797

The Volume of the SeIla Turcica in Children: New

Standards

Lance

A. Chilto&2 John P. Dorst1 Stanley M. Garn3

Measurement of the sella turcica is valuable in the assessment of a variety of pituitary and other conditions. The volume, a more reliable measurement than cellar area, has been difficult to interpret for lack of adequate standards. This study presents mean and 10th, 50th, and 90th percentIles for sellar volume In normal children aged 6I 6 years on the basis of measurements in 960 sets of skull radiographs made for orthodontic purposes. SelIar volumes are plotted against chronologic age, and against skeletal age for the 62% of measurements for which a simultaneous bone age determinatlon had been made. As expected, the sellar volume increases with age: for example, mean volume for a boy 5 years 9 months to 6 years 8 months is 228 mm3, for a boy 1 5 years 9 months to 1 6 years 8 months is 640 mm3. For most age groups, cellar volume in males Is greater than In females. Tenth and ninetieth percentiles for cellar volume are widely separated, giving a wide range of normal. Nevertheless they should be useful In assessing sellar volume in clinical situations.

The radiographic size of the sella tuncica has been the object of many studies. Silverman [i I measured the area of the sella turcica on lateral skull radiognaphs of normal children by planimetry and developed curves relating sellar area to chronologic age and to height. However, DiChiro [2] found that sellar area correlated poorly with the size of the pituitary gland. DiChiro and Nelson [3] developed a formula for calculating sellar volume and showed that this correlated well with pituitary volume (r = 0.862) and with the volume of a cast of the removed sella (r = 0.846). These correlations were confirmed by McLachlan et
al. [4]. In a subsequent article, DiChiro and his colleagues [5] derived normal

Received
sion December
, Department ences, Johns 21205. 2

March

9, 1982;

accepted

after

reviSciMD

2, 1982.

of Radiology and Radiologic Hopkins Hospital, Baltimore,

address: Department of Pediatrics,

Present

Lovelace Medical Center, 5400 buquerque, NM 871 08. Address to L. A. Chilton. Febs Research 45387. Present
3

GIbson reprint

S. E., Alrequests

Institute, address:

Yellow Center
University

Springs, OH for Human

of Michigan,

Growth

and

Development,

Ann Arbor,
AJR

MI 48109.

values for sellar volume on radiographs of 347 individuals ranging in age from birth to 26 years. These pioneering studies have limitations: They lack statistical treatment (e.g. the number of individuals at each age is not specified and percentiles or standard deviations are not listed) and they were made on patients with neuromuscular disease, epilepsy, and leukemia rather than on a normal population. More recent studies have used DiChiro and Nelsons [3] method of calculating sellar volume. Yamada et al. [6] measured sellar volumes of 570 normal Japanese subjects aged i -60 years. The values obtained were used in comparison to values obtained from radiographs of patients with hypo- and hyperthyroidism; details of the statistical methods were not published. Underwood et al. [7] measured sellar volume in 38 normal children and, using a ratio to mean values obtained in DiChiros study [5], determined an estimate of scatter of a normal population about these means. The limited sample size makes these estimates of uncertain value. Our study attempts to establish normal values for sellan volume in childhood,
,

140:797-801 , April 1983 0361 -803X/83/1 404-0797 American Roentgen Ray Society

using

a large

number

of radiographs

obtained

during

orthodontic

care

as a close

approximation establish i 0th,

of the normal 50th, and 90th

population percentiles

and applying for each year

statistical methods during childhood.

to

798

CHILTON

ET

AL.

AJR:140,

April

1983

Materials

and

Methods of 427 childen were aged made

6-1 6 years were selected.

w-l3mm

-*

Radiographs

Measurements
films. work

were done on 960 pairs of technically

by the same An additional

excellent

skull

All measurements at Johns Hopkins

person

(L. A. C.), of films

Fig. 1 -Frontal indicated. (Reprinted and lateral from [3].) views of sella turcica, with measurements

who had demonstrated were discarded because

excellent
Hospital.

test-retest

reliability

in preliminary could not be

1 00 pairs

the width of the sella turcica

ascertained with certainty on the frontal radiographs. DiChiro [2] found that over 90% of standard frontal views demonstrated a clearly measurable sellar width; he commented that tomograms may

be necessary
About 95%

to define the borders

of the children filmed

in the rest.
were orthodontic patients; the TABLE
1 : Sellar

Volume
No.

by Gender
Mean

and Chronologic
Percentile 1 0th 50th

Age

rest were their normal siblings.

