Magnetic resonance imaging of the hypothalamic-neurohypophyseal system

Magnetic resonance imaging (MRI) is a revolutionary advance in diagnostic imaging of the hypothalamic-neurohypophyseal system (HNS). The detailed anatomy of the sellar and parasellar region is clearly visible using MRI, because it has no bony artifacts and multidirectional capability. The posterior lobe of the pituitary gland displays a characteristic bright signal on the MR T1-weighted image (T1WI), and is distinctly separated from the anterior lobe. The bright signal is absent in patients with central diabetes insipidus, and is thought to reflect normal vasopressin storage in the posterior lobe. The signal intensity ratio of the posterior lobe to the pons on T1WI is strongly correlated with vasopressin content in the posterior lobe. In addition to the morphological evaluation, MRI provides unique information concerning the function of the HNS. The MRI findings of the HNS (normal condition, central diabetes insipidus, a depleted posterior lobe, an ectopic posterior lobe, and a damming-up phenomenon of the neurosecretory vesicles in the pituitary stalk) are demonstrated in this article.