Pituitary adenoma MRI

Pituitary adenoma Microchapters
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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]

MRI Findings in Pituitary Adenoma

Macroadenoma

• T1

• T1 typically isointense to grey matter

• Larger lesions are often heterogeneous and vary in signal due to areas of cystic change, necrosis, or haemorrhage.

• T1 C+ (Gd)

• A solid components demonstrates moderate to bright enhancement.

• T2

• T2 typically isointense to grey matter.

• 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 marcoadenoma

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  MRI axial T1
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  MRI axial TI post-contrast
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  MRI sag T1
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  MRI axial FLAIR
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  MRI axial T2

Patient #2: Pituitary marcoadenoma

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Microadenoma

• MRI is the mainstay of imaging for pituitary microadenomas, contrast enhanced MRIs have a sensitivity of 90%.

• Subtle morphology changes can be identified on non-contrast images, these changes include:

• Bulkiness of the pituitary gland on the side of the microadenoma

• Remodeling of the floor of the sella

• Deviation of the pituitary infundibulum away from the adenoma

MRI Phases

• T1

• T1 is usually shows isointense to normal pituitary gland.

• 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.