Hypopituitarism MRI
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American Roentgen Ray Society Images of Hypopituitarism MRI |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2] Iqra Qamar M.D.[3]
Overview
MRI is the imaging procedure of choice in the diagnosis of hypopituitarism. It is preferred over the CT scan as optic chiasm, pituitary stalk, and cavernous sinuses can be seen in MRI. An MRI lesion needs to be related to clinical and lab findings. The absence of an MRI lesion mostly indicates a non-organic etiology. Cystic lesions, such as Rathke's cleft cysts may have a low-intensity signal on T1-weighted images and a high-intensity signal on T2-weighted images. Meningiomas have a homogenous postcontrast enhancement than pituitary adenomas and have a suprasellar attachment. Hemorrhage into the pituitary gland results in a high-intensity signal on both T1- and T2-weighted images.
MRI
- MRI scan with intravenous gadolinium is the imaging procedure of choice in the diagnosis of hypopituitarism. It is preferred over the CT scan as optic chiasm, pituitary stalk, and cavernous sinuses can be seen in MRI[1]
- MRI is the single best imaging modality in the evaluation of sellar masses as certain findings are suggestive of some specific sellar masses and help to differentiate them
- If MRI is not possible due to any reason, high-resolution CT scan with contrast administration, in coronal plane, may be used as an alternative
- An magnetic resonance imaging (MRI) scan may show a three-dimensional image of pituitary gland, hypothalamus, and the surrounding intracranial structures
- MRI is used to detect the underlying cause of pituitary adenoma that can be seen as a mass with hormonal hypersecretion
- There is a positive correlation between MRI findings and the number of pituitary hormonal deficiencies[2][3]
- An MRI lesion needs to be related to clinical and lab findings. The absence of an MRI lesion mostly indicates a non-organic etiology
- MRI scan may show the following findings in cases of hypopituitarism:[4]
- Decreased size of the pituitary gland
- Empty sella may be noticed in some cases
- Pituitary stalk may be visible, thin, or totally absent
- Posterior lobe of the pituitary may be absent
- Mass may appear in the pituitary
- Ectopic posterior lobe of the pituitary gland may be observed in cases of pituitary dwarfism
- Infiltrative disorders such a sarcoidosis and histiocytosis may present as thickening of infundibulum[5]
- In central DI, T1 weighted MR shows absence of high internsity bright spot that is normally seen in posterior pituitary[6]
- Cystic lesions, such as Rathke's cleft cysts may have
- A low-intensity signal on T1-weighted images
- A high-intensity signal on T2-weighted images
- Meningiomas have a homogenous postcontrast enhancement than pituitary adenomas and have a suprasellar attachment[7]
- Hemorrhage into the pituitary gland results in a high-intensity signal on both T1- and T2-weighted images
Gallery
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![There is a well defined round lesion noted in the pituitary fossa, the lesion shows homogeneous contrast enhancement.[9]](/images/c/c8/Pituitary-macroadenoma-MR-T1-axial-post-01.jpg)
There is a well defined round lesion noted in the pituitary fossa, the lesion shows homogeneous contrast enhancement.[9]
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![There is a well defined round lesion noted in the pituitary fossa, the lesion is homogeneous and isodense on T1.[9]](/images/9/9c/Pituitary-macroadenoma-MR-T1-sag-01.jpg)
There is a well defined round lesion noted in the pituitary fossa, the lesion is homogeneous and isodense on T1.[9]
![There is a well defined round lesion noted in the pituitary fossa, the lesion shows homogeneous contrast enhancement.[9]](/index.php/File:Pituitary-macroadenoma-MR-T1-axial-post-01.jpg)
![There is a well defined round lesion noted in the pituitary fossa, the lesion is homogeneous and isodense on T1.[9]](/index.php/File:Pituitary-macroadenoma-MR-T1-sag-01.jpg)
References
- ↑ Vance, Mary Lee (1994). "Hypopituitarism". New England Journal of Medicine. 330 (23): 1651–1662. doi:10.1056/NEJM199406093302306. ISSN 0028-4793.
- ↑ Li G, Shao P, Sun X, Wang Q, Zhang L (2010). "Magnetic resonance imaging and pituitary function in children with panhypopituitarism". Horm Res Paediatr. 73 (3): 205–9. doi:10.1159/000284363. PMID 20197674.
- ↑ Child CJ, Zimmermann AG, Woodmansee WW, Green DM, Li JJ, Jung H, Erfurth EM, Robison LL (2011). "Assessment of primary cancers in GH-treated adult hypopituitary patients: an analysis from the Hypopituitary Control and Complications Study". Eur. J. Endocrinol. 165 (2): 217–23. doi:10.1530/EJE-11-0286. PMC 3132593. PMID 21646285.
- ↑ Pozzi Mucelli, R. S.; Frezza, F.; Magnaldi, S.; Proto, G. (1992). "Magnetic resonance imaging in patients with panhypopituitarism". European Radiology. 2 (1): 42–46. doi:10.1007/BF00714180. ISSN 0938-7994.
- ↑ Imashuku S, Kudo N, Kaneda S, Kuroda H, Shiwa T, Hiraiwa T, Inagaki A, Morimoto A (2011). "Treatment of patients with hypothalamic-pituitary lesions as adult-onset Langerhans cell histiocytosis". Int. J. Hematol. 94 (6): 556–60. doi:10.1007/s12185-011-0955-z. PMID 22015494.
- ↑ De Herder WW, Lamberts SW (1995). "Imaging of pituitary tumours". Baillieres Clin. Endocrinol. Metab. 9 (2): 367–89. PMID 7625990.
- ↑ Taylor SL, Barakos JA, Harsh GR, Wilson CB (1992). "Magnetic resonance imaging of tuberculum sellae meningiomas: preventing preoperative misdiagnosis as pituitary macroadenoma". Neurosurgery. 31 (4): 621–7, discussion 627. PMID 1407446.
- ↑ "File:Empty Sella MRT FLAIR sag 001.jpg - Wikimedia Commons". Text "Hellerhoff " ignored (help)
- ↑ 9.0 9.1 Case contributed by Radswiki Radiopaedia(original file ‘’here’’).Creative Commons BY-SA-NC
