouch forms during the 4th week of embryologic development as a rostral outpouching from the roof of the primitive oral cavity. The anterior wall of the pouch gives rise to the anterior lobe of the pituitary (pars distalis). The posterior wall of the pouch does not proliferate and remains as the intermediate lobe of the pituitary (pars intermedia). The lumen of the pouch narrows to form a cleft (Rathke cleft) that normally regresses. Persistence of this cleft with the expansion is believed to be the origin of a Rathke cleft cyst.


The vast majority of Rathke cleft cysts are asymptomatic and incidentally found.

  • If large, they may cause:
  • visual disturbances: due to compression of the optic chaisma
  • pituitary dysfunction
  • due to compression of adjacent pituitary tissue and distortion of the pituitary stalk
  • present in up to 69% of symptomatic cases
  • headaches


On lateral skull x-ray, it can rarely cause sellar enlargement if reaches large size


  • non-contrast
  1. typically non-calcified and of homogeneous low attenuation
  2. uncommonly it may be of mixed iso- and low-attenuation, or contain small curvilinear calcifications in the wall (seen in 10-15% of cases)
  • postcontrast
  1. typically non-enhancing


  • Rathke cleft cysts are usually in the midline, unicameral (without septations) and homogeneous in signal intensity . Fluid fluid levels are uncommon and are more suggestive of a pituitary adenoma .
  • The signal characteristics vary according to the cyst composition, which may be mucoid or serous.


  • 50% are hyperintense (high protein content)
  • 50% are hypointense


  • 70% are hyperintense
  • 30% are iso or hypointense
  • 20 % have a hypointense rim (this is more common in adenomas)

T1 C+ (Gd)

  • no contrast enhancement of the cyst is seen; however, a thin enhancing rim of surrounding compressed pituitary tissue may be apparent
  • An intracystic nodule (sometimes referred to as intracystic dot) is present in 65-75% of cases . When present it is usually hyperintense on T1 and hypointense on T2 compared to surrounding fluid, although, depending on the signal of the surrounding fluid, it may be inapparent on one sequence or the other


cystic pituitary adenoma

  • Shows peripheral enhancement
  • fluid-fluid level or hemorrhagic debris
  • off midline location
  • septations


  • no gender difference
  • similar age group
  • usually suprasellar or have a suprasellar component
  • tend to calcify


Senior Consultant Radiologist
Manipal Hospital, Yeshwanthpur, Bengaluru.

Fellow in Radiology
Manipal Hospital, Yeshwanthpur, Bengaluru.