The various MRI patterns of pituitary apoplexy

Abstract

The aim of this study was to describe the various MRI features, in correlation to surgical and pathological findings, in patients who presented with pituitary apoplexy (PA). Eleven patients presenting with PA, were evaluated with various MR protocols including spin-echo (SE) T1-weighted sequences in 9 of 11 patients, post gadolinium SE T1-weighted sequences in only 8 of 11 patients, and with T2-weighted SE sequences in 2 of 11 patients. All patients had transsphenoidal pituitary surgery after MR studies. The severity of presenting symptoms ranged from headaches to coma. Ten patients had pituitary macroadenoma; one had a non-hemorrhagic metastatic lesion into a non-adenomatous pituitary gland. Of the 11 patients, one was studied at the acute stage of PA (1 day after onset), 9 at the subacute period (3-15 days after onset), and one at the late stage (5 months after onset). Images compatible with intratumoral hemorrhage were found in all macroadenomas, whereas the metastatic pituitary lesion did not show evidence of bleeding. All gadolinium-enhanced studies showed partial tumoral enhancement. The SE T2-weighted studies demonstrated areas of low and high signal intensities in keeping with the presence of blood degradation contents. Pituitary apoplexy present with different MR features, including hemorrhagic and non-hemorrhagic characteristics on T1-weighted images. Gadolinium-enhanced images do not provide complementary diagnostic information when the presence of blood is assessed on plain images.

Osteochondroma of the Sella Turcica Presenting With Intratumoral Hemorrhage -Case Report-

“…Apoplectic sellar turcica tumors with hemorrhagic infarction such as pituitary adenomas, craniopharyngiomas, and Rathke cleft cysts show variable MR imaging intensity, 5,27,32) but characteristic MR imaging findings for sellar turcica osteochondroma with hemorrhage have not been previously reported. Few reports of MR imaging of non-hemorrhagic osteochondroma are available, 10,13,19,23,24,30) and observations include high intensity on T 1 -weighted MR imaging due to extension of fatty marrow into the tumor, 10) mixed laminated high and low intensity of the mass on both T 1 -and T 2 -weighted images, 19) central high intensity on T 1 -and T 2 -weighted images surrounded by a ring of low intensity, 23) and an irregular, well-demarcated mass appearing as high intensity on T 1 -weighted images and reticular mixed intensity on T 2 -weighted images.…”

Differentiation between Cystic Pituitary Adenomas and Rathke Cleft Cysts: A Diagnostic Model Using MRI

“…3 Intratumoral hemorrhage and ischemic infarction are common with larger pituitary adenomas, which may result in hemorrhagic or cystic changes or both, leading to various signal intensities on MR imaging. [4][5][6][7][8] Rathke cleft cyst (RCC) is a benign epithelial cyst believed to originate from the remnants of the Rathke pouch. 9 Typical imaging findings include a nonenhancing, noncalcified, intrasellar/ suprasellar cyst with an intracystic nodule.…”

Pituitary Apoplexy Manifesting as Diffuse Subarachnoid Hemorrhage-Case Report-

“…1,11,15,16) In this case, sagittal MR imaging demonstrated the intratumoral hemorrhage reaching the top of the tumor, in the area adjacent to the pituitary cistern.…”