Large Pituitary Gland Adenomas Evaluated with Magnetic Resonance Imaging

Abstract Magnetic resonance imaging (MRI), computed tomographic (CT) scanning, and angiography or digital subtraction angiography (DSA) were used preoperatively to evaluate 16 surgically proven cases of sellar tumor with extrasellar extension. There were 15 pituitary tumors and 1 schwannoma. The capabilities of MRI in evaluating these tumors were compared with CT scanning and angiography. Bone destruction and tumor calcification were better detected by CT scanning than by MRI. MRI was as effective as CT scanning in detecting a cyst or variation in tumor consistency. Neither MRI nor CT scanning was capable of distinguishing specific tumor types. In every case, MRI was superior to CT scanning for delineating spatial relationships of the tumor to the 3rd ventricle, the optic apparatus, adjacent brain, and parasellar vasculature. Vessel encasement by tumor was clearly seen on MRI when there was no direct indication of this on other studies. Cavernous sinus invasion was not demonstrated by CT scanning, but was indicated by MRI in 5 cases and was surgically confirmed in 3. MRI can provide more precise spatial information on extrasellar tumor extension. Vascular encasement and cavernous sinus invasion may be determined preoperatively. Treatment expectations and operative approaches can be guided by this information. When MRI is available, it is the test of choice for the preoperative evaluation of patients with suspected large pituitary gland (sellar region) tumors. Contrast-enhanced CT scanning and angiography can be used as supplementary studies to add information inherently unique to these techniques. (Neurosurgery 21:540-546, 1987)

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Assessment of magnetic resonance imaging criteria for the diagnosis of cavernous sinus invasion by pituitary tumors

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2021.06.010 ◽

2021 ◽

Vol 90 ◽

pp. 262-267

Author(s):

Nicholas Chang ◽

Jessica W. Grayson ◽

João Mangussi-Gomes ◽

Sebastian Fung ◽

Raquel Alvarado ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Cavernous Sinus ◽

Pituitary Tumors ◽

Resonance Imaging ◽

Cavernous Sinus Invasion

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Magnetic resonance imaging appearance of the medial wall of the cavernous sinus for the assessment of cavernous sinus invasion by pituitary adenomas

Journal of Neuroradiology ◽

10.1016/j.neurad.2013.06.003 ◽

2013 ◽

Vol 40 (4) ◽

pp. 245-251 ◽

Cited By ~ 12

Author(s):

Lei Cao ◽

Hongjie Chen ◽

Jingfang Hong ◽

Ming Ma ◽

Qun Zhong ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Cavernous Sinus ◽

Pituitary Adenomas ◽

Medial Wall ◽

Resonance Imaging ◽

Cavernous Sinus Invasion ◽

Imaging Appearance ◽

Magnetic Resonance Imaging Appearance

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Evaluation of magnetic resonance imaging criteria for cavernous sinus invasion in patients with pituitary adenomas: logistic regression analysis and correlation with surgical findings

Surgical Neurology ◽

10.1016/j.surneu.2005.05.021 ◽

2006 ◽

Vol 65 (2) ◽

pp. 130-135 ◽

Cited By ~ 70

Author(s):

Joaquim O. Vieira ◽

Arthur Cukiert ◽

Bernardo Liberman

Keyword(s):

Magnetic Resonance Imaging ◽

Logistic Regression ◽

Regression Analysis ◽

Magnetic Resonance ◽

Cavernous Sinus ◽

Logistic Regression Analysis ◽

Pituitary Adenomas ◽

Resonance Imaging ◽

Cavernous Sinus Invasion

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Faculty Opinions recommendation of Magnetic resonance imaging changes in the pituitary gland following acute traumatic brain injury.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1103222.559073 ◽

2008 ◽

Author(s):

Nicolas Bruder

Keyword(s):

Magnetic Resonance Imaging ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Magnetic Resonance ◽

Pituitary Gland ◽

Resonance Imaging ◽

Acute Traumatic Brain Injury

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Migraine or idiopathic intracranial hypertension: Magnetic resonance venography and magnetic resonance imaging findings

The Neuroradiology Journal ◽

10.1177/1971400920919322 ◽

2020 ◽

Vol 33 (3) ◽

pp. 244-251

Author(s):

Aynur Guliyeva ◽

Melda Apaydin ◽

Yesim Beckmann ◽

Gulten Sezgin ◽

Fazil Gelal

Keyword(s):

