Pituitary adenoma MRI: Difference between revisions

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==Overview==
==Overview==
On brain [[Magnetic resonance imaging|MRI]], pituitary adenoma is characterized by a large mass with heterogeneous signal. Other findings may include remodeling of the floor of the [[sella]] and deviation of the pituitary [[infundibulum]] to the opposite side.


==MRI Findings in Pituitary Adenoma==
==MRI Findings in Pituitary Adenoma==
===Microadenoma===


===Macroadenoma<ref name=Radiopaedia> Pituitary Microadenoma. http://radiopaedia.org/articles/pituitary-microadenoma. URL Accessed on 9 30, 2015</ref>===
*[[Magnetic resonance imaging|MRI]] is the mainstay of imaging for pituitary microadenomas
*Contrast enhanced [[Magnetic resonance imaging|MRIs]] have a [[Sensitivity (tests)|sensitivity]] of 90%.<small><ref name="Radiopaedia12"> Pituitary Macroadenoma. http://radiopaedia.org/articles/pituitary-macroadenoma-1. URL Accessed on 9 30, 2015</ref></small>


*'''T1'''
*Subtle morphology changes can be identified on non-contrast images, these changes include:
 
:*Bulkiness of the [[pituitary gland]] on the side of the microadenoma


:*T1 typically isointense to grey matter
:*Remodeling of the floor of the [[sella]]


:*Larger lesions are often heterogeneous and vary in signal due to areas of cystic change, necrosis, or haemorrhage.
:*Deviation of the [[Pituitary gland|pituitary]] [[infundibulum]] away from the adenoma


*'''T1 C+ (Gd)'''
====MRI Phases====


:*A solid components demonstrates moderate to bright enhancement.
*'''T1'''


*'''T2'''
:*T1 is usually shows isointense to normal [[pituitary gland]].


:*T2 typically isointense to grey matter.
*'''T1 C+ (Gd)'''


:*Larger lesions are often heterogeneous and vary in signal due to areas of cystic change, necrosis, or haemorrhage.
:*Dynamic sequences demonstrate a rounded region of delayed enhancement compared to the rest of the gland.


*'''T2 gradient echo parameters'''
:*Delayed images are variable, ranging from hypo-enhancement (most common) to isointense to the rest of the gland, to hyperintense (retained contrast).


:*most sensitive for detecting any haemorrhagic components, which appear as areas of signal loss.
*'''T2'''
:*calcification is rare, but should be excluded by reviewing CT scans.


'''Patient #1: Pituitary marcoadenoma'''
:*T2 is variable, but often  shows a little hyperintensity.
'''Patient #1: Pituitary mircoadenoma'''
<gallery>
<gallery>
Image:
Image:
 
Pituitary-microadenoma-1.jpg|Pituitary microadenoma on T1.<ref name=radio3> Image courtesy of Dr Hani Al Salam. [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/pituitary-microadenoma-1 ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
Pituitary-macroadenoma-MR-T1-axial-pre-01.jpg|MRI axial T1
Image:
 
Pituitary-microadenoma-1(1).jpg|Pituitary microadenoma on T2.<ref name=radio3> Image courtesy of Dr Hani Al Salam. [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/pituitary-microadenoma-1 ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
Image:
Image:
 
Pituitary-microadenoma-1(2).jpg|Pituitary microadenoma    on T1.<ref name=radio3> Image courtesy of Dr Hani Al Salam. [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/pituitary-microadenoma-1 ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
Pituitary-macroadenoma-MR-T1-axial-post-01.jpg|MRI axial TI post-contrast
 
Image:
Image:
 
Pituitary-microadenoma-1(3).jpg|Pituitary microadenoma on T2.<ref name=radio3> Image courtesy of Dr Hani Al Salam. [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/pituitary-microadenoma-1 ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
Pituitary-macroadenoma-MR-T1-sag-01.jpg|MRI sag T1
</gallery>
 
'''Patient #2: Pituitary mircoadenoma'''
<gallery>
Image:
Image:
Pituitary-microadenoma(1).jpg|T1 C+ demonstrating a pituitary microadenoma, seen as a rounded expansion of the gland to the right of the midline slightly displacing the stalk to the left. On post contrast images it enhances less than the surrounding pituitary.<ref name=radio6> Image courtesy of Dr Frank Gairllard. [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/pituitary-microadenoma ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
</gallery>


Pituitary-macroadenoma-MR-FLAIR-01.jpg|MRI axial FLAIR
===Macroadenoma<small><ref name="Radiopaedia"> Pituitary Microadenoma. http://radiopaedia.org/articles/pituitary-microadenoma. URL Accessed on 9 30, 2015</ref></small>===
====MRI Phases====
*'''T1'''


Image:
:*T1 typically isointense to grey matter


Pituitary-macroadenoma-MR-T2-01.jpg|MRI axial T2
:*Larger lesions are often heterogeneous and vary in signal due to areas of [[cystic]] change, [[necrosis]], or [[haemorrhage]].
</gallery>
'''Patient #2: Pituitary marcoadenoma'''
<gallery>
Image:


Pituitary marcoadenoma 001.jpg
*'''T1 C+ (Gd)'''


Image:
:*A solid component demonstrates moderate to bright enhancement.


