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| LETTER TO EDITOR |
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| Year : 2017 | Volume
: 3
| Issue : 1 | Page : 204-205 |
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Role of dynamic contrast magnetic resonance imaging in pituitary microadenomas
Reddy Ravikanth
Department of Radiology, St. John's Medical College, Bengaluru, Karnataka, India
| Date of Web Publication | 7-Jul-2017 |
Correspondence Address:
Reddy Ravikanth
St. John's Medical College, Bengaluru - 560 034, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/IJAM.IJAM_28_17
How to cite this article:
Ravikanth R. Role of dynamic contrast magnetic resonance imaging in pituitary microadenomas. Int J Acad Med 2017;3:204-5 |
To the Editor,
A 40-year-old female with history of headache and menstrual irregularity since 12 months presented to the gynecology department of our hospital. At the age of 14 years, she found her skeletal growth retarded. Since then, she had not shown any development of secondary sex characters, such as change of voice, appearance of public and axillary hair, and development of external genital organs. Ophthalmologic examinations were normal. On examination, vitals were stable. Bleeding parameters were within normal limits. Hormonal analysis revealed elevated serum total T4 of 13.5 μg/dl, elevated serum cortisol of 24.6 μg/dl and hyperprolactinemia for which treatment with bromocriptine was initiated and referred for a dedicated magnetic resonance (MR) contrast study of the sella. MR imaging (MRI) revealed T1 hypointense nodule measuring 4 mm × 4.5 mm in the anterior pituitary which was not showing contrast enhancement on dynamic contrast imaging. Diagnosis of pituitary microadenoma was made.
Pituitary microadenoma often shows uncontrolled production of pituitary hormones and causes endocrine disorders such as Cushing disease, acromegaly, and hyperprolactinemia. Although pharmacotherapy has recently played a more pivotal role in treating functional pituitary microadenoma, resection of the tumor by transsphenoidal surgery is still considered the criterion standard. MRI with or without contrast agent is most commonly used for this purpose, and dynamic contrast-enhanced techniques are applied for better tumor visualization. Microadenomas appear as focal areas of low signal intensity in T1-weighted noncontrast images.[1] Peak enhancement of the microadenoma occurs after the normal tissue, therefore scanning immediately after giving contrast bolus in a method called “dynamic MR contrast imaging” increases the sensitivity. Compared to the normal pituitary gland, microadenomas show delayed gadolinium uptake. They are best detected by imaging immediately after contrast administration when they appear as an area of relative nonenhancement.[2]
Pituitary microadenoma often shows uncontrolled production of pituitary hormones and causes endocrine disorders such as Cushing disease, acromegaly, and hyperprolactinemia. MRI with or without contrast agent is most commonly used for this purpose, and recently dynamic contrast-enhanced techniques are applied for better tumor visualization. Pituitary imaging is important not only in confirming the diagnosis of pituitary lesions but also in determining the differential diagnosis of other sellar lesions.[3]
Dynamic contrast MRI has emerged as a promising tool in the evaluation of pituitary adenomas, particularly in accurate delineation of those microadenomas with no contour abnormality and in differentiating residual/recurrent adenoma from surrounding postoperative tissue. Dynamic MRI technique captures a temporal phase, in which there is a high level of contrast between tumor and the normal pituitary gland. This fleeting moment lasting seconds aids in the optimal delineation of the tumor.[4] Although pharmacotherapy has recently played a more pivotal role in treating functional pituitary microadenoma, resection of the tumor by transsphenoidal surgery is still considered the criterion standard.[5]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Przybylowski CJ, Dallapiazza RF, Williams BJ, Pomeraniec IJ, Xu Z, Payne SC, et al. Primary versus revision transsphenoidal resection for nonfunctioning pituitary macroadenomas: Matched cohort study. J Neurosurg 2016;20:1-8. [Epub ahead of print].  |
| 2. | Lee HB, Kim ST, Kim HJ, Kim KH, Jeon P, Byun HS, et al. Usefulness of the dynamic gadolinium-enhanced magnetic resonance imaging with simultaneous acquisition of coronal and sagittal planes for detection of pituitary microadenomas. Eur Radiol 2012;22:514-8. [ PUBMED] |
| 3. | Chaudhary V, Bano S. Imaging of the pituitary: Recent advances. Indian J Endocrinol Metab 2011;15 Suppl 3:S216-23. [ PUBMED] |
| 4. | Rossi Espagnet MC, Bangiyev L, Haber M, Block KT, Babb J, Ruggiero V, et al. High-resolution DCE-MRI of the pituitary gland using radial k-space acquisition with compressed sensing reconstruction. AJNR Am J Neuroradiol 2015;36:1444-9. [ PUBMED] |
| 5. | Berkmann S, Fandino J, Zosso S, Killer HE, Remonda L, Landolt H. Intraoperative magnetic resonance imaging and early prognosis for vision after transsphenoidal surgery for sellar lesions. J Neurosurg 2011;115:518-27. [ PUBMED] |
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