Prolactinoma MRI
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American Roentgen Ray Society Images of Prolactinoma MRI |
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.
- 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
An important fact of life needs to be kept in mind when reporting pituitary MRIs: small pituitary incidentalomas are relatively common, with up to 2-30% of autopsies identifying small asymptotic microadenomas.[1]