Prolactinoma MRI

Prolactinoma Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]

Overview

Magnetic resonance imaging (MRI), is the most sensitive test for detecting pituitary tumors and determining their size. MRI scans may be repeated periodically to assess tumor progression and the effects of therapy. MRI is more sensitive than CT in detecting pituitary tumors.

MRI

Magnetic resonance imaging (MRI) is the most sensitive test for detecting pituitary tumors and determining their size. MRI scans may be repeated periodically to assess tumor progression and the effects of therapy. MRI is more sensitive than CT in detecting pituitary tumors. MRI is the mainstay of imaging for pituitary microadenomas, and required dedicated pituitary sequences (thin slice, small field of view, dynamic contrast acquisition). Contrast enhanced MRIs have a sensitivity of 90%. Post contrast and especially thin section dynamic contrast enhanced imaging is an important part of a pituitary MRI and has significantly improved diagnostic accuracy. Some often subtle morphology changes can be identified on non-contrast images however. These include bulkiness of the gland on the side of the microadenoma, subtle remodelling of the floor of the sella, deviation of the pituitary infundibulum away from the adenoma. Findings on MRI scan suggestive of prolactinoma include:

MRI Component	Features
T1​	usually isointense to normal pituitary
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	variable, but often a little hyperintense

References

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