Intraneural ganglia in the hip and pelvic region

2009 ◽  
Vol 111 (2) ◽  
pp. 317-325 ◽  
Author(s):  
Robert J. Spinner ◽  
Marie-Noëlle Hébert-Blouin ◽  
Robert T. Trousdale ◽  
Rajiv Midha ◽  
Stephen M. Russell ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Mr Imaging ◽  
Hip Joint ◽  
Lumbosacral Plexus ◽  
Mr Images ◽  
Mechanism Of Formation ◽  
Intraneural Ganglion ◽  
Rare Site ◽  
Joint Connection ◽  
Insight Into

Object The authors describe their experience in a series of cases of intraneural ganglia within the hip and pelvic regions, and explain the mechanism of formation and propagation of this pathological entity. Methods Five patients with 6 intraneural ganglia are presented. Four patients presented with symptomatic intraneural ganglia in the buttock and pelvis affecting the sciatic and lumbosacral plexus elements. An asymptomatic cyst affecting the opposite sciatic nerve was found on MR imaging in 1 patient. The fifth patient, previously reported on by another group, had an obturator intraneural ganglion that the authors reinterpreted. Results All 5 intraneural ganglia affecting the sciatic and lumbosacral plexus elements were found to have a joint connection to the posteromedial aspect of the hip joint; the obturator intraneural cyst had a joint connection to the anteromedial aspect of the hip joint. In all cases, initial review of the MR images led to their misinterpretation. Conclusions To the authors' knowledge, these are the first cases of intraneural ganglia demonstrated to have a connection to the hip joint. This finding at a rare site provides further evidence for the unifying articular (synovial) theory for the formation of intraneural ganglia and reveals a shared mechanism for their propagation. Furthermore, understanding the pathogenesis of these lesions provides insight into their successful treatment and their recurrence.

Extreme intraneural ganglion cysts

2011 ◽  
Vol 114 (1) ◽  
pp. 217-224 ◽  
Author(s):  
Robert J. Spinner ◽  
Marie-Noëlle Hébert-Blouin ◽  
Michael G. Rock ◽  
Kimberly K. Amrami
Keyword(s):  
Sciatic Nerve ◽  
Mr Imaging ◽  
Mr Arthrography ◽  
Imaging Study ◽  
Intraneural Ganglion ◽  
Anterior Portion ◽  
Posterior Portion ◽  
Articular Branch ◽  
Joint Connection ◽  
Recurrent Cyst

Object The mechanism responsible for exceptional examples of intraneural ganglia with extensive longitudinal involvement has not been understood. Such cases of intraneural cysts, seemingly remote from a joint, have been thought not to have articular connections. Decompression and attempted resection of the cyst has led to intraneural recurrence and poor neurological recovery. The purpose of this report is not only to clarify the pathogenesis of these cysts, but also to discuss their treatment based on modern concepts of intraneural ganglia. Methods Two examples of extreme longitudinal propagation of intraneural ganglia are presented. Results A patient with a moderate tibial neuropathy was found to have a tibial intraneural ganglion. Prospective interpretation of the MR imaging study demonstrated the cyst's origin from the posterior portion of the superior tibiofibular joint (STFJ), with proximal extension within the sciatic nerve to the lower buttock region. Communication between the STFJ and the cyst was confirmed with direct knee MR arthrography. The tibial intraneural cyst was treated successfully by a relatively limited exposure in the distal popliteal fossa: the cyst was decompressed, the articular branch disconnected, and the STFJ resected. Postoperatively, the patient improved neurologically and there was no evidence of recurrent cyst on postoperative MR imaging. A second patient, previously reported by another group, was reexamined 22 years after surgery. This patient had an extensive peroneal intraneural ganglion that extended into the sciatic nerve from the knee to the buttock; no joint connection or recurrent cyst had initially been described. In this patient, the authors hypothesized and established with MR imaging the presence of both: a joint connection to the anterior portion of the STFJ from the peroneal articular branch as well as recurrent cyst within the peroneal and tibial nerves. Conclusions This paper demonstrates that extreme intraneural cysts are not clinical outliers but represent extreme examples of other more typical intraneural cysts. They logically obey the same principles, previously described in the unified articular (synovial) theory. The degree of longitudinal extension is probably due to high intraarticular pressures within the degenerative joint of origin. The generalizability of the mechanistic principles is highlighted by the fact that these 2 cases, involving the tibial and the peroneal nerve respectively, both extended well distant (that is, to the buttock) from the STFJ via their respective articular branch of origin. These extensive intraneural cysts can be treated successfully by disconnecting the affected articular branch and by resection of the joint of origin, rather than by a more aggressive operation resecting the cyst and cyst wall.