Pituitary marcoadenoma 002.jpg
*'''T2'''


Image:
:*T2 typically isointense to [[grey matter]]


Pituitary marcoadenoma 003.jpg
:*Larger lesions are often heterogeneous and vary in signal due to areas of cystic change, [[necrosis]], or [[haemorrhage]].


</gallery>
*'''T2 gradient echo parameters'''


===Microadenoma<ref name=Radiopaedia> Pituitary Macroadenoma. http://radiopaedia.org/articles/pituitary-macroadenoma-1. URL Accessed on 9 30, 2015</ref>===
:*Most [[Sensitivity (tests)|sensitive]] for detecting any haemorrhagic components, which appear as areas of signal loss.
:*Calcification is rare, but should be excluded by reviewing CT scans.


*MRI is the mainstay of imaging for pituitary microadenomas, contrast enhanced MRIs have a sensitivity of 90%.
'''Patient #1: Pituitary macroadenoma'''


* Subtle morphology changes can be identified on non-contrast images, these changes include:
<gallery>
Image:


:*Bulkiness of the [[pituitary gland]] on the side of the microadenoma
Pituitary-macroadenoma-MR-T1-axial-pre-01.jpg|There is a well defined round lesion noted in the pituitary fossa, the lesion is homogeneous and isodense on T1.<ref name=radio> Case contributed by Radswiki [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/pituitary-adenoma ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
Image:
Pituitary-macroadenoma-MR-T1-axial-post-01.jpg|There is a well defined round lesion noted in the pituitary fossa, the lesion shows homogeneous contrast enhancement.<ref name=radio> Case contributed by Radswiki [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/pituitary-adenoma ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>


:*Remodeling of the floor of the [[sella]]
Image:


:*Deviation of the pituitary infundibulum away from the adenoma
Pituitary-macroadenoma-MR-T1-sag-01.jpg|There is a well defined round lesion noted in the pituitary fossa, the lesion is homogeneous and isodense on T1.<ref name=radio> Case contributed by Radswiki [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/pituitary-adenoma ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>


====MRI Phases====


*'''T1'''
Image:


:*T1 is usually shows isointense to normal pituitary gland.
Pituitary-macroadenoma-MR-FLAIR-01.jpg|There is a well defined round lesion noted in the pituitary fossa, the lesion is slightly hyperintense on axial FLAIR.<ref name=radio> Case contributed by Radswiki [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/pituitary-adenoma ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>


*'''T1 C+ (Gd)'''


:*Dynamic sequences demonstrate a rounded region of delayed enhancement compared to the rest of the gland.
Image:


:*Delayed images are variable, ranging from hypo-enhancement (most common) to isointense to the rest of the gland, to hyperintense (retained contrast).
Pituitary-macroadenoma-MR-T2-01.jpg|There is a well defined round lesion noted in the pituitary fossa, the lesion is homogeneous and isodense on T2.<ref name=radio> Case contributed by Radswiki [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/pituitary-adenoma ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
</gallery>
'''Patient #2: Pituitary marcoadenoma'''
<gallery>
Image:


*'''T2'''
Pituitary marcoadenoma 001.jpg|There is a well defined homogeneously enhancing lesion in the pituitary fossa on Sagittal T1 C+ suggestive of pituitary adenoma.<ref name=radio> Case contributed by Radswiki [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/pituitary-adenoma-1 ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>


:*T2 is variable, but often  shows a little hyperintensity.
Image:
Pituitary marcoadenoma 003.jpg|There is a well defined homogeneously enhancing lesion in the pituitary fossa on Axial T1 C+ suggestive of pituitary adenoma.<ref name=radio> Case contributed by Radswiki [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/pituitary-adenoma-1 ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
</gallery>


==References==
==References==
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[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Mature chapter]]
[[Category:Mature chapter]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Neurology]]
[[Category:Neurosurgery]]
[[Category:Endocrinology]]

Latest revision as of 19:50, 2 October 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]

Overview

On brain MRI, pituitary adenoma is characterized by a large mass with heterogeneous signal. Other findings may include remodeling of the floor of the sella and deviation of the pituitary infundibulum to the opposite side.

