Home Archive Vol 35, No.1, 2009 Original Papers Pituitary Macroadenomas - Imagistic Evaluation

Pituitary Macroadenomas - Imagistic Evaluation

Simona Bondari(1), Dana-Maria Albulescu(2), Adriana Iliescu(1)

(1)Department of Radiology and Imagistic Medicine, University of Medicine and Pharmacy of Craiova; (2)Department of Anatomy, University of Medicine and Pharmacy of Craiova


Abstract As regarding the pituitary pathology, lesions of adenoma types are the most frequent; for many types are the most frequent; for many time diagnoses is complex, including the imagistic one. Pituitary lesions secreting or non-secreting macroadenomas have been characterized by a greater or smaller degree of invasivity. Those lesions extrasellar extension is well appreciated by imagistic methods giving minute information on the tumoral process ranging and on affecting the adjacent anatomical structures. In present paper suggests an imagistic aspects analysis of the macroadenomas extension, by computer tomography and magnetic resonance, each of the methods having its own specificity concerning the correct diagnosis of the pituitary pathology.

Keywords pituitary, macroadenoma, imagistic methods

 

Introduction

Pituitary pathology represents about 14% of the brain tumors. Usually lesions are benigne, of macro- or microadenomas type. Their diagnosis involves clinical and paraclinical data, corroboration from various fields such as: endocrinology, imagery, ophthalmology, neurosurgery and radiation therapy (3, 4, 7).

Pituitary macroadenomas can be secreting or nonsecreting ones, but their extrasellar extension mostly determines the clinical data leading the patient to the doctor.

Imagistic methods, computer tomography and magnetic resonance respectively, represent a real progress for the diagnosis and therapeutic attitude of those diseases (1-3, 6).

Possibility to precisely decelate extrasellar extension brings a significant contribution in firmly assessing all the anatomical structures of the sellar and parasellar regions that can be involved into the pituitary macroadenoma development (1, 7, 8).

Material and Methods

A set of 15 pacients, 10 males and 5 females, diagnosed with pituitary adenomas secreting GH, in 7 males patients, the rest presenting unsystemizing symptomatology (cephalea, sight disorders) was available for the present paper.

CT evaluation was performed in 8 patients by Hitachi Presto; examinations have been natively and postcontrast made, in fine axial sections, with subsequent sagitally and coronally reformation.

RM scanning was performed by Airis Mate Hitachi, natively and postcontrastly, with the following scanning parameters : spin-echo or 1-2 mm gradient-echo; big rebuilding 3 mm matrix (512); a small of about 20-23 cm “field of view (FOV).

Results and Discussions

CT scanning images analysis reveal native native heterogenous and postcontrast brain tumors with pituitary starting point; supra- and lateral sellar extension was estabilished in 12 cases with compression effects onto the optic chiasma, cavernous sinus compression or invasion effects and mass effects upon the adjacent cerebral parenchyma ( figure 1). Another consequence of the suprasellar development of macroadenomas is also the compression upon the ventricle III and Monro orifice obstruction leading to obstructive hydrocephalia.

Infasellar extension from the sphenoidal sinus level was decelated in one case, sagitally reconstruction was suggestive (figure 2).

CT evaluated macroadenomas were accompanied by remarkable bony distructions, visible in window for bone and in 3D reconstructions (figure 3).

MR scanning images reveal areas with heterogenous signal in native and postcontrast T1. Sagitally and coronally, sequences give minute information on movement, compressions upon the optical the optical chiasma and cavernous sinus was seen in the cases taken to be studied (fig. 4). Compared to CT, bony structures cannot be appreciated with the same clarity. Both CT and MR exams were possible in two patients, suggestive images being displayed below.

Figure 1 Pituitary adenoma, axial CT reveals a tumor with supra and laterosellar growth

Figure 2 Sagittal CT reconstruction

Figure 3 CT 3D reconstruction

F:\POZE DANA\macro RM contrast extensie laterala0001.jpgF:\POZE DANA\macro RM contrast extensie laterala0002.jpgF:\POZE DANA\macro RM contrast ext lat Sag.jpg

Figure nr 4 Pituitary macroadenoma.Coronal and sagittal T1-weighted images reveal a large tumor within the cavity of enlarged sella turcica with supra, latero and infra sellar growth.

Similar aspects comparable to the macroadenomas extension can be easily observed by means of the two imagistic methods: equal sizes, proximity anatomical structure affection. We can, however, state that the two methods were comparable as specificity, regarding extrasellar extension of the pituitary macroadenomas.

In patients with non-secreting adenomas, imagistic aspects explained their symptomathology, the sight disorders were significantly correlated to the mass effect on the optical chiasma, compressions on the adjacent cerebral parenchyma and the secondary obstructive hydrocephalia leading to intense cephalea.

Conclusions

1. Pituitary macroadenomas invasive character is correct evaluated by computer tomography and magnetic resonance imposing those investigations to be performed for diagnosis aim.

2. The evaluation of the pituitary macroadenomas extension degree is comparable by the two imagistic methods, with mention that the bony structures changes remain the privilege of the computer tomography.

3. Possibility for the pituitary lesions were visualized in different planes by imagistic methods, gives remarkable information for the subsequent therapeutic either surgical or radiotherapeutic attitude toward the patient.

4. Pituitary macroadenomas imagistic aspects were similar, both those obtained by CT exam and MR scanning.

References

1.    1.Abe T., Izumiyama H., Fujisawa I. - Evaluation of pituitary adenomas by multidirectional multislice dynamic CT,  Acta Radiol. 2002 Nov;43(6):556-9)

2.     2.Bonneville JF, Bonneville F., and Françoise Cattin - Magnetic resonance imaging of  pituitary adenomas,  Journal of Radiology 2005, vol 15,  number 3 p. 543-548

3.     3.Cottier J.P., Destrieux C, Brunereau L et al. Cavernos Sinus Invasion by pituitary adenoma: MR Imaging, Radiology 2000,  215: 463-469

4.     4.Kucharczyk W, Davis DO, Kelly WM, et al - Pituitary adenoma: High resolution MRI Radiology 161 p.761-765 2006

5.     5.Lum C., Kucharczyk W, Montera WJ, Becker LE, The sella turcica and parasellar region  Atlas SW. Magnetic resonance imaging of the brain and spine  3rd edition  2002 p 1283-1362

6.     6.Miki Y., Kanagaki M., et al -  Evaluation of pituitary macroadenomas with multidetector-row CT (MDCT): comparison with MR imaging, Neuroradiology  vol 49 number  p. 327- 333 4 april 2007

7.     7.Serri O., Chik C.L., Ur E., Ezzat S.: Diagnosis and management of hyperprolactinemia. Can.Med.Assoc.J. 2003; 169(6): 575-581

8.     8.Tabarin A., Laurent F., et al - Comparative evaluation o conventional and dinamic magnetic resonance imaging o the pituitary gland or diagnosis o Cushing disease  Clinical Endocrinology vol.49 pag.293-300 2008 octomber

 

 

 

Corresponding Adress: Assistant Simona Bondari MD, , Department of Radiology and Imagistic Medicine, University of Medicine and Pharmacy of Craiova, Street Petru Rares no. 2-4, 200 349, Craiova, Romania, phone/fax 0251-419400, E-mail simonabondari@yahoo.com

 


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