American College of Radiology
ACR Appropriateness Criteria®

Neuroendocrine Imaging

Variant 1: Adult. Suspected or known hypofunctioning pituitary gland (hypopituitarism, growth hormone deficiency, growth deceleration, panhypopituitarism, hypogonadotropic hypogonadism). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI sella without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 1 14
References Study Quality
2 (27890190) 4
1 (27003878) 4
19 (22875743) 4
42 (17159354) 4
41 (17578763) 3
40 (8222293) 3
39 (19963090) 3
38 (20020580) 3
37 (17576206) 4
36 (18317442) 4
35 (17524347) 4
34 (17157037) 4
33 (11022195) 4
32 (17873755) 4
31 (17698579) 4
30 (1593348) 4
29 (20500966) 4
28 (1564527) 4
27 (23040741) 4
26 (21470998) 4
25 (26614829) 4
24 (24364195) 3
23 (22749386) 4
48 (20197674) 3
47 (17594050) 4
46 (17964354) 4
45 (1424165) 2
44 (17964033) 4
43 (18226737) 4
54 (18174733) 4
53 (19320653) 4
52 (18046535) 4
51 (2336284) 4
50 (2064861) 3
49 (15379423) 4
60 (18209870) 4
59 (17126479) 4
58 (18625361) 4
57 (17954416) 4
56 (2112091) 4
55 (19809320) 4
65 (7945110) 4
64 (2677826) 4
63 (25658782) 2
62 (10796926) 2
61 (17467517) 4
MRI sella without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 1 1 2 9 1 0
References Study Quality
2 (27890190) 4
1 (27003878) 4
19 (22875743) 4
26 (21470998) 4
25 (26614829) 4
24 (24364195) 3
23 (22749386) 4
30 (1593348) 4
29 (20500966) 4
28 (1564527) 4
27 (23040741) 4
34 (17157037) 4
33 (11022195) 4
32 (17873755) 4
31 (17698579) 4
38 (20020580) 3
37 (17576206) 4
36 (18317442) 4
35 (17524347) 4
43 (18226737) 4
42 (17159354) 4
41 (17578763) 3
40 (8222293) 3
39 (19963090) 3
48 (20197674) 3
47 (17594050) 4
46 (17964354) 4
45 (1424165) 2
44 (17964033) 4
53 (19320653) 4
52 (18046535) 4
51 (2336284) 4
50 (2064861) 3
49 (15379423) 4
58 (18625361) 4
57 (17954416) 4
56 (2112091) 4
55 (19809320) 4
54 (18174733) 4
63 (25658782) 2
62 (10796926) 2
61 (17467517) 4
60 (18209870) 4
59 (17126479) 4
CT sella with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 2 1 2 5 5 0 0 0
References Study Quality
18 (24594782) 3
12 (22084178) 4
MRI sella with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 4 2 2 1 6 1 0 0 0
References Study Quality
27 (23040741) 4
26 (21470998) 4
25 (26614829) 4
24 (24364195) 3
23 (22749386) 4
19 (22875743) 4
2 (27890190) 4
1 (27003878) 4
32 (17873755) 4
31 (17698579) 4
30 (1593348) 4
29 (20500966) 4
28 (1564527) 4
37 (17576206) 4
36 (18317442) 4
35 (17524347) 4
34 (17157037) 4
33 (11022195) 4
41 (17578763) 3
40 (8222293) 3
39 (19963090) 3
38 (20020580) 3
45 (1424165) 2
44 (17964033) 4
43 (18226737) 4
42 (17159354) 4
49 (15379423) 4
48 (20197674) 3
47 (17594050) 4
46 (17964354) 4
53 (19320653) 4
52 (18046535) 4
51 (2336284) 4
50 (2064861) 3
57 (17954416) 4
56 (2112091) 4
55 (19809320) 4
54 (18174733) 4
65 (7945110) 4
64 (2677826) 4
63 (25658782) 2
62 (10796926) 2
61 (17467517) 4
60 (18209870) 4
59 (17126479) 4
58 (18625361) 4
CTA head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 3 6 1 1 1 0 0 0
References Study Quality
20 (3683835) 3
MRA head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 1 6 4 0 1 0 0 0
References Study Quality
22 (1584359) 4
21 (11499817) 4
CT sella without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 2 3 3 5 1 1 0 0 0
References Study Quality
18 (24594782) 3
12 (22084178) 4
MRA head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 5 4 3 2 0 1 0 0 0
References Study Quality
22 (1584359) 4
21 (11499817) 4
MRA head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 5 4 4 1 0 1 0 0 0
References Study Quality
22 (1584359) 4
21 (11499817) 4
Venous sampling petrosal sinus Usually not appropriate Limited Varies Varies Varies 1 1 14 1 0 0 0 0 0 0 0
References Study Quality
68 (22286783) 3
67 (8881446) 4
66 (21990499) 4
Radiography sella Usually not appropriate Limited ☢ <0.1 mSv 1 1 13 2 0 0 0 0 0 0 0
References Study Quality
69 (8927393) 4
CT sella without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 8 2 1 3 1 0 0 0 0
References Study Quality
