Radiological Case: Giant Hypothalamic Hamartoma

Mougnyan Cox, MD; Julia Ahn, DO; Vinay Kandula, MD; and Joseph Piatt, MD


Appl Radiol. 2017;46(5):31A-31B. 

In This Article

Imaging Findings

MR imaging of the brain without and with contrast was performed, and showed a large, slightly heterogeneous mass in the suprasellar region. The mass was isointense to the brain on the unenhanced T1- and T2-weighted images (Figures 1 and 2), without abnormal enhancement (Figure 3). The mass had a cerebriform appearance, resembling a 'brain-within-a-brain' architecture. There was associated mass effect on the optic chiasm, and superolateral displacement of the bilateral internal carotid arteries. There was no hydrocephalus or vascular encasement/narrowing. The pituitary gland was separate from the mass, and the sella was not expanded.

Figure 1.

Axial T1-weighted MR of the brain in this patient with a giant hypothalamic hamartoma shows a large mass (blue arrow) that is isointense to brain parenchyma centered in the suprasellar cistern.

Figure 2.

Coronal T2-weighted image of the same patient with a giant hypothalamic hamartoma shows that the mass is slightly heterogeneous in appearance, with components that are isointense to gray matter (red arrow) and white matter (white arrow). The area immediately subjacent to the red arrow shows a cerebriform architecture with gray and white matter, mimicking normal brain.

Figure 3.

Coronal fat-suppressed postcontrast T1-weighted image shows that the mass remains isointense to brain parenchyma without abnormal enhancement.