Hemorrhage in pituitary adenoma: correlation of MR imaging with operative findings

The aim of this study was to correlate MR imaging and operative findings of hemorrhage in pituitary macroadenomas. We retrospectively reviewed MR images of 113 surgically proven pituitary adenomas. All patients were examined on a 1.5-T MR system. The intensity of intratumoral cystic cavities was correlated with operative findings. In 15 patients with pituitary apoplexy, we determined relationship between interval of MR examination after apoplectic event and MR signal intensity. In 8 patients with repeated preoperative MR examination, we evaluated sequential changes of intratumoral hemorrhage. There were 54 cavities at surgery: 52 were hemorrhagic and 2 were nonhemorrhagic. Twenty-nine of 52 hemorrhagic cysts demonstrated high/low signal (H/L) fluid-fluid levels on T2-weighted image (T2WI). In 19 of them, two components could be separately seen at operation: the supernatant high-intensity area represented xanthochromic fluid, and the dependent low-intensity area represented liquefied hematoma. The H/L fluid-fluid level was observed predominantly in hematomas on MR images obtained after longer intervals. In patients with repeated MR examination, follow-up MR imaging revealed additional hemorrhage or new formation of fluid-fluid levels. It was surprising that 12 of 14 cysts preoperatively judged as nonhemorrhagic in fact contained hemorrhagic components. The preoperative MR images are well correlated to the operative findings in hemorrhagic pituitary macroadenomas. It proved that 52 of 54 cystic cavities had hemorrhagic component.