18 (24594782) 3
12 (22084178) 4
Variant 2: Adult. Suspected or known hyperfunctioning pituitary adenoma (hyperthyroidism [high thyroid-stimulating hormone], Cushing syndrome [high adrenal corticotrophic hormone], hyperprolactinemia, acromegaly, or gigantism). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI sella without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 1 14
References Study Quality
81 (28452619) 2
80 (11809542) 3
79 (11566239) 2
78 (16785841) 4
77 (22066905) 2
76 (26782836) 3
75 (24248770) 3
74 (20116954) 3
60 (18209870) 4
41 (17578763) 3
15 (2645603) 4
13 (21291344) 4
MRI sella without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 1 1 3 7 1 1
References Study Quality
81 (28452619) 2
80 (11809542) 3
79 (11566239) 2
78 (16785841) 4
77 (22066905) 2
76 (26782836) 3
60 (18209870) 4
41 (17578763) 3
15 (2645603) 4
CT sella with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 2 2 0 4 7 0 0 0
References Study Quality
73 (8357624) 4
72 (8189257) 4
71 (6734060) 4
70 (2679524) 4
28 (1564527) 4
CT sella without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 3 3 1 5 3 0 0 0 0
MRI sella with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 4 4 4 2 1 2 6 1 0 0 0
References Study Quality
75 (24248770) 3
74 (20116954) 3
15 (2645603) 4
13 (21291344) 4
80 (11809542) 3
79 (11566239) 2
78 (16785841) 4
77 (22066905) 2
76 (26782836) 3
81 (28452619) 2
60 (18209870) 4
41 (17578763) 3
CTA head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 4 5 1 0 1 0 0 0
References Study Quality
20 (3683835) 3
Venous sampling petrosal sinus Usually not appropriate Limited Varies Varies Varies 2 2 7 2 2 2 1 1 0 0 0
References Study Quality
68 (22286783) 3
67 (8881446) 4
66 (21990499) 4
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 3 5 0 0 0 0 0 0
MRA head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 3 4 1 0 0 0 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 3 3 1 0 0 0 0 0
Radiography sella Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 14 1 0 0 0 0 0 0 0
CT sella without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 8 3 1 0 2 1 0 0 0
References Study Quality
73 (8357624) 4
72 (8189257) 4
71 (6734060) 4
70 (2679524) 4
28 (1564527) 4
Variant 3: Adult. Diabetes insipidus. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI sella without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 0 15
References Study Quality
82 (22877954) 4
23 (22749386) 4
MRI sella without IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 1 1 1 3 6 2 1
CT sella with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 0 2 1 0 4 7 1 0 0
CT sella without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 2 3 1 6 2 1 0 0 0
MRI sella with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 4 2 2 1 6 1 0 0 0
References Study Quality
82 (22877954) 4
23 (22749386) 4
CTA head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 3 4 1 1 1 0 0 0
References Study Quality
20 (3683835) 3
Venous sampling petrosal sinus Usually not appropriate Expert Consensus Varies Varies Varies 1 1 15 0 0 0 0 0 0 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 4 3 0 0 0 0 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 3 3 1 0 0 0 0 0
Radiography sella Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 15 0 0 0 0 0 0 0 0
MRA head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 4 2 1 0 0 0 0 0
CT sella without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 8 1 2 0 3 1 0 0 0
Variant 4: Adult. Pituitary apoplexy. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI sella without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 0 15
References Study Quality
85 (23585661) 3
84 (17898201) 2
83 (26414232) 4
MRI sella without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 2 2 5 4 1
References Study Quality
85 (23585661) 3
84 (17898201) 2
83 (26414232) 4
CT sella without IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 4 0 4 1 6 2 2 0 1 0
References Study Quality
16 (15927868) 4
