Aim: To describe magnetic resonance imaging (MRI) findings of Rathke cleft cysts (RCC) and contribute to the RCC diagnosis by revealing the most common radiological features.

Materials and Methods: From 2010 to 2022, patients who had MRI findings compatible with RCC were included in the study. The radiological findings of the cases were discussed with the pituitary hormone profiles; by the MRI-based imaging analysis, the largest diameter, location in the sellar cavity, the signal characteristics on T1-weighted and T2-weighted images, contrast enhancement pattern following intravenous contrast agent injection, and intra-cystic nodule characteristics of RCCs were recorded.

Results: In 121 cases that had characteristic MRI findings with RCC, 64% of RCCs were hypointense, 19% were hyperintense, and 16% were isointense with the adenohypophysis on T1-weighted images; while RCCs were hyperintense in 53% and hypointense in 47% of the cases on T2-weighted images. In addition, intra-cystic nodules, which were hypointense on both T1-weighted and T2-weighted images, were determined in 16% of the cases. Four cases that had an intra-cystic nodule, showed nodular contrast enhancement in the post-contrast series. The mean age of the patients with intra-cystic nodules in RCCs was significantly higher than the patients who had not (p<0.001).

Conclusion: Although the MRI signal characteristics of RCCs may vary according to the content of the lesion, the presence of an intra-cystic nodule formation is an important radiological tool contributing to the diagnosis.