Bone ages were available

for 592 of
chronologic Age (years/months): Gender 90th

these sets of radiographs. None of the children were known to have any neurologic, endocrine, or skeletal diseases. All of the films were made with a source-to-film distance of 60 inches (1 52.4 cm) with the head placed against the cassette. Measurements were made with a Helios caliper, graduated to 0.05 mm. Silverman [1 ] states that the problem of what to measure is much greater than how to measure. For this reason we carefully followed the method of DiChino and Nelson [3] (fig. 1): For length we have chosen to use the greatest, anteropostenior diameter in the horizontal plane. . . . For depth, it has seemed sensible to set an upper limit approximating the position of the sellar diaphragm. Although the diaphragm usually originates just below the tip of the tuberculum, we have chosen for the sake of clarity to draw a line from the top of the tubenculum to the top of the dorsum, to drop a perpendicular to this line to the deepest part ofthe floor and to measure along that perpendicular. . . . For the measurement of the width of the floor, the distance between the two highest points located on the edges of the plateau is used. Bone ages were determined from hand films made at the same time as the skull films; they were analyzed by means of the method of Greulich and Pyle [8]. Ages recorded at the time of sellar measurement were at 3 months before to 3 months after a birthday or half-birthday ; when combined to form year-long intervals, they result in gaps (e.g. , 8 years 9 months to 9 years 9 months).

5/9-6/8: M

. .

4 5

196 255

(161) (212)

190 255

(239) (313)

F
6/9-7/8: M

21
21
. .

304
281

F
7/9-8/8: M F 8/9-9/8:

194 198

305 265

389 388

42
41

312
285

237
200

307
276

379
372

M F F
M F M

59

329

239

309

444

65
.

293
352
307

202
251
216

294
330
294

384
458
461

9/9-10/8: M
.

61
81

10/9-11/8:

59
. . .
. ,

350
329
391

225
204
268

340
335
395

463
451
505

65
75

11/9-12/8:
.
.

F
12/9-13/8: M .

90
55

360
411

243
310

370
395

461
574

F
13/9-14/8: M F 14/9-15/8: M

62
35 40 21
31
.
.

348
464 385 389
428
549

235
300 273 272
305
323

346
439 379 442
430
453

444 698 506 526

545
958

Results Table 1 lists mean and 1 0th, values for sellan volume derived 50th, from and 90th percentile measurement of the

F
15/9-16/8: M .

18

F
Note-Data
millimeters. insufficient
corrected

462

(301)

454

(740)

960 sets of skull films, related to chronologic age. Table 2 gives the same information for sellam volume related to skeletal age (disregarding chronologic age) in the 592 cases where it was available. The same data are shown in figure 2, where the curves have been smoothed by a method of
moving averages.

on 960 children, 450 male and 51 0 female. volumes given in cubic Numbers in parentheses are smallest and largest volumes measured due to number of subjects to calculate 1 0th and 90th percentIles. volumes shown are for geometric magnification at filming distance of 60 inches (1 52.4 cm).

As noted above, the orthodontic skull films were taken at a 60-inch (i 52.4 cm) source-to-film distance rather than the usual 34-inch (86.4 cm) to 40-inch (i Oi .6 cm) distance
used in clinical radiology. If the sella is about 3 inches (7.6

observed sellan volume on a 34-inch film, multiply the given values by the factor 1 .32; for a 40-inch source-to-film distance, multiply by i .26.

cm) from the film, a 60-inch duces magnification of 5.2%. i 6.6%, and correspondingly
and

source-to-film distance proThe volume will be magnified 3i .7% for a 34-inch distance
Therefore, 1 and to obtain 2, measured the volTo to tables

Discussion

CT scanning
pituitary diographs sinuses When

offers

a far more

reliable

way of recognizing

26.3%

for a 40-inch sellar volume,

distance. for

actual

umes have been multiplied by the factor 1 /1 .i 7 or 0.86. convert the volumes given in the tables and figures

tumors than skull radiographs do. Yet regular maof the skull, mastoids, facial bones, and pananasal continue to be useful and display the sella tuncica. sella appears too large or too small, many radiol-

the

AJR:140,

April

1983

VOLUME

OF

SELLA

TURCICA

799

TABLE

2: Sellar Volume
No.

by Gender
Mean

and Skeletal

Age

5keletal Age (years/months):

Percentile 1 0th 50th 90th

tumors. Slowly growing tumors such as craniopharyngioma may cause only increase in the size of the sella without
erosion also anorexia of the been clinoids or the sellar with

floor.

