"Post-contrast and especially thin-section dynamic contrast-enhanced imaging is an important part of a pituitary MRI and has significantly improved diagnostic accuracy 2,3. However, subtle morphology changes may still be identified in non-contrast images. These include bulkiness of the gland on the side of the microadenoma, subtle remodelling of the floor of the sella and deviation of the pituitary infundibulum away from the adenoma 2."
"T1: usually isointense to normal pituitary"
"T2: variable, but often a little hyperintense"
"Differential diagnosis "
"Although CT is able to detect up to 80-90% of microadenomas between 5-10 mm in size, it is a highly specialised technique, radiologist-dependent, and has difficulty in identifying smaller nodules 2. The advent of MRI means that CT is generally no longer used for this indication, relegating it to imaging the base of skull for bony anatomy to aid in surgical planning. However, photon counting CT is being investigated as a technique for identifying MRI occult ACTH secreting adenomas 8,9."
"delayed images are variable, ranging from hypo-enhancement (most common) to isointense to the rest of the gland, to hyperintense (retained contrast)"
"confirm the presence of a microadenoma, rather than a non-pituitary source 4; this is especially the case of Cushing disease, as there are many sources of extra-pituitary ACTH (e.g. some lung cancers)"
"no enhancement rather than hypo-enhancement"
"Rathke cleft cyst"
Expected headings
"Inferior petrosal sinus sampling"
"Differential diagnosis "
"For a general discussion, including epidemiology, detailed clinical presentation, treatment and prognosis, please refer to the article on pituitary adenomas."
"dynamic sequences demonstrate a rounded region of delayed enhancement compared to the rest of the gland 1; it takes 90 to 120 seconds for microadenoma to enhance while the normal anterior pituitary takes only 60 to 80 seconds to enhance 6"
"confirm the presence of a microadenoma, rather than a non-pituitary source 4; this is especially the case of Cushing disease, as there are many sources of extra-pituitary ACTH (e.g. some lung cancers)"