Frequency and variation of the posterior pituitary bright signal on MR images

Brooks, B S; Gammal, T el; Allison, J. B.; Hoffman, William H.

doi:10.2214/ajr.153.5.1033

Cited by 81 publications

(63 citation statements)

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“…The rate of detection of a PBS in normal adult subjects varies from 52% to 100%, 5,6,8,23 but the direction of the frequency encoding gradient (FEG) was found to have an impact on the rate of detection. When the FEG direction was anteroposterior, the PBS was detected in 100% of cases in one study, whereas it was detected in only 54% of cases when it was directed caudocephalad.…”

Section: Discussionmentioning

confidence: 99%

“…The PBS may be absent in up to 48% of normal subjects, more often in older patients. 5,23 Individual variations in the appearance of the PBS have been observed. Physiological conditions such as very young age, pregnancy, or lactation may result in an enlarged PBS.…”

mentioning

confidence: 93%

“…This phenomenon, often referred to as the pituitary bright spot (PBS), is thought to result from the T1-shortening effect of stored vasopressin in the posterior lobe of the pituitary 1,12 and is observed in 100% of children 15,17 and in 52% to 100% of adults 5,6,8,19,22 without pituitary disease. The PBS may be absent in up to 48% of normal subjects, more often in older patients.…”

mentioning

confidence: 99%

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Normal dimensions of the posterior pituitary bright spot on magnetic resonance imaging

Côté¹,

Salzman

Sorour³

et al. 2014

JNS

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A n area of T1 hyperintensity is normally observed in the posterior part of the sella turcica on MR images of the brain. This phenomenon, often referred to as the pituitary bright spot (PBS), is thought to result from the T1-shortening effect of stored vasopressin in the posterior lobe of the pituitary 1,12 and is observed in 100% of children 15,17 and in 52% to 100% of adults 5,6,8,19,22 without pituitary disease. The PBS may be absent in up to 48% of normal subjects, more often in older patients.5,23 Individual variations in the appearance of the PBS have been observed. Physiological conditions such as very young age, pregnancy, or lactation may result in an enlarged PBS. 2An abnormal PBS can also be seen in various pathological processes. Central diabetes insipidus (DI) results from low blood levels of vasopressin and may be primary or secondary to a number of causes. In primary central DI, the PBS has been found to be absent in 25% to 100% of cases. 12,15,17 Secondary central DI is a feature of Langerhans cell histiocytosis, germinoma, teratoma, craniopharyngioma, idiopathic giant cell granulomatous hypophysitis, and Wolfram syndrome. When DI was a presenting symptom of one of these conditions, the PBS was always absent. 7,9,12,15,17,18 In conditions in which the posterior pituitary is depleted of its vasopressin granules, the hyperintense T1 signal can also be lost. An absent PBS was observed in 32% of patients with uncontrolled diabetes mellitus 11 and in a patient with severe anorexia nervosa. 21Finally, when the pituitary stalk is interrupted, the vasopressin synthesized in the hypothalamus does not reach the posterior pituitary. The absence of a normal PBS in these cases is often accompanied by an ectopic bright spot due to the storage of vasopressin granules in another anatomical location. A patient with pituitary dwarfism was found to have an absent PBS with an ectopic bright spot. 24Acquired section of the pituitary stalk of traumatic or surgical origin has also been found to result in an absent PBS and ectopic bright spot. Object. The normal pituitary bright spot seen on unenhanced T1-weighted MRI is thought to result from the T1-shortening effect of the vasopressin stored in the posterior pituitary. Individual variations in its size may be difficult to differentiate from pathological conditions resulting in either absence of the pituitary bright spot or in T1-hyperintense lesions of the sella. The objective of this paper was to define a range of normal dimensions of the pituitary bright spot and to illustrate some of the most commonly encountered pathologies that result in absence or enlargement of the pituitary bright spot.Methods. The authors selected normal pituitary MRI studies from 106 patients with no pituitary abnormality. The size of each pituitary bright spot was measured in the longest axis and in the dimension perpendicular to this axis to describe the typical dimensions. The authors also present cases of patients with pituitary abnormalities to highlight the differences and potential ov...

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Section: Discussionmentioning

confidence: 99%

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confidence: 93%

mentioning

confidence: 99%

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Normal dimensions of the posterior pituitary bright spot on magnetic resonance imaging

Côté¹,

Salzman

Sorour³

et al. 2014

JNS

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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. There is also uncertainty regarding the physical appearance of the normal gland and its correlation to pituitary axis dysfunction.…”

Section: 15mentioning

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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“…The absence of this finding serves as a nonspecific indicator of DI, although the frequency of hyperintensity declines with aging in normal subjects (Brooks, el Gammal et al 1989). The frequency of these radiologic abnormalities in patients with DI is poorly defined.…”

Section: Imaging Studies Of the Hypothalamic-pituitary Region After Tmentioning

confidence: 99%

Diabetes Insipidus and Traumatic Brain Injury

Chou¹,

Wang²,

Chou³

2011

Diabetes Insipidus

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Frequency and variation of the posterior pituitary bright signal on MR images

Cited by 81 publications

References 9 publications

Normal dimensions of the posterior pituitary bright spot on magnetic resonance imaging

Normal dimensions of the posterior pituitary bright spot on magnetic resonance imaging

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

Diabetes Insipidus and Traumatic Brain Injury

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