Dynamic gadolinium-enhanced MR imaging of pituitary adenomas: usefulness of sequential sagittal and coronal plane images

doi:10.1016/S0720-048X(01)00354-0

European Journal of Radiology

Volume 39, Issue 3, September 2001, Pages 139-146

https://doi.org/10.1016/S0720-048X(01)00354-0 Get rights and content

Abstract

Dynamic magnetic resonance (MR) imaging for pituitary adenomas is usually performed in a coronal direction; however, small lesions between slices, or lesions located at the anterior or posterior aspect of the pituitary gland might be overlooked on MR images in only the coronal direction. The purpose of our study was to evaluate whether consecutive dynamic MR images in the coronal and sagittal planes improve detection of pituitary adenomas. Eighteen patients with pituitary microadenomas and nine with healthy pituitary glands were included in this study. MR images were performed with 1.5 T superconductive units and commercially-available head coils. After a 5 ml gadolinium contrast injection, eight serial dynamic sagittal images were obtained. Within 3 or 6 min, this was followed by a 10–15 ml gadolinium injection and acquisition of eight serial dynamic coronal images. Dynamic MR images and conventional noncontrast- and contrast-enhanced sagittal and coronal T1-weighted images were evaluated independently in a blind fashion by two neuroradiologists regarding the depiction of pituitary microadenomas. The sensitivities of dynamic enhanced MR imaging in the detection of microadenomas were 61.1% in sagittal direction, 72.2% in coronal direction respectively, and were superior to those of conventional noncontrast- and contrast-enhanced T1-weighted imaging (22.2–50%). The sensitivity of a combination of sagittal and coronal dynamic enhanced MR imaging for the detection of microadenomas was 88.9% and was superior to those of conventional noncontrast- and contrast-enhanced T1-weighted imaging combining sagittal and coronal directions (61.1%, 61.1%) (P<0.05, P<0.05, respectively). The specificity and accuracy of dynamic enhanced MR imaging with combination of sagittal and coronal images was 88.9% respectively. Dynamic gadolinium-enhanced MR imaging, especially using both sagittal and coronal planes, was concluded to be useful for the detection of pituitary microadenomas.

Introduction

The healthy pituitary gland is rapidly enhanced by contrast medium due to the lack of blood brain barrier. When using contrast material, the posterior pituitary gland enhances first, followed by enhancement of the pituitary stalk and then the anterior pituitary gland [1], [2], [3], [4], [5]. Furthermore, pituitary adenomas are gradually enhanced [1], [2], [4], [6], [7], or rapidly enhanced [4], [5], [6], [7] as compared with a normal anterior pituitary gland. The contrast between pituitary adenomas and a normal pituitary gland is estimated to be much higher in the early phase after injection of contrast material than in the late phase [1], [2], [4], [5], [6], [7]. Therefore dynamic gadolinium-enhanced MR imaging of the pituitary gland enables distinction of normal pituitary structures from adenomas.

Dynamic MR imaging for pituitary adenomas is usually performed in a coronal direction [1], [4], [7], [8], [9], however, small lesions between slices, or lesions located at the anterior or posterior aspect of the pituitary gland, might be overlooked on MR images using only the coronal direction. We thought that sagittal plane images may be required to improve diagnostic accuracy. Therefore, we attempted to obtain, within a few minutes, both sagittal and coronal dynamic gadolinium-enhanced MR images for each patient. The purpose of our study was to assess whether sequential dynamic MR images in the coronal and sagittal planes are useful in the detection of pituitary microadenomas.

Section snippets

Methods and materials

This study consisted of 18 patients (seven males and 11 females, aged 25–72 years; average age 41.6 years) with pituitary microadenomas (five adrenocorticotropin hormone producing adenomas, one growth hormone producing adenoma, two thyroid stimulating hormone producing adenomas, six prolactinomas, and four nonfunctioning adenomas) and nine normal subjects (three males and six females, aged 28–53 years; average age 39.1 years). Diagnoses of pituitary microadenomas were made by surgical and

Results

The sensitivities of dynamic enhanced sagittal MR imaging for the detection of pituitary microadenomas were 61.1%, and were superior to sensitivities (22.2%) of conventional noncontrast-enhanced sagittal T1-weighted imaging (P<0.01) (Table 1). The sensitivities of dynamic enhanced coronal MR imaging for the detection of pituitary microadenomas were 72.2%, and were superior to sensitivities (50% and 44.4%) of conventional noncontrast- and contrast-enhanced coronal T1-weighted imaging (P<0.05, P

Discussion

A normal posterior pituitary lobe receives direct arterial blood supply from the inferior hypophyseal arteries; blood is supplied to the stalk from the superior hypophyseal arteries; and the anterior lobe is supplied with blood from the superior hypophyseal arteries indirectly through the pituitary portal system [2], [3], [5]. Therefore, in the dynamic gadolinium-enhanced MR imaging of pituitary glands, contrast enhancement was estimated to be viewed in the following order described in

