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Pituitary microadenomas: diagnosis with two-and three-dimensional MR imaging at 1.5 T before and after injection of
T Stadnik1, A Stevenaert, A Beckers
1Department of Radiology and Medical Imaging, University Hospital Vrije Universiteit Brussel, Belgium.
Abstract:
The usefulness of different magnetic resonance (MR) imaging sequences (coronal and sagittal spin-echo [SE] and three-dimensional fast low-angle shot [3D FLASH]) in the detection of pituitary microadenomas before and after gadolinium injection was prospectively evaluated in 28 patients with surgical confirmation. When evaluated separately, the most useful sequences in the detection of these microadenomas were coronal pregadolinium T1-weighted SE, coronal pregadolinium 3D FLASH, coronal postgadolinium T1-weighted SE, and coronal postgadolinium 3D FLASH. The combination of pre- and postgadolinium T1-weighted sequences with pre-and postgadolinium 3D FLASH sequences produced the highest number of true-positive findings (90%) and the lowest number of false-positive findings (5%). When a 1.5-T imaging unit with a high signal-to-noise ratio allowing useful three-dimensional acquisition is used, the authors advocate a coronal T1-weighted SE sequence, followed (if necessary) by a coronal 3D FLASH sequence, both without injection of gadolinium, in the diagnosis of pituitary microadenomas. When no confident diagnosis is reached, the same sequences should be performed after the injection of gadolinium. The sagittal pre- and postgadolinium T1-weighted SE and long-TR SE sequences are useful only in specific cases.
Insights
This study evaluated magnetic resonance (MR) imaging sequences for detecting pituitary microadenomas. Coronal T1-weighted SE and 3D FLASH sequences, with or without gadolinium, are recommended for accurate diagnosis.
Area of Science:
- Radiology
- Medical Imaging
- Endocrinology
Background:
- Pituitary microadenomas require precise imaging for diagnosis.
- Evaluating the efficacy of various magnetic resonance (MR) imaging sequences is crucial for improving detection rates.
Purpose of the Study:
- To prospectively assess the diagnostic utility of different MR imaging sequences for detecting pituitary microadenomas.
- To compare the effectiveness of pre- and post-gadolinium contrast sequences.
Main Methods:
- Prospective evaluation of 28 patients with surgically confirmed pituitary microadenomas.
- Utilized coronal and sagittal spin-echo (SE) and three-dimensional fast low-angle shot (3D FLASH) sequences.
- Compared imaging findings before and after gadolinium injection.
Main Results:
- Coronal pregadolinium T1-weighted SE and 3D FLASH sequences demonstrated high utility.
- Combining pre- and post-gadolinium T1-weighted and 3D FLASH sequences yielded 90% true-positive and 5% false-positive findings.
- Sagittal sequences were deemed useful only in specific cases.
Conclusions:
- Coronal T1-weighted SE, followed by coronal 3D FLASH (without gadolinium), is advocated for initial diagnosis of pituitary microadenomas.
- Gadolinium-enhanced sequences should be used if initial diagnosis is uncertain.
- The choice of MR sequence impacts the accuracy of pituitary microadenoma detection.