scholarly journals Intraneural ganglion cysts: a systematic review and reinterpretation of the world's literature

2016 ◽  
Vol 125 (3) ◽  
pp. 615-630 ◽  
Author(s):  
Nicholas M. Desy ◽  
Huan Wang ◽  
Mohanad Ahmed Ibrahim Elshiekh ◽  
Shota Tanaka ◽  
Tae Woong Choi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ganglion Cyst ◽  
Mr Images ◽  
Intraneural Ganglion ◽  
Intraneural Ganglion Cyst ◽  
Ganglion Cysts ◽  
Significant Difference ◽  
Joint Connection ◽  
Cyst Recurrence ◽  
Univariate Analyses

OBJECTIVE The etiology of intraneural ganglion cysts has been controversial. In recent years, substantial evidence has been presented to support the articular (synovial) theory for their pathogenesis. The authors sought to 1) perform a systematic review of the world's literature on intraneural cysts, and 2) reinterpret available published MR images in articles by other authors to identify unrecognized joint connections. METHODS In Part 1, all cases were analyzed for demographic data, duration of symptoms, the presence of a history of trauma, whether electromyography or nerve conduction studies were performed, the type of imaging, surgical treatment, presence of a joint connection, intraneural cyst recurrence, and postoperative imaging. Two univariate analyses were completed: 1) to compare the proportion of intraneural ganglion cyst publications per decade and 2) to assess the number of recurrences from 1914 to 2003 compared with the years 2004–2015. Three multivariate regression models were used to identify risk factors for intraneural cyst recurrence. In Part 2, the authors analyzed all available published MR images and obtained MR images from selected cases in which joint connections were not identified by the original authors, specifically looking for unrecognized joint connections. Two univariate analyses were done: 1) to determine a possible association between the identification of a joint connection and obtaining an MRI and 2) to assess the number of joint connections reported from 1914 to 2003 compared with 2004 to 2015. RESULTS In Part 1, 417 articles (645 patients) were selected for analysis. Joint connections were identified in 313 intraneural cysts (48%). Both intraneural ganglion cyst cases and cyst recurrences were more frequently reported since 2004 (statistically significant difference for both). There was a statistically significant association between cyst recurrence and percutaneous aspiration as well as failure to disconnect the articular branch or address the joint. In Part 2, the authors identified 43 examples of joint connections that initially went unrecognized: 27 based on their retrospective MR image reinterpretation of published cases and 16 of 16 cases from their sampling of original MR images from published cases. Overall, joint connections were more commonly found in patients who received an MRI examination and were more frequently reported during the years 2004 to 2015 (statistically significant difference for both). CONCLUSIONS This comprehensive review of the world's literature and the MR images further supports the articular (synovial) theory and provides baseline data for future investigators.

scholarly journals Peroneal and tibial intraneural ganglia: correlation between intraepineurial compartments observed on magnetic resonance images and the potential importance of these compartments

2007 ◽  
Vol 22 (6) ◽  
pp. 1-10 ◽  
Author(s):  
Robert J. Spinner ◽  
Kimberly K. Amrami ◽  
Diana Angius ◽  
Huan Wang ◽  
Stephen W. Carmichael
Keyword(s):  
Magnetic Resonance ◽  
Sciatic Nerve ◽  
Mr Imaging ◽  
Tibial Nerve ◽  
Cyst Formation ◽  
Magnetic Resonance Images ◽  
Imaging Features ◽  
Mr Images ◽  
Superior Tibiofibular Joint ◽  
Tibiofibular Joint