Large

sellas [6-i

have 5],

Gender

found

in patients

hypothyroidism

5/9-6/8: M F 6/9-7/8:

13

274

157

291

376

11 24 26

270 270 275

311

202 241 216

226

265
319

347
409

M
F 7/9-8/8:

nervosa [i 6], and the empty sella syndrome [7], suggesting a role of the pituitary in these disorders. Small sellas have been described in hypopituitanism, hypothyroidism, and myotonic dystrophy [5].
Martinez-Faninas [i 8] and DiChino [2] listed the many

256
305

368
423

M
F 8/9-9/8: M
.

35
. .

34

277

198

271

363

different methods that have been used to measure the sella turcica, most determining area rather than volume. Fisher and DiChiro [5] showed that a small sella turcica on lateral
projection may a false be associated impression with a large sellan width, thus fossa. giving of the volume of the pituitary

32

F
9/9-10/8:

37 34
56 38
. .

335 315

251 178

310 266

486 426

M
F 10/9-11/8: M

370
311 360
312

259
202 265
190

354
308 426
305

539
441 459
426

DiChiro and Nelson [3] had already shown close correlation between pituitary volume and radiographically determined
sellar since drome is quite choice volume. only 75% However, it is hardly sella is filled surprising by the

that

comegland in

spondence
31

between
of the

the two measurements [3]. The well accepted

is not precise,
pituitary

F
11/9-12/8: M . F
12/9-13/8:

the average

case

empty

sella

syn-

51 55

379 335

267 226

375 335

497 438

[i 7] proves that the size of the sella different from the size of the gland.

on occasions

A second
of M 42
. 37

problem
the

in use of sellar height,

Many

volume other

data

concerns be used
and

independent

variable-should

chronologic

396
389

284
247

373
384

522
529

F
13/9-14/8: M

age,

skeletal

age,

on some
authors,

measure

as a reference

point?

including

DiChiro

F
14/9-15/8:

.
. . .

22
. 9

447
431

306
281

462
415

687
625

M
F 15/9-16/8:

Nelson [3], have related sellam volume only to chronologic age. Should these data apply to children delayed in their growth? Silverman [1 ] related sellar area to height as well
as to chronologic more be nearly age, finding that the height:sellam line than area the larger curve approximated a straight

329

(281)

352

(372)

(228)

(228)

M F

0
1

age:sellar

area curve.
considered

He also noted
separately,

that males
males

and females
have

(589)

(505)

must

since not

on 592 children, 294 male and 298 female (bone ages not available for 368 patients). volumes given in cubic milimeters, corrected for geometric magnification at filming distance of 60 inches (1 52.4 cm). Numbers in parentheses smallest and largest volumes measured due to insufficient number of subjects to calculate 10th and 90th percentiles.

Note-Data

sellas
of the based

than
children on

females
in our

at most
study

ages.
was sellar which

Unfortunately
usually and cranial

the height indices the

of

recorded. dimensions.

Martinez-Faninas
comparisons

[i 8] and
of turcica, little

Riach

[1 9] calculated in our study

is part with

These
growth

methods
of the may

were
sella have

not applied

because
chondrogrowth the

of the

ogists measure its volume to determine whether an unsuspected pituitary abnormality deserves further investigation. Moreover in the pediatric endocrine clinics in our hospitals and in many others, frontal and lateral skull radiographs are used to search for an unlikely craniopharyngioma in children with early puberty and/or short stature who have no clinical signs on symptoms of a pituitary lesion (Migeon CJ, personal communication). Measurements of the sella turcica have been made on radiographs since at least i 9i 2 [9] and were summarized
by Kanlas in 1 948 [i 0]. The central location of the sella

cranium,

correspondence

the membranous calvania [20]. Because growth and development of the bony skeleton depend largely on anterior pituitary hormones, we postulated that osseous development, expressed as bone age, might correlate closely to pituitary size and thus to the size of the pituitary fossa (table 2). The curves of bone age related to sellar volume proved to be similar to the curves of
chronologic age to sellar volume and offered no advantages

in evaluating our normal patients. However, helpful in evaluating patients with conditions
tism, hypopituitanism, and other forms the chronologic of development age often provides than bone age.