CT sella with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 0 4 1 7 3 1 0 0 0
References Study Quality
16 (15927868) 4
MRI sella with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 4 2 1 3 5 1 0 0 0
References Study Quality
85 (23585661) 3
83 (26414232) 4
CTA head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 3 5 1 1 0 0 0 0
References Study Quality
20 (3683835) 3
Venous sampling petrosal sinus Usually not appropriate Expert Consensus Varies Varies Varies 1 1 15 0 0 0 0 0 0 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 4 1 2 0 0 0 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 4 1 1 1 0 0 0 0
Radiography sella Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 15 0 0 0 0 0 0 0 0
MRA head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 3 2 1 0 0 0 0 0
CT sella without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 3 0 2 0 1 0 0 0
References Study Quality
16 (15927868) 4
Variant 5: Adult. Surveillance postpituitary or sellar mass resection.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI sella without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 0 14
References Study Quality
97 (29329735) 2
96 (28073906) 3
86 (21959621) 3
64 (2677826) 4
MRI sella without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 3 2 4 3 2
References Study Quality
97 (29329735) 2
96 (28073906) 3
CT sella without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 1 3 4 7 1 0 0 0 0
References Study Quality
95 (21436342) 3
CT sella with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 0 2 1 5 3 3 1 0 0
References Study Quality
95 (21436342) 3
MRI sella with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 4 2 2 2 4 1 1 0 0
References Study Quality
64 (2677826) 4
97 (29329735) 2
96 (28073906) 3
86 (21959621) 3
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 0 3 4 0 1 0 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 1 3 3 0 1 0 0 0
MRA head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 3 2 2 0 1 0 0 0
CT sella without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 1 2 2 1 2 0 0 0
References Study Quality
95 (21436342) 3
Venous sampling petrosal sinus Usually not appropriate Expert Consensus Varies Varies Varies 1 1 15 0 0 0 0 0 0 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 2 2 2 0 1 0 0 0
Radiography sella Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 15 0 0 0 0 0 0 0 0
Variant 6: Child, males younger than 9 years of age; females younger than 8 years of age. Precocious puberty. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI sella without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 0 0 14
References Study Quality
113 (25878671) 3
112 (18509122) 4
107 (27148371) 4
105 (23150859) 4
MRI sella without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 4 2 6 2 1
References Study Quality
113 (25878671) 3
112 (18509122) 4
107 (27148371) 4
105 (23150859) 4
MRI sella with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 4 2 1 3 4 2 0 0 0
References Study Quality
113 (25878671) 3
112 (18509122) 4
107 (27148371) 4
105 (23150859) 4
CTA head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 3 6 0 0 1 0 0 0
References Study Quality
20 (3683835) 3
CT sella without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 3 5 1 3 1 2 0 0 0
References Study Quality
111 (3554937) 4
CT sella with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 2 8 3 3 0 0 0 0 0
References Study Quality
111 (3554937) 4
Venous sampling petrosal sinus Usually not appropriate Expert Consensus Varies Varies Varies 1 1 14 1 0 0 0 0 0 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 2 2 1 0 0 1 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 3 1 1 0 0 0 0 1
Radiography sella Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 15 0 0 0 0 0 0 0 0
MRA head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 2 2 1 0 0 1 0 0
CT sella without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 8 1 3 2 1 0 0 0 0
References Study Quality
111 (3554937) 4
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.