Clinical and radiological features of Rathke's cleft cysts with inflammatory change: Multivariable analysis of 262 surgically treated cases.
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OBJECTIVE: To characterize clinical and MRI features of Rathke's cleft cysts (RCCs) with inflammatory change and assess their associations with endocrine and surgical outcomes. METHODS: We retrospectively reviewed 262 surgically treated RCCs at a single institution (1998-2023). All patients underwent preoperative MRI and endocrine testing. Postoperative pathology classified cases as with inflammatory change (Group A, n = 56) or without (Group B, n = 206). Group comparisons used standard statistics; key MRI signs were circumferential rim enhancement and mixed T2 signal. RESULTS: Compared with Group B, Group A had more impaired pituitary axes (mean 3.9 vs. 1.1; p < 0.001) and higher rates of diabetes insipidus (33.9 % vs. 1.5 %; p < 0.0001) and visual field defects (62.5 % vs. 31.6 %; p < 0.0001). Circumferential rim enhancement (71.4 % vs. 6.3 %; p < 0.0001) and mixed T2 signal (66.1 % vs. 6.8 %; p < 0.0001) were strongly associated with inflammatory change. Postoperative endocrine recovery was less frequent in Group A (21.7 % vs. 64.6 %; p < 0.0001), and reoperation for recurrence was more common (14.3 % vs. 2.4 %; p = 0.001). Two illustrative cases demonstrated concordance between inflammation severity, MRI features, and outcomes. CONCLUSION: RCCs with inflammatory change are associated with severe preoperative pituitary dysfunction, poorer endocrine recovery, and higher recurrence. Simple MRI signs-especially circumferential rim enhancement and mixed T2 signal-may help identify inflammatory cases preoperatively and support consideration of earlier surgical intervention to preserve pituitary function.