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Gadolinium-DTPA and MR imaging of pituitary adenoma: a preliminary report
P C Davis1, J C Hoffman, J A Malko
1Department of Radiology, Emory University School of Medicine, Atlanta, GA 30322.
Abstract:
Gadolinium-DTPA MR imaging (Gd-MR), unenhanced MR imaging, and contrast-enhanced CT studies were compared prospectively in six patients with surgically confirmed pituitary adenomas and three patients without sellar pathology to determine the utility of Gd-MR in the diagnosis of pituitary adenoma. In normal patients, the pituitary gland, cavernous sinus, and infundibulum enhanced by T1 shortening after gadolinium. In adenoma patients, two of four focal lesions identified with contrast-enhanced CT were identified with Gd-MR, and one was identified with unenhanced MR. The earliest short repetition-time sequence performed after gadolinium injection was best for focal lesion detection. Normal cavernous sinus enhancement by gadolinium made identification of cavernous sinus extension of adenoma difficult. Infundibulum displacement was better seen with contrast-enhanced CT (two vs one); however, unenhanced and Gd-MR were better than contrast-enhanced CT for demonstrating chiasmal compression (four vs three). Contrast-enhanced CT, Gd-MR, and plain MR were equally able to identify gland enlargement, sellar floor erosion, and abnormalities of the diaphragma sellae. In this preliminary series, we found Gd-MR to be promising for imaging adenomas; however, modifications in Gd-MR technique including thinner slices and immediate scanning after gadolinium injection are necessary for the best detection of focal lesions.
Insights
Gadolinium-enhanced MR imaging shows promise for diagnosing pituitary adenomas, but technique modifications are needed for optimal focal lesion detection. Unenhanced and enhanced MR imaging better visualized chiasmal compression compared to CT scans.
Area of Science:
- Radiology
- Neuroimaging
- Endocrinology
Background:
- Pituitary adenomas require accurate diagnostic imaging for effective management.
- Conventional MRI and CT have limitations in fully characterizing these lesions.
Purpose of the Study:
- To prospectively compare Gadolinium-enhanced MR imaging (Gd-MR), unenhanced MR imaging, and contrast-enhanced CT for pituitary adenoma diagnosis.
- To determine the diagnostic utility and optimal techniques for Gd-MR in identifying pituitary adenomas.
Main Methods:
- Prospective study involving six patients with surgically confirmed pituitary adenomas and three controls.
- Comparison of Gd-MR, unenhanced MR, and contrast-enhanced CT findings.
Main Results:
- Gd-MR identified two of four focal lesions seen on CT; unenhanced MR identified one.
- Early post-gadolinium short repetition-time sequences were best for focal lesion detection.
- Gd-MR and unenhanced MR better visualized chiasmal compression than CT.
- All imaging modalities were comparable for detecting gland enlargement, sellar floor erosion, and diaphragma sellae abnormalities.
Conclusions:
- Gd-MR is a promising technique for pituitary adenoma imaging.
- Technical modifications, including thinner slices and immediate post-contrast scanning, are crucial for improving focal lesion detection.