Distortion of Normal Pituitary Structures in Sellar Pathologies on MRI

Sade, Burak; Mohr, Gérard; Vezina, J L

doi:10.1017/s0317167100003644

Cited by 10 publications

(7 citation statements)

References 20 publications

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“…MRI diagnosis value for cases of sellar region lesions has been recognized and MRI has been proved to be the best imaging method to observe pituitary structure and lesions (21). With higher signal-to-noise ratio and tissue contrast, 3.0T MRI can optimize the display of microscopic anatomical structures, improve spatial image resolution thus it is suitable to be used in study of pituitary lesions in children.…”

Section: Discussionmentioning

confidence: 99%

MRI features of growth hormone deficiency in children with short stature caused by pituitary lesions

Xu¹,

Zhang²,

Dong³

et al. 2017

Experimental and Therapeutic Medicine

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We verified the advantages of using magnetic resonance imaging (MRI) for improving the diagnostic quality of growth hormone deficiency (GHD) in children with short stature caused by pituitary lesions. Clinical data obtained from 577 GHD patients with short stature caused by pituitary lesions were retrospectively analyzed. There were 354 cases (61.3%) with anterior pituitary dysplasia; 45 cases (7.8%) of pituitary stalk interruption syndrome (PSIS); 15 cases (2.6%) of pituitary hyperplasia due to primary hypothyroidism; 38 cases (6.6%) of Rathke cleft cyst; 68 cases (11.8%) of empty sella syndrome; 16 cases (2.8%) of pituitary invasion from Langerhans cell histiocytosis; 2 cases (0.3%) of sellar regional arachnoid cyst and 39 cases (6.8%) of craniopharyngioma. MRI results showed that the height of anterior pituitary in patients was less than normal. Location, size and signals of posterior pituitary and pituitary stalk were normal in anterior pituitary dysplasia. In all cases pituitary hyperplasia was caused by hypothyroidism. MRI results showed that anterior pituitary was enlarged, and we detected upward apophysis and obvious homogeneous enhancement. There were no pituitary stalk interruption and abnormal signal. We also observed that after hormone replacement therapy the size of pituitary gland was reduced. Anterior pituitary atrophy was observed in Rathke cleft cyst, empty sella syndrome, sellar regional arachnoid cyst and craniopharyngioma. The microstructure of hypophysis and sellar region was studied with MRI. We detected pituitary lesions, and the characteristics of various pituitary diseases of GHD in children with short stature. It was concluded that in children with GHD caused by pituitary lesions, MRI was an excellent method for early diagnosis. This method offers clinical practicability and we believe it can be used for differential diagnosis and to monitor the therapeutic effects.

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Section: Discussionmentioning

confidence: 99%

MRI features of growth hormone deficiency in children with short stature caused by pituitary lesions

Xu¹,

Zhang²,

Dong³

et al. 2017

Experimental and Therapeutic Medicine

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show abstract

“…In all the patients, the axial, sagittal, and coronal series were evaluated, to specifically identify the NRPG including the neurohypophyseal bright spot (BS) and the residual adenohypophysis (RAH) on the pre- and post-gadolinium images, respectively. The maximal diameters in each plane were used to calculate the NRPG volume, which was compared with a database of 102 normal controls,[20] in order to obtain a percentage of the preoperative compression of the NRPG as well as the percent of the postoperative reconstitution. All pre- and postoperative MR images were also evaluated according to the detectability, location, and configuration of the pituitary gland.…”

Section: Methodsmentioning

confidence: 99%

Pre- and postoperative magnetic resonance imaging appearance of the normal residual pituitary gland following macroadenoma resection: Clinical implications