References (13)

Y Miki et al.
Pituitary adenomas and normal pituitary tissue: enhancement patterns on gadopentetate-enhanced MR imaging
Radiology
(1990)
Y Sakamoto et al.
Normal and abnormal pituitary glands: gadopentetate dimeglumine-enhanced MR imaging
Radiology
(1991)
R.D Tien
Sequence of enhancement of various portions of the pituitary gland on gadolinium-enhanced MR images: correlation with regional blood supply
AJR
(1991)
D.A Finelli et al.
Varied microcirculation of pituitary adenomas at rapid, dynamic, contrast-enhanced MR imaging
Radiology
(1993)
W.T.C Yuh et al.
Sequential MR enhancement pattern in normal pituitary gland and in pituitary adenoma
AJNR
(1994)
J.F Bonneville et al.
Pituitary microadenomas: early enhancement with dynamic CT-implications of arterial blood supply and potential importance
Radiology
(1993)

There are more references available in the full text version of this article.

Cited by (34)

Golden-angle radial sparse parallel (GRASP) MRI in clinical routine detection of pituitary microadenomas: First experience and feasibility
2019, Magnetic Resonance Imaging
Citation Excerpt :
Moreover, the thinner slice thickness in GRASP results in less volume averaging, theoretically increasing sensitivity of very small microadenomas. Additionally, the isotropic voxels in GRASP allow for sagittal reconstruction of the first-pass dynamic contrast enhanced study, a method already shown to increase sensitivity in microadenoma detection [5] currently requiring, however, dedicated sagittal slices and a second administration of double or even triple dose contrast. Again, the advantage of GRASP is clear, all planes can be assessed using only a single dose of contrast.
Background and purpose
To demonstrate the clinical feasibility of a novel MRI pulse sequence, Golden-angle radial sparse parallel MRI (GRASP) through comparison to the current imaging technique, dynamic T1- weighted contrast enhanced (DCE) imaging in terms of image quality and lesion depiction in the detection of microlesions (microadenomas and cysts) of the pituitary gland.
16 patients (11 microadenomas, 5 cysts) underwent two MRI examinations (Siemens 1.5T and 3T) on separate dates, one using standard DCE (temporal resolution 30 s) and the other using GRASP (temporal resolution of 4.4 s). Two neuroradiologists separately recorded measures of image quality (Scale 1–5, 5 = best), lesion size and contrast arrival times in terms of first and best lesion conspicuity.
In qualitiative analysis there were no significant differences in terms of average visual image sharpness (DCE 3.9 ± 0.9, GRASP 3.9 ± 0.9) or visual contrast scores (DCE 4.1 ± 1.2, GRASP 4.4 ± 0.8). Pearson's correlation coefficients for interreader lesion measurements (width and height, mm) ranged from substantial to almost perfect agreement (r = 0.73 to 0.88). Analysis of contrast arrival times revealed an average lesion first-conspicuity time of 60.7 ± 16.7 s for DCE compared to 50.2 ± 10.3 s for GRASP with a difference of 10.5 ± 16.2 s (p = 0.023).
Depiction of pituitary microlesions is feasible with GRASP, which has the potential to increase sensitivity through higher temporal resolutions combined with isotropic acquisition allowing for multi-planar reconstructions; this remains to be proven in larger cohorts.
ACR Appropriateness Criteria<sup>®</sup> Neuroendocrine Imaging
2019, Journal of the American College of Radiology
Citation Excerpt :
MRI has been used to characterize tissue consistency [76] and has been used to predict response to therapy in cases of acromegaly [77]. Dynamic contrast-enhanced imaging of the pituitary is advocated by some authors for detection of microadenoma [78-80]. Additionally, recent studies have noted an increased sensitivity for spoiled gradient-echo 3-D T1 sequence in the detection of hormone-secreting adenomas [81].
Neuroendocrine dysfunction includes suspected hyper- and hypofunction of the pituitary gland. Causative lesions may include primary masses of the pituitary such as pituitary microadenomas and macroadenomas, as well as extrinsic masses, typically centered in the suprasellar cistern. Clinical syndromes related to hormonal dysfunction can be caused by excessive hormonal secretion or by inhibited secretion due to mass effect upon elements of the hypothalamic-pituitary axis. Additionally, complications such as hemorrhage may be seen in the setting of an underlying mass and can result in hormonal dysfunction. MRI with high-resolution protocols is the best first-line test to evaluate the sella turcica and parasellar region. CT provides complementary information regarding bony anatomy, and may be appropriate as a first-line test in certain instances, but it provides less detail and lesion characterization when compared to MRI.
The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Magnetic resonance imaging characteristics and surgical results of adrenocorticotropin-secreting pituitary adenomas
2008, Chinese Medical Sciences Journal
To evaluate magnetic resonance imaging (MRI) characteristics and surgical results of adrenocorticotropin (ACTH)-secreting pituitary adenomas.
