Rathke’s Cleft Cyst

General characteristics

Rathke’s cleft cysts are uncommon benign cystic lesions that are derived from the remnants of the epithelium embryologically lining the craniopharyngeal duct (Naylor et al. 1995).

Autopsy series have shown that Rathke’s cleft cysts can be found in up to 30% of asymptomatic subjects. Location is usually intrasellar in 50% of cases, suprasellar in 25% of cases, and both in 25% of cases.

Imaging and Location

The cysts are usually simple, lined by a single epithelial layer. They may contain variable amounts of protein, mucopolysaccharide, cellular debris, and cholesterol. Depending on their contents, their signal intensity may be high, low, or intermediate on T1- and T2-weighted sequences. They usually do not show Gd enhancement, but they may rarely show a thin peripheral enhancement (Bonneville et al. 2006; Cohan et al. 2004).

Differential diagnosis

Craniopharyngiomas and cystic pituitary adenomas should be considered in the differential diagnosis of Rathke’s cleft cyst.

  • Craniopharyngiomas have common floccular calcification and usually have contrast enhancing solid or rim-like components.
  • Cystic adenomas usually reveal peripheral contrast enhancement.

Clinical symptoms

Rathke’s cleft cysts are usually asymptomatic and are discovered incidentally. They may cause mass effect with headache, pituitary dysfunction or in very large cases visual disturbances. Most cases of Rathke’s cleft cyst are stable and do not need any treatment.


  1. M.F. Reiser, W. Semmler, H. Hricak (Eds.) "Magnetic Resonance Tomography", Springer 2008