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PDF Mri of The Pituitary Gland Bonneville Ebook Full Chapter
PDF Mri of The Pituitary Gland Bonneville Ebook Full Chapter
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Jean-François Bonneville, Fabrice Bonneville, Françoise Cattin and
Sonia Nagi
Fabrice Bonneville
Department of Neuroradiology, University Hospital Paul Sabatier, Toulouse,
France
Françoise Cattin
Department of Neuroradiology and Endovascular Therapy, University
Hospital of Besançon, Besançon, France
Sonia Nagi
Faculty of Medicine National Institute of Neurology, University of Tunis El
Manar, Tunis, Tunisia
The publisher, the authors and the editors are safe to assume that
the advice and information in this book are believed to be true and
accurate at the date of publication. Neither the publisher nor the
authors or the editors give a warranty, express or implied, with
respect to the material contained herein or for any errors or
omissions that may have been made.
5 Prolactinoma in Women
9 Prolactinoma in Men
10 Aggressive Pituitary Adenoma
13 Pituitary Apoplexy
14 Acromegaly
15 Cushing Disease
17 Pituitary Carcinoma
22 Craniopharyngioma
25 Intraoperative MRI
31 Suprasellar Germinoma
32 Melanoma
33 Pituitary Metastases
35.1 Aneurysm
35.7 Metastases
39 Sphenoid Mucocele
40 Primary Hypophysitis
41.1 Sarcoidosis
41.2 Histiocytosis
42 Pituitary Abscess
43 Empty Sella
44 Sheehan Syndrome
47 Pituitary Hemochromatosis
48 Arachnoid Cyst
49 Epidermoid Cyst
50 Dermoid Cyst
51 Neurenteric Cyst
54 Lipoma
60 Aneurysms
Index
Collaborators
Michael Buchfelder, MD, PhD
Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
Cyrine Drissi
Faculty of Medicine, University of Tunis El Manar, Department of
Neuroradiology, Institut National de Neurologie, Tunis, Tunisia
Julie Kreutz
Department of Radiology, Centre Hospitalier Universitaire de Liège, Liège,
Belgique
Maha Mahmoud
Faculty of Medicine, University of Tunis El Manar, Department of
Neuroradiology, Institut National de Neurologie, Tunis, Tunisia
Iulia Potorac
Department of Endocrinology, Centre Hospitalier Universitaire de Liège,
Liège, Belgique
Sven-Martin Schlaffer, MD
Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen,
Germany
© Springer International Publishing Switzerland 2016
Jean-François Bonneville, Fabrice Bonneville, Françoise Cattin and Sonia Nagi,
MRI of the Pituitary Gland, DOI 10.1007/978-3-319-29043-0_1
Fig. 1.1 Sagittal T1WI. The coronal cuts are obtained perpendicularly to the sub-callosal
plane
Fig. 1.2 Normal pituitary gland. (a, b) Sagittal T1 and CE T1WIs. (c, d) Coronal T1 and
T2 WIs at the anterior part of the pituitary gland. (e, f) Coronal T1 and T2 WIs, 2 mm
posterior to (c) and (d). Anterior lobe (curved arrow). Posterior lobe (thick arrow).
Pituitary stalk (thin arrow). On T2WI, a flow artifact in the suprasellar cistern blurs the
pituitary stalk. Optic chiasm (asterisk). After gadolinium injection (b), enhancement of
anterior lobe, pituitary stalk, and tuber cinereum (open arrow)
When an intrasellar lesion is suspected on the sequences
without contrast, the diagnosis can be confirmed by the realization
of coronal T1WI after gadolinium injection (CE T1WI). A low dose of
contrast medium (0.05 mmol/k) is recommended to avoid a too
intense enhancement, which may hide a small intraglandular lesion.
Nevertheless, it is our own policy to spare gadolinium
administration when the clinical situation is clear and confirmed by
the noncontrast T1 and T2WI, for instance when searching for
microprolactinomas. Delayed imaging 45 min after gadolinium
injection can have some interest, mainly in Cushing disease, in
revealing a very small microadenoma (“picoadenoma”) when T1,
T2, and CE T1WI are not informative.
In the case of a lesion with suprasellar extension, coronal and
sagittal T1W sequence after gadolinium injection and, if necessary,
a 3D gradient echo T1W acquisition with gadolinium for
neurosurgical planning are performed.
1.2 Additional Sequences
Axial TWI, preferentially with fat saturation is the best sequence to
evaluate the storage of vasopressin and is thus highly
recommended for the exploration of diabetes insipidus. This
sequence will also be extremely useful to consolidate the diagnosis
of intrasellar Rathke cleft cyst even when associated with pituitary
microadenoma.
In the exploration of Cushing disease, if the standard sequences
including the sequences after gadolinium injection are negative, a
dynamic imaging is obtained (Fig. 1.3). A 3D T1W gradient-echo
sequence with inframillimetric section thickness may demonstrate a
tiny ACTH-secreting pituitary microadenoma.
Fig. 1.3 Dynamic MRI of the normal pituitary gland. (a) Before contrast injection. (b)
About 30 s later, opacification of the pituitary stalk and the secondary capillary bed
(arrow). (c) At 60 s, the enhancement of the pituitary gland is intense and homogeneous.
(d–f) Slow decrease of enhancement intensity
3D TOF MRA is useful in the lesions affecting the cavernous
sinus, particularly in the diagnosis of aneurysm of the
intracavernous internal carotid artery, ectasic carotid siphons, and
dural fistula, or to confirm anatomical variations such as persistent
trigeminal artery.