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Vertical Triband Flag Sign for Differential Diagnosis of Rathke's Cleft Cyst Publisher



Sharifi G1, 2 ; Amin Darozzarbi AA1, 2 ; Paraandavaji E2 ; Lotfinia M2, 3 ; Kazemi MA4, 5 ; Hajikarimloo B2 ; Jafari A1, 2 ; Mohammadi E7 ; Davoudi Z2, 6 ; Akbari Dilmaghani N2, 8
Authors
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Authors Affiliations
  1. 1. Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  2. 2. Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  3. 3. Department of Neurosurgery, Medical Center Saarbruecken, Saarland, Germany
  4. 4. Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Department of Endocrinology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  7. 7. Department of Neurosurgery, University of Oklahoma Health Sciences Center, OK, United States
  8. 8. Department of Otolaryngology, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Source: World Neurosurgery: X Published:2024


Abstract

Background: The Rathke cleft cyst (RCC) is a type of cystic growth that is benign, circular, and well-defined with an incidence rate of 4 %. This study aims to identify a useful diagnostic imaging sign that can aid in the differentiation of RCC from other cystic lesions. Methods: We retrospectively analyzed the records of 42 symptomatic RCC patients who were referred to our facility between 2016 and 2023. The data for the study were obtained from our electronic database. All magnetic resonance imaging (MRI) studies were performed using a 1.5-T superconducting magnetic scanner. All patients underwent endonasal transsphenoidal surgical resection. All MRIs were reviewed and evaluated by a neurosurgeon and a neuroradiologist. Results: There were 8 (19 %) males and 34 (81 %) females with a mean age of 37.2-years. Our study identified a distinct imaging characteristic in 38 of the cases, which we have named the “vertical triband flag sign”, due to the growth of the cyst developing a specific appearance. The flag sign was mostly observed only in the T1-images (71.5 %), while in four cases the sign was spotted only in T2-images, and in four cases it appeared in both T1 and T2. In 4 cases, the flag sign was not observed in which further investigations revealed that these cases were suprasellar or small sellar RCCs. The dot sign, which is a characteristic finding in RCCs was only observed in one of our cases. Conclusion: Early diagnosis of RCCs may be facilitated by utilizing the vertical triband flag sign. © 2023 The Authors