Object Previously the authors demonstrated that peroneal and tibial intraneural ganglia arising from the superior tibiofibular joint may occasionally extend proximally within the epineurium to reach the sciatic nerve. The dynamic nature of these cysts, dependent on intraarticular pressures, may give rise to differing clinical and imaging presentations that have remained unexplained until now. To identify the pathogenesis of these unusual cysts and to correlate their atypical magnetic resonance (MR) imaging appearance, the authors retrospectively reviewed their own experience as well as the published literature on these types of intraneural ganglia. Methods A careful review of MR images obtained in 22 patients with intraneural ganglia located about the knee region (18 peroneal and four tibial intraneural ganglia) allowed the authors to substantiate three different patterns: outer (epifascicular) epineurial (20 cases); inner (interfascicular) epineurial (one case); and combined outer and inner epineurial (one case). In these cases serial MR images allowed the investigators to track the movement of the cyst within the same layer of the epineurium. All lesions had connections to the superior tibiofibular joint. Nine patients were identified as having lesions with sciatic nerve extension. Seven patients harboring an outer epineurial cyst (six in whom the cyst involved the peroneal nerve and one in whom it involved the tibial nerve) had signs of sciatic nerve cross-over, with the cyst seen in the sciatic nerve and/or other terminal branches. In only two of these cases had the cyst previously been recognized to have sciatic nerve involvement. In contrast, in one case an inner epineurial cyst involving the tibial nerve ascended within the tibial division of the sciatic nerve and did not cross over. A single patient had a combination of both outer and inner epineurial cysts; these were easily distinguished by their distinctive imaging patterns. Conclusions This anatomical compartmentalization of intraneural cysts can be used to explain varied clinical and imaging patterns of cleavage planes for cyst formation and propagation. Compartmentalization elucidates the mechanism for cases of outer epineurial cysts in which there are primary ascent, sciatic cross-over, and descent of the lesion down terminal branches; correlates these cysts' atypical MR imaging features; and contrasts a different pattern of inner epineurial cysts in which ascent and descent occur without cross-over. The authors present data demonstrating that the dynamic phases of these intraneural ganglia frequently involve the sciatic nerve. Their imaging features are subtle and serve to explain the underrecognition and underreporting of the longitudinal extension of these cysts. Importantly, cysts extending to the sciatic nerve are still derived from the superior tibiofibular joint. Combined with the authors' previous experimental data, the current observations help the reader understand intraneural ganglia with a different, deeper degree of anatomical detail.

Synovitis in legg-calvé-perthes disease

1998 ◽  
Vol 39 (5) ◽  
pp. 532-537 ◽  
Author(s):  
P. Hochbergs ◽  
G. Eckerwall ◽  
N. Egund ◽  
K. Jonsson ◽  
H. Wingstrand
Keyword(s):  
Clinical Outcome ◽  
Mr Imaging ◽  
Hip Joint ◽  
Group Iv ◽  
Perthes Disease ◽  
Mr Images ◽  
Poor Clinical Outcome ◽  
Lateral Pillar ◽  
Group I ◽  
Signal Changes

Purpose: to evaluate, by means of MR imaging, the degree and persistence of synovitis in the hip joint in Legg-Calvé-Perthes disease and to correlate the degree of synovitis with the degree of epiphyseal necrosis Material and Methods: A total of 170 MR images in 72 patients (84 hips) were examined. the T2-weighted MR images were taken in the coronal plane in order to evaluate the degree of synovitis in the hip joint Results: MR revealed synovitis in all cases in the early phase of the disease. in Catterall group II, synovitis was discreet to moderate for up to 6 months after diagnosis. Hips with more severe necrosis, Catterall groups III and IV, had moderate or intense degrees of synovitis. There was a correlation between the degree of synovitis and the lateral pillar classification according to HERRING et al. Also, there was a good correlation between the extent of signal changes in the epiphysis on MR imaging and the degree of synovitis. There was no difference when signal changes were evaluated on T1- or T2-weighted images. Signs of synovitis could be seen for up to 30 months after diagnosis in Catterall group I hips, and in Catterall groups II and III for up to 36 months, and in 2 cases even longer. Some Catterall group IV hips had discreet or mild synovitis for 60 months or more, after diagnosis Conclusion: the degree of synovitis on MR imaging correlates to the extent of epiphyseal necrosis seen on radiographs or MR imaging as well as to the lateral pillar classification, i.e. to a poor clinical outcome. in Catterall group IV hips, synovitis can even persist for up to 60 months after diagnosis

scholarly journals Gravity determines the direction of nerve roots sedimentation in the lumbar spinal canal