MRI Findings in Pituitary Adenoma

Microadenoma

  • MRI is the mainstay of imaging for pituitary microadenomas
  • Contrast enhanced MRIs have a sensitivity of 90%.[1]
  • Subtle morphology changes can be identified on non-contrast images, these changes include:
  • Remodeling of the floor of the sella

MRI Phases

  • T1
  • T1 C+ (Gd)
  • Dynamic sequences demonstrate a rounded region of delayed enhancement compared to the rest of the gland.
  • Delayed images are variable, ranging from hypo-enhancement (most common) to isointense to the rest of the gland, to hyperintense (retained contrast).
  • T2
  • T2 is variable, but often shows a little hyperintensity.

Patient #1: Pituitary mircoadenoma

  • Pituitary microadenoma on T1.[2]

    Pituitary microadenoma on T1.[2]

  • Pituitary microadenoma on T2.[2]

    Pituitary microadenoma on T2.[2]

  • Pituitary microadenoma on T1.[2]

    Pituitary microadenoma on T1.[2]

  • Pituitary microadenoma on T2.[2]

    Pituitary microadenoma on T2.[2]

Patient #2: Pituitary mircoadenoma

  • T1 C+ demonstrating a pituitary microadenoma, seen as a rounded expansion of the gland to the right of the midline slightly displacing the stalk to the left. On post contrast images it enhances less than the surrounding pituitary.[3]

    T1 C+ demonstrating a pituitary microadenoma, seen as a rounded expansion of the gland to the right of the midline slightly displacing the stalk to the left. On post contrast images it enhances less than the surrounding pituitary.[3]

Macroadenoma[4]

MRI Phases

  • T1
  • T1 typically isointense to grey matter
  • T1 C+ (Gd)
  • A solid component demonstrates moderate to bright enhancement.
  • T2
  • Larger lesions are often heterogeneous and vary in signal due to areas of cystic change, necrosis, or haemorrhage.
  • T2 gradient echo parameters
  • Most sensitive for detecting any haemorrhagic components, which appear as areas of signal loss.
  • Calcification is rare, but should be excluded by reviewing CT scans.

Patient #1: Pituitary macroadenoma

  • There is a well defined round lesion noted in the pituitary fossa, the lesion is homogeneous and isodense on T1.[5]

    There is a well defined round lesion noted in the pituitary fossa, the lesion is homogeneous and isodense on T1.[5]

  • There is a well defined round lesion noted in the pituitary fossa, the lesion shows homogeneous contrast enhancement.[5]

    There is a well defined round lesion noted in the pituitary fossa, the lesion shows homogeneous contrast enhancement.[5]

  • There is a well defined round lesion noted in the pituitary fossa, the lesion is homogeneous and isodense on T1.[5]

    There is a well defined round lesion noted in the pituitary fossa, the lesion is homogeneous and isodense on T1.[5]

  • There is a well defined round lesion noted in the pituitary fossa, the lesion is slightly hyperintense on axial FLAIR.[5]

    There is a well defined round lesion noted in the pituitary fossa, the lesion is slightly hyperintense on axial FLAIR.[5]

  • There is a well defined round lesion noted in the pituitary fossa, the lesion is homogeneous and isodense on T2.[5]

    There is a well defined round lesion noted in the pituitary fossa, the lesion is homogeneous and isodense on T2.[5]

Patient #2: Pituitary marcoadenoma

  • There is a well defined homogeneously enhancing lesion in the pituitary fossa on Sagittal T1 C+ suggestive of pituitary adenoma.[5]

    There is a well defined homogeneously enhancing lesion in the pituitary fossa on Sagittal T1 C+ suggestive of pituitary adenoma.[5]

  • There is a well defined homogeneously enhancing lesion in the pituitary fossa on Axial T1 C+ suggestive of pituitary adenoma.[5]

    There is a well defined homogeneously enhancing lesion in the pituitary fossa on Axial T1 C+ suggestive of pituitary adenoma.[5]

References

  1. ↑ Pituitary Macroadenoma. http://radiopaedia.org/articles/pituitary-macroadenoma-1. URL Accessed on 9 30, 2015
  2. ↑ 2.0 2.1 2.2 2.3 Image courtesy of Dr Hani Al Salam. Radiopaedia(original file ‘’here’’).Creative Commons BY-SA-NC
  3. ↑ Image courtesy of Dr Frank Gairllard. Radiopaedia(original file ‘’here’’).Creative Commons BY-SA-NC
  4. ↑ Pituitary Microadenoma. http://radiopaedia.org/articles/pituitary-microadenoma. URL Accessed on 9 30, 2015
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 Case contributed by Radswiki Radiopaedia(original file ‘’here’’).Creative Commons BY-SA-NC
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