they may prove such as giganwhere

turcica and the importance of the pituitary undoubtedly account for the frequency with which the sella has been studied, and the association of clinical disease with alteration in the size and shape has commanded the attention of numerous writers [i 1 -i 4]. Shape, however, is not susceptible of measurement, but size should offer a more precise, if possibly less sensitive, parameter. Measurements of sellar size are valuable in a variety of conditions, most obviously in the recognition of intrasellar

of dwarfism,

a much poorer estimate Since there is a positive

correlation
the variability

between
in sellar

sellar
volume

volume

and

bone

age,

some
chron-

of

for children

of a given

ologic age is related to different mates of bony development. The problem of age limitation also arises. Among others, Silverman [i ] and Fisher and DiChiro [5] measured the sella
in children from the first year of life. Kier [1 2] noted that the

800

CHILTON

ET

AL.

AJR:140,

April

1983

800

a 800

(11171

Fig.

2.-Volume

of sella

turcica

cor-

rected for magnification for boys girls by chronologic age and bone
70

and age.
90th

700

Lines moving

represent averages.

1 0th,

50th,

and

percentiles,

calculated

by a method

of

600

601

a
500

500

400
a

400

30

a a
300

20

a:

#{163}90th Percentile
S50et
00 Percentile Percentile IC

a .

90th 50th i0?h

Percenlie Percenhie Percentile

.- lOIN

.. ..

5,, T. 6.C

6/9 b

7/9 1,

819 9/9 0/9 T#{149} T#{149} b

/9
1. IS/C

IVS
b 3/S

G4
2, 4/C

4/8 5/C

5/8
b *11 ,

as
y#{149} 7/8

7/8

5/5

9/8

0/8

VS

7/a s
8/8

8/9

n,
9/8

9/9 . 0/8

0S

ii/9 2/8

n.
ii/8

2/9 t, 158

3/9 t, 4/8

4/9 t,

nig ,, 6/8

ers

CHRONOLOGIC tyeers/menttis)

AGE

CHRONOLOGIC

AGE

yearsknaiths)

80C

800

70C

700 a

600

600

500

500

a U

,,4oo

30
S

200

a:
. .
a,

a,9cth

Percentile

90w 50th
0th

Pvcentiie
Percentile Percentile
00

#{149}SOth Percentile ., 0th Percentile

00

S.

..

5/9 6C

6/9 7/8

7/9 8/8

8/9 9/8

9/9 10/8

0/9 1/8

1/9 2/8

2/9 3/8

3/9 4/8

4/9 5/8

5/9 6/8

5,9
6m

s.g
7/8

vs
8/8

as
918

ss
0/8

i0i9
il/C

il/S 2/8

iiS 3/8

13/9 4/8

14/S 15/8

/9 6/8

BONE
(years

AGE

BONE
(yeOrS

AGE
monthsl

/monlhst

domsum

sellae

is not entirely

ossified

at birth.

In our

expeni-

The

upper

age

limit

in this

study

was

dictated

by

the

ence with pneumoencephalography in young children, aim in the subamachnoid space is at considerable distance fom the
image this of the ossified chondmocmanium. studies (unpublished We data) have using confirmed autopsy in preliminary

unavailability which sellam

of films for children olden than dimensions no longer increase

1 6. The age at seems to be in

specimens from young children. Thus it is unlikely that sellar measurements on plain films are a valid reflection of the
volume under further the work sellam will diahnagm at least through age 4

question; Fisher and DiChimo [5] indicate a flattening of the curve at about i 3-i 5 years, but the areas measured by Silverman [i ] continued to increase through 1 8 years, at which Our volume almost curves time his study ended. increasing a notable studies lines sellam gender at data show, as expected, a roughly as a function of age. Theme is also The male sella is larger as 90th than that all ages. However, of the 1 0th and in other percentile

years.
study;

We have chosen on skeletal age

6 years at which

as a lower the sella

age limit for this

the chron-

be necessary

to establish

difference:

of the female

ologic
ossified.

is completely

[i , 5], the are widely

AJR:140,

April

1983

VOLUME

OF

SELLA

TURCICA

801

separated and quite irregular. Fine distinctions between sellar volume in normal children and in children with such conditions as hypothyroidism, gonadal dysgenesis, congenital vinilizing adrenal hyperplasia, and even hypopituitanism and hyperpituitanism are probably not possible in many
instances. tumor The wide range of normal usually could also indicates that a by in the sellar region not be diagnosed

turcica. 5. Fisher
1964;91

Br J Radiol 1 968;41 : 323-330 RL, DiChiro G. The small

:996-1 008

sella

turcica.

