Preliminary Diagnosis: Craniopharyngioma

I. What imaging technique is first-line for this diagnosis?

MR imaging of the brain with intravenous contrast.

II. Describe the advantages and disadvantages of this technique for diagnosing craniopharyngioma.

Advantages
  • Diagnostic in the appropriate clinical scenario.

  • Able to localize the area of abnormality and predict any secondary neurological complications.

  • Does not utilize ionizing radiation.

Disadvantages
  • Expensive.

  • Time consuming.

  • Susceptible to motion artifact.

  • IV contrast requires the patient to have good renal function (GFR > 30).

III. What are the contraindications for the first-line imaging technique?

MR imaging is contraindicated in patients with non-MR compatible metallic hardware or foreign bodies.

IV. What alternative imaging techniques are available?

Non-enhanced and contrast enhanced CT.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing craniopharyngioma.

Advantages
  • Better than MRI at detecting calcifications that are often associated with craniopharyngiomas.

  • Quicker, less expensive, and requires less patient cooperation than MRI.

Disadvantages
  • CT is nonspecific and lacks the anatomic detail obtained with MRI.

  • CT exposes the patient to ionizing radiation.

VI. What are the contraindications for the alternative imaging techniques?

CT is contraindicated in pregnant patients, especially during the first two trimesters.