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jun Yang ◽  
Zhiyun Feng ◽  
Nian Chen ◽  
Zhenhua Hong ◽  
Yongyu Zheng ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Mr Imaging ◽  
Spinal Canal ◽  
Ventral Side ◽  
Lateral Position ◽  
Dorsal Side ◽  
Mr Images ◽  
Nerve Roots ◽  
Cross Sectional ◽  
Dural Sac

Abstract Objectives To investigate the role of gravity in the sedimentation of lumbar spine nerve roots using magnetic resonance (MR) imaging of various body positions. Methods A total of 56 patients, who suffered from back pain and underwent conventional supine lumbar spine MR imaging, were selected from sanmen hospital database. All the patients were called back to our hospital to perform MR imaging in prone position or lateral position. Furthermore, the sedimentation sign (SedSign) was determined based on the suspension of the nerve roots in the dural sac on cross-sectional MR images, and 31 cases were rated as positive and another 25 cases were negative. Results The mean age of negative SedSign group was significantly younger than that of positive SedSign group (51.7 ± 8.7 vs 68.4 ± 10.5, P < 0.05). The constitutions of clinical diagnosis were significantly different between patients with a positive SedSign and those with a negative SedSign (P < 0.001). Overall, nerve roots of the vast majority of patients (48/56, 85.7%) subsided to the ventral side of the dural sac on the prone MR images, although that of 8 (14.3%) patients remain stay in the dorsal side of dural sac. Nerve roots of only one patient with negative SedSign did not settle to the ventral dural sac, while this phenomenon occurred in 7 patients in positive SedSign group (4% vs 22.6%, P < 0.001). In addition, the nerve roots of all the five patients subsided to the left side of dural sac on lateral position MR images. Conclusions The nerve roots sedimentation followed the direction of gravity. Positive SedSign may be a MR sign of lumbar pathology involved the spinal canal.

Epiphyseal bone-marrow abnormalities and restitution in legg-calvé-perthes disease

1997 ◽  
Vol 38 (5) ◽  
pp. 855-862 ◽  
Author(s):  
P. Hochbergs ◽  
G. Eckervall ◽  
H. Wingstrand ◽  
N. Egund ◽  
K. Jonsson
Keyword(s):  
Bone Marrow ◽  
Mr Imaging ◽  
Perthes Disease ◽  
Mr Images ◽  
Group I ◽  
Radiological Classification ◽  
Signal Changes ◽  
Over Time ◽  
Epiphyseal Bone

Purpose: By means of MR imaging, to determine signal abnormalities in the femoral epiphysis; to determine their location, extent and restitution over time; and to correlate these findings to the Catterall radiological classification. Material and Methods: A total of 247 MR images in 86 patients (101 hips) with Legg-CalvC-Perthes disease were examined. The MR images were taken in the coronal plane, and the images through the center of the femoral head were used for this study. Results: T1-weighted images proved as good as T2-weighted images for the MR evaluation of the extent of the necrosis. In almost every case, the central-cranial part of the epiphysis showed a low initial signal. In Catterall group I, the medial part was never involved. In Catterall III and IV, almost the entire epiphysis showed signal changes. In the period 3–6 years after diagnosis, we still found signal changes in the epiphysis in some hips but there was no correlation with the Catterall classification. After 6 years, the epiphysis showed normal signal intensity in MR imaging. In T1-weighted images, Gd-enhancement occurred in the peripheral regions in the early stages of the disease. The central part of the epiphysis became more enhanced over time and peaked in the period 1–3 years after diagnosis. Conclusion: MR is a valuable modality for monitoring changes in the femoral epiphysis. We propose a new classification of the extent and pattern of epiphyseal bone-marrow abnormalities based on the 4 zones most commonly observed in MR imaging.

scholarly journals Perineural spread of pelvic malignancies to the lumbosacral plexus and beyond: clinical and imaging patterns

2015 ◽  
Vol 39 (3) ◽  
pp. E14 ◽  
Author(s):  
Stepan Capek ◽  
Benjamin M. Howe ◽  
Kimberly K. Amrami ◽  
Robert J. Spinner
Keyword(s):  
Sciatic Nerve ◽  
Lumbosacral Plexus ◽  
Perineural Spread ◽  
Tumor Spread ◽  
Spinal Nerves ◽  
Lumbosacral Plexopathy ◽  
Pelvic Cancer ◽  
Group A ◽  
Group B

