Role of MRI in Assessment of Pituitary Lesions: A Case Series of Pituitary Masses
Authors/Creators
- 1. Department of Radiodiagnosis, People's College of Medical Sciences and Research Centre, Bhopal - 462037
Description
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.
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References
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