{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T09:33:24Z","timestamp":1774949604237,"version":"3.50.1"},"reference-count":16,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Differentiation between cystic pituitary adenoma and Rathke\u2019s cleft cyst (RCC) is clinically important because these lesions require different treatment strategies. This study aimed to develop and internally validate an MRI-based multivariable diagnostic prediction model to differentiate cystic pituitary adenoma from Rathke\u2019s cleft cyst before treatment. Materials and Methods: A retrospective analysis was performed on 56 adult patients (27 cystic pituitary adenomas and 29 RCCs) who underwent pituitary MRI between 2019 and 2021. MRI examinations were independently evaluated for ten predefined imaging features. Diagnoses were established using histopathology or a validated clinical\u2013radiological diagnostic algorithm. Interobserver agreement and diagnostic performance were analyzed using multivariable logistic regression, with internal validation performed using bootstrap resampling. Results: Interobserver agreement was excellent (\u03ba (kappa) = 0.81\u20131.0). Fluid\u2013fluid level, hypointense rim on T2-weighted images, septation, and paramedian coronal location were significantly associated with cystic pituitary adenoma. In contrast, spontaneous T1-weighted hyperintensity, intracystic nodule, and midline sagittal location were more frequently observed in RCC. The final multivariable model demonstrated excellent discrimination (AUC = 0.91), with stable performance after bootstrap validation (optimism-corrected AUC = 0.88). Conclusions: The proposed MRI-based multivariable prediction model demonstrated high discrimination and provides a structured approach for estimating the probability of cystic pituitary adenoma using routinely available MRI features. Such an approach may help reduce unnecessary surgical interventions in patients with Rathke\u2019s cleft cyst while facilitating appropriate treatment planning for cystic pituitary adenomas. However, external validation in larger cohorts is required before routine clinical implementation.<\/jats:p>","DOI":"10.3390\/medicina62040659","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T08:09:18Z","timestamp":1774944558000},"page":"659","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and Internal Validation of an MRI-Based Diagnostic Prediction Model for Differentiating Cystic Pituitary Adenoma and Rathke\u2019s Cleft Cyst"],"prefix":"10.3390","volume":"62","author":[{"given":"Elif Kapitasi","family":"Kerter","sequence":"first","affiliation":[{"name":"Department of Radiology, Zonguldak Ataturk State Hospital, Zonguldak 67030, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ozlem","family":"Unal","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t University, Ankara 06300, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayse Nur Sirin","family":"Ozcan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Bilkent City Hospital, Ankara 06530, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1097\/00004728-199007000-00006","article-title":"MR appearance and cyst content of Rathke cleft cysts","volume":"14","author":"Asari","year":"1990","journal-title":"J. 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