Maio

Biswas²,

Vezina³

et al. 2012

Surg Neurol Int

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Background:To assess the relationship between the preoperative magnetic resonance imaging (MRI) appearance of the normal residual pituitary gland (NRPG) and pituitary functional outcome following transsphenoidal resection of pituitary macroadenomas.Methods:We retrospectively reviewed the medical records of 100 consecutive patients with a pituitary macroadenoma, who underwent transsphenoidal resection. The preoperative configuration of the displaced NRPG was stratified as superior, superolateral or lateral. The extent of postoperative restitution of the NRPG was divided into four groups: Group 1 — normal residual gland or almost normal; Group 2 — more than 50% restitution; Group 3 — less than 50% of the normal residual gland; and Group 4 — barely visible or absent residual gland. The pre- and postoperative NRPG appearance was correlated with pituitary functional status.Results:Preoperatively, the NRPG was identifiable in 79 patients, with extrasellar displacement in 53%. The displacement pattern was superior in 8%, superolateral in 32%, and lateral in 58% of the patients. If the NRPG was displaced laterally, the ipsilateral cavernous sinus was not invaded by the pituitary macroadenoma. Partial or complete pituitary function was lost in 6 / 23 (26.1%) patients with superior or superolateral displacement of the NRPG, compared to only 1 / 36 (2.8%) patients without superior displacement of the NRPG (P = 0.025). Progressive postoperative reconstitution of the NRPG was related to the preservation of the pituitary hormonal axis (Pearson Chi-Square P < 0.001).Conclusions:Progressive displacement of the NRPG preoperatively, and lack of restitution of the NRPG on postoperative MRI appeared to correlate with the postoperative pituitary functional loss.

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“…4,19,20 Furthermore, localization of the normal gland distorted by sellar pathology often relies on inconsistent findings, such as a hyperintense posterior pituitary. 1,6 Qualitative descriptions only of mass in the pituitary fossa also fail to provide a reproducible guide for preoperative planning and intraoperative manipulation.…”

Section: 15mentioning

confidence: 99%

“…To date, a single study has taken this ap- proach. In a retrospective study, Sade et al 19 identified the normal gland via the "bright spot." They found an overall sensitivity of 58% in their patient population.…”

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confidence: 99%

Magnetic resonance imaging validation of pituitary gland compression and distortion by typical sellar pathology

Cho¹,

Barkhoudarian

Hsu³

et al. 2013

JNS

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A ccurAte identification of the normal pituitary gland in the setting of pituitary mass lesions helps to ensure a safe and thorough resection of pituitary lesions. 16,23 Preservation of the normal gland as well as the infundibulum after surgery also minimizes anterior pituitary dysfunction and diabetes insipidus (DI), making significant clinical impact on patient outcome. 12,15Although previous studies have described MRI characteristics of the normal pituitary gland as well as the gland affected by various lesions, few have correlated preoperative imaging with actual intraoperative findings. 4,19,20 Furthermore, localization of the normal gland distorted by sellar pathology often relies on inconsistent findings, such as a hyperintense posterior pituitary. 1,6 Qualitative descriptions only of mass in the pituitary fossa also fail to provide a reproducible guide for preoperative planning and intraoperative manipulation. There is also uncertainty regarding the physical appearance of the normal gland and its correlation to pituitary axis dysfunction. As a primary aim, this is a retrospective study to validate the MRI modality in its ability to localize the normal pituitary gland in relation to sellar pathology. It is a consecutive series of cases treated using a proven imaging modality, MRI, with a gold standard of surgery. As a secondary aim, this is an analysis of pituitary axis dysfunction as it relates to gland localization as well as gland compression as seen on imaging and during surgery.The overall goal is an improved understanding and prediction of normal pituitary location, which may influence surgical planning and decrease postoperative pituitary dysfunction. Object. Identification of the normal pituitary gland is an important component of presurgical planning, defining many aspects of the surgical approach and facilitating normal gland preservation. Magnetic resonance imaging is a proven imaging modality for optimal soft-tissue contrast discrimination in the brain. This study is designed to validate the accuracy of localization of the normal pituitary gland with MRI in a cohort of surgical patients with pituitary mass lesions, and to evaluate for correlation between presurgical pituitary hormone values and pituitary gland characteristics on neuroimaging.Methods. Fifty-eight consecutive patients with pituitary mass lesions were included in the study. Anterior pituitary hormone levels were measured preoperatively in all patients. Video recordings from the endoscopic or microscopic surgical procedures were available for evaluation in 47 cases. Intraoperative identification of the normal gland was possible in 43 of 58 cases. Retrospective MR images were reviewed in a blinded fashion for the 43 cases, emphasizing the position of the normal gland and the extent of compression and displacement by the lesion.Results. There was excellent agreement between imaging and surgery in 84% of the cases for normal gland localization, and in 70% for compression or noncompression of the normal gland. There was no consistent ...

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Distortion of Normal Pituitary Structures in Sellar Pathologies on MRI

Cited by 10 publications

References 20 publications

MRI features of growth hormone deficiency in children with short stature caused by pituitary lesions

MRI features of growth hormone deficiency in children with short stature caused by pituitary lesions

Pre- and postoperative magnetic resonance imaging appearance of the normal residual pituitary gland following macroadenoma resection: Clinical implications

Magnetic resonance imaging validation of pituitary gland compression and distortion by typical sellar pathology

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