AJR

6. Yamada T, Tsukui T, Ikijini K, Yukimara Y, Kotani M. Volume of sella turcica in normal subjects and in patients with primary hypothyroidism and hyerthyroidism. J Clin Endocrinol Metab

1976;42:81

7-822

sellar measurements on a single pair of radiographs until it became quite large. Nevertheless, in the presence of clinical signs or symptoms, the finding of a sellar volume larger than
the 90th percentile takes on added significance, as do serial

radiographs

showing an unnaturally rapid increase in volume. Clearly, as DiChiro [2] has shown, a volume measurement is of greaten value than a measurement of the area alone. It must be emphasized, however, that one must consider not only the volume in comparison with these tables, but also the shape and presence or absence of erosion of the sella before arriving at a conclusion regarding pathology of its contents. CT scans of the brain and pituitary
gland should be obtained in most cases when the plain film

7. Underwood LE, Radcliffe WB, Giunto FC. New standards for the assessment of sella turcica volume in children. Radiology 1976;1 19:651 -654 8. Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hands and wrists. Stanford: Stanford University Press, 1954 9, Cushing H. The pituitary body and its disorders. Philadelphia: Lippincott, 1912
1 0.

Karlas GA. Morphological

body of sphenoid

observations

on superior

surface

of

bone in human

adults(inaugural

dissertation).

1 1 .

Helsingfors, Finland: University of Helsingfors, 1948 Kier EL. The infantile sella turcica. AJR 1 968;1 02 : 747-767
Vidic B. The postnatal development of the sphemoidal sinics

1 2.

findings

are questionable

or clearly

outside

normal

limits.

ACKNOWLEDGMENTS

This study is based on skull radiographs obtained by Arthur B. Lewis, Dayton, OH, who also made the evaluations of skeletal maturation. We thank Edward Gehret, Alan Gittelsohn, and Betty Skipper for preparation of the statistical display, and Aggie McDermott and Julie Machell for help in manuscript preparation.

its spread into the dorsum sellae and posterior clinoid processes. AJR 1968;104:177-183 1 3. McLachlan MSF, Williams ED, Doyle FH. Applied anatomy of the pituitary gland and fossa. A radiological and histopathological study based on 50 necropsies. Br J Radiol 1968;41 : 782788 1 4. Bruneton JN, Drouillard JP, Sabatier JC, Elie GP, Tavernier JF. Normal variants of the sella turcica. Radiology 1979;1 31 :99104
1 5.

and

McCarten

KM, Kuhns LR. The area and volume

of the sella

REFERENCES 1 . Silverman FN. Roentgen standards for size of the pituitary fossa from infancy through adolescence. AJR 1957;78:451 460 2. DiChiro G. Width (third dimension) of sella turcica. AJR 1960;84 : 26-37 3. DiChiro G, Nelson KB. Volume of sella turcica. AJR 1962;87:989-1 008 4. McLachlan MSF, Wiliams ED, Fortt RW, Doyle FH. Estimation of pituitary gland dimensions from radiographs of the sella

turcica in childhood primary hypothyroidism. Radiology 1976;1 19:645-650 1 6. Bergstrom K, Lundberg P0, Sjovall A. Volume of sella turcica in patients with anorexia nervosa. Eur Neurol 1 973;9 :183189
1 7.

Kaufman

B. The empty

intrasellar

subarachnoid
LO.

sella turcica-a space. Radiology

manifestation
1968;90:931

of the
-941

1 8. Martinez-Farinas 1 967;88 :264-267

1 9. Riach ICF. The

The
index-a

sellar-cranial
relationship

index.
between

Radiology
the area

sellar

of the sella turcica 1966;39 : 824-827 J Phys Anthropol

and

lateral

area

of the skull.

Br J Radiol Am

20. Moss ML, Young RW. A functional

1960;18:218-292

approach

to craniology.