Related Experiment Videos
[Searching for prolactin microadenoma: scanner or MRI?]
F Delecourt1, X Leclerc, Y Ardaens
1Service d'Endocrinologie et de Diabétologie, Centre Hospitalier et Universitaire, Lille.
Abstract:
Thirty three hyperprolactinemic women, aged 16-46 years, have been investigated by pituitary CT and MRI scans, searching for a microadenoma. The MRI scan with Gadolinium injection (MRI G+) appeared more efficient than the CT scan to detect a picture highly suggestive of a microprolactinoma (30/33 positive scans vs 21/33, respectively, p = 0.06). However, when the CT scan was performed optimaly (i.e. thin cuts, sequential imaging after iode injection, no artefact), its diagnostic potenty was close to the one of MRI G+, missing only 17.6% of lesions. All these were less than 5 mm in diameter. The indirect signs of microadenoma (focal convexity of the superior surface of pituitary, tilting of pituitary stalk, focal sella floor erosion or destruction) had a minimal value. Their sensitivity was 66.6% and 63.3 for convexity, and 63.3 and 46.6% for tilting of pituitary stalk, by MRI and CT scans, respectively. Therefore, they did not afford any help in our experience. Considering the cost and the limited accessibility of MRI, at least in our country, we advise to use CT scan as the primary morphologic means to detect a microadenoma.
Insights
CT scans are effective for detecting pituitary microadenomas in hyperprolactinemic women. While MRI with Gadolinium is more sensitive, optimized CT scans offer comparable diagnostic potential for microadenoma detection.
Area of Science:
- Endocrinology
- Radiology
- Oncology
Background:
- Hyperprolactinemia is often caused by pituitary microadenomas.
- Accurate imaging is crucial for diagnosing these tumors.
Purpose of the Study:
- To compare the diagnostic efficacy of CT and MRI scans in detecting pituitary microadenomas in hyperprolactinemic women.
Main Methods:
- Thirty-three hyperprolactinemic women (aged 16-46) underwent both CT and MRI scans (with Gadolinium contrast).
- Image analysis focused on direct visualization of microadenomas and indirect signs (e.g., pituitary stalk tilting, sella floor erosion).
Main Results:
- MRI with Gadolinium (MRI G+) showed higher sensitivity (30/33) than CT (21/33) for detecting microadenomas.
- Optimized CT scans (thin cuts, iodine contrast) demonstrated comparable diagnostic power, missing only 17.6% of lesions, primarily those <5mm.
- Indirect signs of microadenoma had minimal diagnostic value, with lower sensitivity on CT compared to MRI G+.
Conclusions:
- Optimized CT scans are a valuable primary tool for detecting pituitary microadenomas.
- Considering cost and accessibility, CT is recommended as the initial imaging modality, reserving MRI for complex cases or when CT is inconclusive.