Magnetic Resonance Imaging ◽

Optic Nerve ◽

Magnetic Resonance ◽

Intracranial Pressure ◽

Pituitary Gland ◽

Optic Nerve Sheath ◽

Imaging Findings ◽

Resonance Imaging ◽

Chi Square ◽

Nerve Sheath

Background Idiopathic intracranial hypertension (IIH) is a disease characterised by increased cerebral pressure without a mass or hydrocephalus. We aimed to differentiate migraine and IIH patients based on imaging findings. Results Patients with IIH ( n = 32), migraine patients ( n = 34) and control subjects ( n = 33) were evaluated. Routine magnetic resonance imaging, contrast-enhanced 3D magnetic resonance venography and/or T1-weighted 3D gradient-recalled echo were taken with a 1.5 T magnetic resonance scanner. Optic-nerve sheath distention, flattened posterior globe and the height of the pituitary gland were evaluated in the three groups. Transverse sinuses (TS) were evaluated with respect to score of attenuation/stenosis and distribution. Pearson chi-square, Fisher’s exact test and chi-square trend statistical analyses were used for comparisons between the groups. A p-value of <0.05 was considered statistically significant. Decreased pituitary gland height, optic-nerve sheath distention and flattened posterior globe were found to be statistically significant ( p < 0.001) in IIH patients. Bilateral TS stenosis was also more common in IIH patients than in the control group and migraine group ( p = 0.02). Conclusion Decreased pituitary gland height, optic-nerve sheath distention, flattened posterior globe, bilateral stenosis and discontinuity in TS are significant findings in differentiating IIH cases from healthy individuals and migraine patients. Bilateral TS stenosis may be the cause rather than the result of increased intracranial pressure. The increase in intracranial pressure, which is considered to be responsible for the pathophysiology of IIH, is not involved in the pathophysiology of migraine.

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Do We Need Intraoperative Magnetic Resonance Imaging in All Endoscopic Endonasal Pituitary Adenoma Surgery Cases? A Retrospective Study

Frontiers in Oncology ◽

10.3389/fonc.2021.733838 ◽

2021 ◽

Vol 11 ◽

Author(s):

Emrah Celtikci ◽

Muammer Melih Sahin ◽

Mustafa Caglar Sahin ◽

Emetullah Cindil ◽

Zuhal Demirtaş ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Pituitary Adenoma ◽

Magnetic Resonance ◽

Cavernous Sinus ◽

Residual Tumor ◽

Correct Prediction ◽

Resonance Imaging ◽

Mri Scan ◽

Endoscopic Endonasal ◽

Grade 3

There are previous reports investigating effectiveness of intraoperative magnetic resonance imaging (IO-MRI) in pituitary adenoma surgery but there is no clear data in the literature recommending when there is no need of intraoperative scan. This retrospective analysis was based on determining which patients does not need any IO-MRI scan following endoscopic endonasal pituitary adenoma surgery. Patients with functional or non-functional pituitary adenomas that were operated via endoscopic endonasal approach (EEA) between June 2017 and May 2019 were enrolled. Patients younger than 18 years old, patients who did not underwent IO-MRI procedure or not operated via EEA were excluded from the study. Hence, this study is designed to clarify if IO-MRI is useful in both functional and non-functional pituitary adenomas, functional adenomas did not split into subgroups. A total of 200 patients treated with pituitary adenoma were included. In Knosp Grade 0 – 2 group, primary surgeon’s opinion and IO-MRI findings were compatible in 150 patients (98.6%). In Knosp Grade 3 – 4 correct prediction were performed in 32 (66.6%) patients. When incorrectly predicted Knosp Grade 3 – 4 patients (n = 16) was analyzed, in 13 patients there were still residual tumor in cavernous sinus and in 3 patients there were no residual tumor. Fisher’s exact test showed there is a statistically significant difference of correct prediction between two different Knosp Grade groups (two-tailed P < 0.0001). Eighteen patients had a residual tumor extending to the suprasellar and parasellar regions which second most common site for residual tumor. Our findings demonstrate that there is no need of IO-MRI scan while operating adenomas limited in the sellae and not invading the cavernous sinus. However, we strongly recommend IO-MRI if there is any suprasellar and parasellar extension and/or cavernous sinus invasion.

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