OBJECT Perineural spread along pelvic autonomie nerves has emerged as a logical, anatomical explanation for selected cases of neoplastic lumbosacral plexopathy (LSP) in patients with prostate, bladder, rectal, and cervical cancer. The authors wondered whether common radiological and clinical patterns shared by various types of pelvic cancer exist. METHODS The authors retrospectively reviewed their institutional series of 17 cases concluded as perineural tumor spread. All available history, physical examination, electrodiagnostic studies, biopsy data and imaging studies, evidence of other metastatic disease, and follow-up were recorded in detail. The series was divided into 2 groups: cases with neoplastic lumbosacral plexopathy confirmed by biopsy (Group A) and cases included based on imaging characteristics despite the lack of biopsy or negative biopsy results (Group B). RESULTS Group A comprised 10 patients (mean age 69 years); 9 patients were symptomatic and 1 was asymptomatic. The L5–S1 spinal nerves and sciatic nerve were most frequently involved. Three patients had intradural extension. Seven patients were alive at last follow-up. Group B consisted of 7 patients (mean age 64 years); 4 patients were symptomatic, 2 were asymptomatic, and 1 had only imaging available. The L5–S1 spinal nerves and the sciatic nerve were most frequently involved. No patients had intradural extension. Four patients were alive at last follow-up. CONCLUSIONS The authors provide a unifying theory to explain lumbosacral plexopathy in select cases of various pelvic neoplasms. The tumor cells can use splanchnic nerves as conduits and spread from the end organ to the lumbosacral plexus. Tumor can continue to spread along osseous and muscle nerve branches, resulting in muscle and bone “metastases.” Radiological studies show a reproducible, although nonspecific pattern, and the same applies to clinical presentation.

Integrated positron emission tomography and magnetic resonance imaging–guided resection of brain tumors: a report of 103 consecutive procedures

2006 ◽  
Vol 104 (2) ◽  
pp. 238-253 ◽  
Author(s):  
Benoît Pirotte ◽  
Serge Goldman ◽  
Olivier Dewitte ◽  
Nicolas Massager ◽  
David Wikler ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Brain Tumors ◽  
Mr Imaging ◽  
Tumor Resection ◽  
Tracer Uptake ◽  
Emission Tomography ◽  
Mr Images ◽  
Pet Tracer ◽  
Positron Emission ◽  
Pet Scanning

Object The aim of this study was to evaluate the integration of positron emission tomography (PET) scanning data into the image-guided resection of brain tumors. Methods Positron emission tomography scans obtained using fluorine-18 fluorodeoxyglucose (FDG) and l-[methyl-11C]methionine (MET) were combined with magnetic resonance (MR) images in the navigational planning of 103 resections of brain tumors (63 low-grade gliomas [LGGs] and 40 high-grade gliomas [HGGs]). These procedures were performed in 91 patients (57 males and 34 females) in whom tumor boundaries could not be accurately identified on MR images for navigation-based resection. The level and distribution of PET tracer uptake in the tumor were analyzed to define the lesion contours, which in turn yielded a PET volume. The PET scanning–demonstrated lesion volume was subsequently projected onto MR images and compared with MR imaging data (MR volume) to define a final target volume for navigation-based resection—the tumor contours were displayed in the microscope’s eyepiece. Maximal tumor resection was accomplished in each case, with the intention of removing the entire area of abnormal metabolic activity visualized during surgical planning. Early postoperative MR imaging and PET scanning studies were performed to assess the quality of tumor resection. Both pre- and postoperative analyses of MR and PET images revealed whether integrating PET data into the navigational planning contributed to improved tumor volume definition and tumor resection. Metabolic information on tumor heterogeneity or extent was useful in planning the surgery. In 83 (80%) of 103 procedures, PET studies contributed to defining a final target volume different from that obtained with MR imaging alone. Furthermore, FDG-PET scanning, which was performed in a majority of HGG cases, showed that PET volume was less extended than the MR volume in 16 of 21 cases and contributed to targeting the resection to the hypermetabolic (anaplastic) area in 11 (69%) of 16 cases. Performed in 59 LGG cases and 23 HGG cases, MET-PET demonstrated that the PET volume did not match the MR volume and improved the tumor volume definition in 52 (88%) of 59 and 18 (78%) of 23, respectively. Total resection of the area of increased PET tracer uptake was achieved in 54 (52%) of 103 procedures. Conclusions Imaging guidance with PET scanning provided independent and complementary information that helped to assess tumor extent and plan tumor resection better than with MR imaging guidance alone. The PET scanning guidance could help increase the amount of tumor removed and target image-guided resection to tumor portions that represent the highest evolving potential.

