Pituitary stalk thickening: the role of an innovative MRI imaging analysis which may assist in determining clinical management

Abstract

Context: Disease processes that affect the pituitary stalk are broad; the diagnosis and management of these lesions remains unclear. Objective: The aim was to assess the clinical, biochemical and histopathological characteristics of pituitary stalk lesions and their association with specific MRI features in order to provide diagnostic and prognostic guidance. Design and methods: Retrospective observational study of 36 patients (mean age 37 years, range: 4-83) with pituitary stalk thickening evaluated at a university hospital in Oxford, UK, 2007UK, -2015. We reviewed morphology, signal intensity, enhancement and texture appearance at MRI (evaluated with the ImageJ programme), along with clinical, biochemical, histopathological and long-term follow-up data. Results: Diagnosis was considered certain for 22 patients: 46% neoplastic, 32% inflammatory and 22% congenital lesions. In the remaining 14 patients, a diagnosis of a non-neoplastic disorder was assumed on the basis of long-term follow-up (mean 41.3 months, range: 12-84). Diabetes insipidus and headache were common features in 47 and 42% at presentation, with secondary hypogonadism the most frequent anterior pituitary defect. Neoplasia was suggested on size criteria or progression with 30% sensitivity. However, textural analysis of MRI scans revealed a significant correlation between the tumour pathology and pituitary stalk heterogeneity in pre-and post-gadolinium T1-weighted images (sensitivity: 88.9%, specificity: 91.7%). Conclusions: New techniques of MRI imaging analysis may identify clinically significant neoplastic lesions, thus directing future therapy. We propose possible textural heterogeneity criteria of the pituitary stalk on pre-and postgadolinium T1 images with the aim of differentiating between neoplastic and non-neoplastic lesions with a high degree of accuracy.

Diabetes insipidus is an unfavorable prognostic factor for response to glucocorticoids in patients with autoimmune hypophysitis

“…In a retrospective study carried out on 152 patients over 20 years, Turcu et al found that a V-shape or a roundshape of the stalk was the only feature most frequently associated with AH (6). Besides, in a recent study (15), it was reported that stalk lesions with a diameter greater than 9 mm were likely to be of neoplastic nature. The current series of patients satisfied either the morphological criteria or the stalk diameter criteria.…”

Late Effects of Parasellar Lesion Treatment: Hypogonadism and Infertility

“…Computed tomography scans are generally considered to offer the most information, as they enable an accurate assessment of bony details and calcifications. However, magnetic resonance imaging is the imaging technique of choice, as it produces multiplanar high-contrast images, while more recent advanced magnetic resonance imaging techniques such as diffusion-weighted imaging and perfusion-weighted imaging [3][4][5] can better define the morphological characteristics of the lesion. 18 F-fluoro-deoxyglucose and 68 Ga-positron emission tomography can be used for functional imaging, but only in specific tumour settings [6,7].…”

ENDOCRINOLOGY AND ADOLESCENCE: Dealing with transition in young patients with pituitary disorders

“…Intracranial tumours can lead to acquired HH in the transition age. HH can be due to the compression of pituitary tissue or pituitary stalk or secondary to inhibition of GnRH secretion in patients with prolactinomas or Cushing's disease (30,31). HH due to prolactinomas are usually treated medically, while surgery is generally first-line treatment for other tumours (32).…”