Danial K. Hallam1

1 University of Washington, Seattle, Washington
Publication Name:  Current Protocols in Magnetic Resonance Imaging
Unit Number:  Unit A5.2
DOI:  10.1002/0471142719.mia0502s03
Online Posting Date:  February, 2002
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Benefiting from superior tissue contrast, multi‐planar capability and lack of bone artifact, MRI readily depicts complex anatomy in and about the pituitary gland. This unit presents three basic protocols for common indications relating to pathology of the sella and parasellar region. The protocols differ in emphasis more than in concept, and share a basic theme of thin slice high‐resolution imaging including the use of gadolinium. With the possible exception of dynamic imaging, all protocols may be readily performed on any MR scanner.

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Table of Contents

  • Basic Protocol 1: Macroadenoma
  • Alternate Protocol 1: Status Post Transphenoidal Surgery
  • Basic Protocol 2: Microadenoma
  • Basic Protocol 3: Cavernous Sinus
  • Commentary
  • Figures
  • Tables
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Basic Protocol 1: Macroadenoma

  • Normal saline (0.9% NaCl), sterile
  • Extravascular contrast agent (e.g., Magnevist, Omniscan, or Prohance)
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Literature Cited

Literature Cited
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   Elster, A.D. 1993. Modern imaging of the pituitary. Radiology 187:1‐14.
   Elster, A.D. 1994. High‐resolution, dynamic pituitary MR imaging: Standard of care or academic pastime? [comment]. Am. J. Roentgenol. 163:680‐682.
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   Knosp, E., Steiner, E., Kitz, K., and Matula, C. 1993. Pituitary adenomas with invasion of the cavernous sinus space: A magnetic resonance imaging classification compared with surgical findings [see comments]. Neurosurgery 33:610‐617; discussion 617‐618.
   Kovacs, K. and Horvath, E. 1986. Tumors of the Pituitary Gland. Armed Forces Institute of Pathology, Washington, D.C.
   Kucharczyk, W., Davis, D.O., Kelly, W.M., Sze, G., Norman, D., and Newton, T.H. 1986. Pituitary adenomas: high‐resolution MR imaging at 1.5 T. Radiology 161:761‐765.
   Kucharczyk, W., Bishop, J.E., Plewes, D.B., Keller, M.A., and George, S. 1994. Detection of pituitary microadenomas: comparison of dynamic keyhole fast spin‐echo,unenhanced, and conventional contrast‐enhanced MR imaging [see comments]. Am. J. Roentgenol. 163:671‐679.
   Lundin, P., Bergstrom, K., Thuomas, K.A., Lundberg, P.O., and Muhr, C. 1991. Comparison of MR imaging and CT in pituitary macroadenomas. Acta Radiol. 32:189‐196.
   Macpherson, P., Hadley, D.M., Teasdale, E., and Teasdale, G. 1989. Pituitary microadenomas. Does Gadolinium enhance their demonstration? Neuroradiology 31:293‐298.
   Nagele, T., Petersen, D., Klose, U., Grodd, W., Opitz, H., Gut, E., Martos, J., and Voigt, K. 1993. Dynamic contrast enhancement of intracranial tumors with snapshot‐FLASH MR imaging. Am. J. Neuroradiol. 14:89‐98.
   Newton, D.R., Dillon, W.P., Norman, D., Newton, T.H., and Wilson, C.B. 1989. Gd‐DTPA‐enhanced MR imaging of pituitary adenomas. Am. J. Neuroradiol. 10:949‐954.
   Nichols, D.A., Laws, E.R. Jr., Houser, O.W., and Abboud, C.F. 1988. Comparison of magnetic resonance imaging and computed tomography in the preoperative evaluation of pituitary adenomas. Neurosurgery 22:380‐385.
   Peck, W.W., Dillon, W.P., Norman, D., Newton, T.H., and Wilson, C.B. 1989. High‐resolution MR imaging of pituitary microadenomas at 1.5 T: experience with Cushing disease. Am. J. Roentgenol. 152:145‐151.
   Scotti, G., Yu, C.Y., Dillon, W.P., Norman, D., Colombo, N., Newton, T.H., De Groot, J., and Wilson, C.B. 1988. MR imaging of cavernous sinus involvement by pituitary adenomas. Am. J. Roentgenol. 151:799‐806.
   Shellock, F.G. 1996. Pocket Guide to MR Procedures and Metallic Objects. Lippincott‐Raven, Philadelphia.
   Stadnik, T., Stevenaert, A., Beckers, A., Luypaert, R., Buisseret, T., and Osteaux, M. 1990. Pituitary microadenomas: Diagnosis with two‐and three‐dimensional MR imaging at 1.5 T before and after injection of gadolinium. Radiology 176:419‐428.
   Steiner, E., Imhof, H., and Knosp, E. 1989. Gd‐DTPA enhanced high resolution MR imaging of pituitary adenomas. Radiographics 9:587‐598.
   Teramoto, A., Hirakawa, K., Sanno, N., and Osamura, Y. 1994. Incidental pituitary lesions in 1,000 unselected autopsy specimens. Radiology 193:161‐164.
Key References
   Shellock, 1996. See above.
  Covers a number of important patient management issues related to MR imaging, including recommended safety procedures, a list of metallic implants that have been tested for MR compatibility, and a list of other sources on MR safety.
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