Dysprosium-enhanced MR imaging for tumor tissue characterization

1997 ◽  
Vol 38 (2) ◽  
pp. 281-286 ◽  
Author(s):  
C. Wang ◽  
A. Sundin ◽  
A. Ericsson ◽  
T. Bach-Gansmo ◽  
A. Hemmingsson ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Tissue Characterization ◽  
Tumor Tissue ◽  
Tumor Model ◽  
Human Colon ◽  
Mr Images ◽  
Histological Sections ◽  
Necrotic Tumor ◽  
Before And After ◽  
Weighted Sequences

Purpose: to evaluate dysprosium-enhanced MR imaging for differentiation between morphologically intact and necrotic tumor tissue in a tumor model. Material and Methods: A human colon carcinoma was transplanted subcutaneously into 9 nude (immunodeprived) rats. MR imaging was performed before and after injection of the dysprosium agent Dy-DTPA-BMA. T1-, T2- and T2*-weighted sequences were acquired. the tumors were dissected, histological sections were prepared, and compared with corresponding MR images. Results: in intact tissue, the MR signal intensity in the T2- and T2*-weighted images decreased after Dy injection and the delineation of the intact regions were sharp and corresponded well to the gross histological sections. Conclusion: Dy-enhanced MR imaging facilitated the differentiation between intact and necrotic tumor tissue.

Hemorrhagic and nonhemorrhagic Rathke cleft cysts mimicking pituitary apoplexy

2008 ◽  
Vol 108 (1) ◽  
pp. 3-8 ◽  
Author(s):  
Mandy J. Binning ◽  
James K. Liu ◽  
John Gannon ◽  
Anne G. Osborn ◽  
William T. Couldwell
Keyword(s):  
Mr Imaging ◽  
Pituitary Tumor ◽  
Pituitary Apoplexy ◽  
Pituitary Tumors ◽  
Imaging Features ◽  
Mr Images ◽  
Acute Hemorrhage ◽  
Consistent Finding ◽  
Imaging Characteristics ◽  
Intracystic Hemorrhage

Object Rathke cleft cysts (RCCs) are infrequently symptomatic, and apoplexy is one of the most unusual presentations. Only a few cases of apoplexy associated with RCCs have been reported, and their clinical, imaging, surgical, and pathological features are poorly understood. In the cases that have been reported, intracystic hemorrhage has been a consistent finding. The authors report 6 cases of RCCs in which the presenting clinical and imaging features indicated pituitary apoplexy, both with and without intracystic hemorrhage. Methods The authors retrospectively reviewed charts and magnetic resonance (MR) imaging studies obtained in patients who underwent transsphenoidal surgery for RCC. Six patients were identified who presented with symptoms and MR imaging characteristics consistent with pituitary apoplexy but were found intraoperatively to have an RCC. All 6 patients presented with a sudden headache, 2 with visual loss, and 1 with diplopia. Review of the preoperative MR images demonstrated mixed signal intensities in the sellar masses suggestive of a hemorrhagic pituitary tumor. In all patients there was a presumed clinical diagnosis of pituitary tumor apoplexy and an imaging-documented diagnosis of hemorrhagic pituitary tumor. Results All 6 patients underwent transsphenoidal resection to treat the suspected pituitary apoplexy. Intraoperative and histopathological findings were consistent with the diagnosis of an RCC in all cases. Only 2 cases showed evidence of hemorrhage intraoperatively. In all cases, an intracystic nodule was found within the RCC at surgery, and this intracystic nodule was present on the initial MR imaging when retrospectively reviewed. The imaging characteristics of the intracystic nodules were similar to those of acute hemorrhage seen in cases of pituitary apoplexy. Conclusions The clinical and imaging features of RCCs appear similar to those of hemorrhagic pituitary tumors, making them often indistinguishable from pituitary apoplexy.

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