MRI characteristics and relationship between MRI positive rate and surgical results of 266 patients with pathologically confirmed Cushing's disease were analyzed retrospectively. All patients underwent thin-section sagittal and coronal scans of the pituitary gland before and after administration of gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) on a 1.5 Tesla MRI scanner, and dynamic enhanced MRI was performed in 39 patients. All patients underwent transsphenoidal adenomectomy. Endocrinological examinations and assessments were performed.
Preoperative MRI revealed normal results in 41 (15.4%) cases, microadenoma in 179 (67.3%), macroadenoma in 42 (15.8%), and huge adenoma in 4 (1.5%). Pituitary apoplexy was found in 13 (4.9%) cases. Positive rate of ACTH-secreting adenomas was 84.6% (225/266) on MRI scans, and that of small microadenomas was 87.2% (34/39) on dynamic enhanced MRI scans. Preoperative endocrinological tests of 199 cases supported the diagnosis of typical Cushing's disease, while the other 67 cases had atypical endocrinological results. The endocrinological cure rate, remission rate, and inefficacy rate were 85.7%, 7.9%, and 6.4%, respectively. There was no difference in the initial endocrinological cure rate between the patients with positive and normal MRI results (90% vs. 87.8%, P = 0.904).
Enhanced coronal pituitary MRI is helpful for preoperative localization of ACTH-secreting pituitary microadenoma. Dynamic enhanced MRI may improve detection rate of microadenoma. There is no marked difference in the surgical results for patients with preoperative MRI results indicating presence or absence of microadenoma.
Dynamic MR imaging for diagnosis of lesions adjacent to pituitary gland
2005, European Journal of Radiology
In this study, we evaluated the usefulness of dynamic studies for the preoperative diagnosis of tumor lesions adjacent to the pituitary gland. We examined 13 tumors. We obtained pre- and post-contrast thin slice T1-weighted images of the sellar regions. FSE sequences were used for dynamic study. The capability to distinguish the tumor from the pituitary gland and additional information obtained from the dynamic study were evaluated. Two meningiomas were identified more clearly on the dynamic than on the delayed study. In two cavernous hemangiomas, the peripheral nodular stains gradually increased during the dynamic study. For the preoperative evaluation of lesions adjacent to the pituitary gland, the dynamic study can often identify the lesions more clearly and may provide additional information.
Pituitary adenomas: An overview
2013, American Family Physician
Citation Excerpt :
If a pituitary mass is suspected, MRI is the best initial imaging study.7 MRI is 61% to 72% sensitive and 88% to 90% specific for sellar masses.20,21 The study should be done with and without gadolinium enhancement.
Prolactinomas and nonfunctioning adenomas are the most common types of pituitary adenomas. Patients with pituitary adenomas may present initially with symptoms of endocrine dysfunction such as infertility, decreased libido, and galactorrhea, or with neurologic symptoms such as headache and visual changes. The diagnosis may also be made following imaging done for an unrelated issue in an asymptomatic patient; this is termed a pituitary incidentaloma. Oversecretion of hormones from a dysfunctional pituitary gland may result in classic clinical syndromes, the most common of which are hyperprolactinemia (from oversecretion of prolactin), acromegaly (from excess growth hormone), and Cushing disease (from overproduction of adrenocorticotropic hormone). In the diagnostic approach to a suspected pituitary adenoma, it is important to evaluate complete pituitary function, because hypopituitarism is common. Therapy for pituitary adenomas depends on the specific type of tumor, and should be managed with a team approach to include endocrinology and neurosurgery when indicated. Dopamine agonists are the primary treatment for prolactinomas. Small nonfunctioning adenomas and prolactinomas in asymptomatic patients do not require immediate intervention and can be observed.
Sphenopalatine ganglion volumetry in episodic cluster headache: from symptom laterality to cranial autonomic symptoms
2023, Journal of Headache and Pain

View all citing articles on Scopus

View full text

Dynamic gadolinium-enhanced MR imaging of pituitary adenomas: usefulness of sequential sagittal and coronal plane images

Abstract

Introduction

Section snippets

Methods and materials

Results

Discussion

Pituitary adenomas and normal pituitary tissue: enhancement patterns on gadopentetate-enhanced MR imaging

Radiology

Normal and abnormal pituitary glands: gadopentetate dimeglumine-enhanced MR imaging

Radiology

Sequence of enhancement of various portions of the pituitary gland on gadolinium-enhanced MR images: correlation with regional blood supply

AJR

Varied microcirculation of pituitary adenomas at rapid, dynamic, contrast-enhanced MR imaging

Radiology

Sequential MR enhancement pattern in normal pituitary gland and in pituitary adenoma

AJNR

Pituitary microadenomas: early enhancement with dynamic CT-implications of arterial blood supply and potential importance

Radiology