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Role of MRI in Assessment of Pituitary Lesions: A Case Series of Pituitary Masses

Authors: Fozia Raza,; GS Rai,; Abhinesh Saraf;

Role of MRI in Assessment of Pituitary Lesions: A Case Series of Pituitary Masses

Abstract

{"references": ["1. Asa SL, Ezzat S. The Cytogenesis and Pathogenesis of Pituitary Adenomas. Endocr Rev. 1998; 19(6): 798\u2013827. doi:10.1210/er.19.6.798. 2. Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, McCutcheon IE. The prevalence of pituitary adenomas: A systematic review. Cancer. 2004; 101(3): 613\u2013619. doi:10.1002/cncr.20412. 3. Bunin GR, Surawicz TS, Witman PA, Preston-Martin S, Davis F, Bruner JM. The descriptive epidemiology of craniopharyngioma. J Neurosurg. 1998; 89(4): 547\u2013551. doi:10.3171/jns.1998.89.4.0547. 4. Basari R, Srivastava V, Vasenwala S, Ansari H. Pituitary adenoma: A case report with special emphasis on approach to diagnosis. Clin Cancer Investig. J 2014; 3(3): 264. doi:10.4103/2278- 0513.132129. 5. Bonneville J-F, Cattin F, Bonneville F. Imagerie des ad\u00e9nomes hypophysaires. Presse Med. 2009; 38(1): 84\u201391. doi:10.1016/j.lpm.2008.09.014. 6. Davies BM, Carr E, Soh C, Gnanalingham KK. Assessing size of pituitary adenomas: a comparison of qualitative and quantitative methods on MR. Acta Neurochir (Wien). 2016; 158(4): 677\u2013683. doi:10.1007/s00701-015-2699-7. 7. Indrajit IK, Chidambaranathan N, Sundar K, Ahmed I. Value of dynamic MRI imaging in pituitary adenomas. Indian J Radiol Imaging. 2001; 11(4): 185\u2013190. 8. Osborn AG, Hedlund G, Salzman KL. Sellar neoplasms and tumor-like lesions. In: Osborn\u00b4s Brain, 2 Edn.; Elsevier, 2018: 771\u2013818. nd 9. Leeds NE, Naidich TP. Computerized tomography in the diagnosis of sellar and parasellar lesions. Semin Roentgenol. 1977; 12(2): 121\u2013135. doi:10.1016/0037- 198X(77)90014-1.", "10. Cottier JP, Destrieux C, Brunereau L, Bertrand P, Moreau L, Jan M, Herbreteau D. Cavernous sinus invasion by pituitary adenoma: MR imaging. Radiology. 2000; 215(2): 463\u2013469. doi:10.1148/ radiology.215.2.r00ap18463. 11. Matsuki M, Kaji Y, Matsuo M, Kobashi Y. MR findings of subarachnoid dissemination of a pituitary adenoma. Br J Radiol. 2000; 73(871): 783\u2013785. doi:10.1259 /bjr.73.871.11089473. 12. Connor SEJ, Wilson F, Hogarth K. Magnetic resonance imaging criteria to predict complete excision of parasellar pituitary macroadenoma on postoperative imaging. J Neurol Surgery, Part B Skull Base. 2014; 75(1): 41\u201346. doi:10.1055/s-0033-1353362. 13. Pierallini A, Caramia F, Falcone C, Tinelli E, Paonessa A, Ciddio AB, Fiorelli M, Bianco F, Natalizi S, Ferrante L, Bozzao L. Pituitary macroadenomas: Preoperative evaluation of consistency with diffusion-weighted MR imaging - Initial experience. Radiology. 2006; 239(1): 223\u2013231. doi:10.1148/radiol.2383042204.", "14. Argyropoulou M, Kiortsis D. Magnetization transfer imaging of the pituitary gland. Hormones. 2003; 2(2): 98\u2013102. doi:10.14310/horm.2002.1188. 15. Stadlbauer A, Buchfelder M, Nimsky C, Saeger W, Salomonowitz E, Pinker K, Richter G, Akutsu H, Ganslandt O. Proton magnetic resonance spectroscopy in pituitary macroadenomas: Preliminary results - Laboratory investigation. J Neurosurg. 2008; 109(2): 306\u2013312. doi:10.3171/JNS/2008/109/8/0306. 16. Schwartz TH, Stieg PE, Anand VK. Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging. Neurosurgery. 2006; 58(SUPPL.1). doi:10.1227/01.NEU. 0000 19 3927 .49862.B6."]}

Pituitary masses are relatively common among general population with incidence varying from 10-12 percent. Most of these lesions are small, even microscopic; consequently, most patients are asymptomatic. Unnecessary surgery should be avoided by improving understanding of disease and its natural history. To diagnose intracranial pathology, we have conducted an observational case series of patients referred to the Department of Radiodiagnosis PCMS and RC for MRI brain. Patients with pituitary masses were identified with pituitary enlargement nearby or approaching the sellar region on MR imaging. The first patient presented with craniopharyngioma of adamantinomatous type. The second patient was diagnosed with pituitary macro adenoma, while third patient was diagnosed after observing small nodule in anterior lobe of pituitary in left half suggestive of micro adenoma. The fourth patient likely had cystic / necrotic transformation of previous macro adenoma with haemorrhage. The fifth patient's MRI Brain reveals empty sella. Dynamic contrast enhanced imaging played a crucial role in accurate localization of hormone secreting microadenomas and other pituitary lesions. MRI precisely assessed the invasion of cavernous sinus by macroadenomas on contrast enhanced imaging. MRI is undoubtedly an indispensible tool to evaluate hypothalamic-pituitary related endocrine disease. MRI not only provides diagnosis, but also helps to plan surgical strategies due to its ability to provide multiplanar details of anatomical relationship of the gland to surrounding structures. It is also a method of choice for follow-up imaging in order to determine the response to conservative therapy as well as to identify remnant lesions/recurrence in postoperative situations. A comprehensive hormonal, radiological and even occasionally ophthalmological examination should be done for patients suspicious of developing pituitary masses. This is best done by a specialized multidisciplinary approach with a preference for the treatment of underlying conditions and constant monitoring for surgery.

Keywords

craniopharyngioma, dynamic MRI, empty sella, microadenoma, pituitary macroadenoma

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