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1. Bonneville JF.. Magnetic Resonance Imaging of Pituitary Tumors. [Review]. Front Horm Res. 45:97-120, 2016. Review/Other-Dx N/A To describe and illustrate the radiological diagnosis of the different tumors of the sellar region, from the common prolactinomas, nonfunctioning adenomas and Rathke's cleft cysts, to the less frequent and more difficult to detect corticotroph pituitary adenomas in Cushing's disease, and other neoplastic and nonneoplastic entities. No results stated in the abstract. 4
2. Go JL, Rajamohan AG. Imaging of the Sella and Parasellar Region. [Review]. Radiol Clin North Am. 55(1):83-101, 2017 Jan. Review/Other-Dx N/A To describe optimum MR imaging of sellar and parasellar lesions. Article discusses use of Contrast. No results stated in the abstract. 4
3. Wong A, Eloy JA, Couldwell WT, Liu JK. Update on prolactinomas. Part 1: Clinical manifestations and diagnostic challenges. [Review]. J Clin Neurosci. 22(10):1562-7, 2015 Oct. Review/Other-Dx N/A To present the clinical manifestations and diagnosis of prolactinomas, including how to navigate the diagnostic dilemmas and challenges.diagnostic challenges of prolactinomas. No intravenous contrast was administered No results stated in the abstract. 4
4. Esteves C, Neves C, Augusto L, et al. Pituitary incidentalomas: analysis of a neuroradiological cohort. Pituitary. 18(6):777-81, 2015 Dec. Observational-Dx 71 pituitary incidentalomas To describe the diagnosis behind detection of pituitary incidentalomas, patient characteristics and their follow up. We detected 71 pituitary incidentalomas, 3 in children/adolescents. In adult patients, mean age was 51.6 ± 18.46 years and 42 were female (61.8 %). The most frequent reason for imaging was headache (33.8 %). The image that first detected the incidentaloma was CT scan in 63.2 and 17.6 % patients presented symptoms that could have led to earlier diagnosis. Pituitary adenoma is the most prevalent lesion (n 48; 70.6 %), followed by Rathke’s cleft cyst (n 9; 13.2 %). Hormonal evaluation revealed hypopituitarism in 14 patients and hypersecretion in 6: 5 prolactinomas and 1 somatotroph adenoma. Twenty-one (28.8 %) patients underwent surgery and there was no malignancy. 4
5. American College of Radiology. ACR Appropriateness Criteria®: Thyroid Disease. Available at: https://acsearch.acr.org/docs/3102386/Narrative/. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for thyroid disease. No abstract available. 4
6. Hoang JK, Hoffman AR, Gonzalez RG, et al. Management of Incidental Pituitary Findings on CT, MRI, and 18F-Fluorodeoxyglucose PET: A White Paper of the ACR Incidental Findings Committee. Journal of the American College of Radiology. 15(7):966-972, 2018 Jul.J. Am. Coll. Radiol.. 15(7):966-972, 2018 Jul. Review/Other-Dx N/A To review the management of Incidental Pituitary Findings on CT, MRI, and 18F-Fluorodeoxyglucose PET N/A 4
7. Eboli P, Shafa B, Mayberg M. Intraoperative computed tomography registration and electromagnetic neuronavigation for transsphenoidal pituitary surgery: accuracy and time effectiveness. J Neurosurg. 2011;114(2):329-335. Observational-Dx 65 Patients To assess the feasibility, anatomical accuracy, and cost effectiveness of frameless electromagnetic (EM) neuronavigation in conjunction with portable intraoperative CT (iCT) registration for transsphenoidal adenomectomy (TSA). In every case, iCT registration was successful and preoperative MR images were fused to iCT scans without affecting navigation accuracy. There was 100% concordance between probe tip location and predetermined bony loci in the first 50 cases involving the iCT/EM technique. Total operating room time was significantly less in the iCT/EM cases (mean 108.9 +/- 24.3 minutes [208 patients]) compared with the fluoroscopy group (mean 121.1 +/- 30.7 minutes [65 patients]; p < 0.001). Similarly, incision-to-closure time was significantly less for the iCT/EM cases (mean 61.3 +/- 18.2 minutes) than for the fluoroscopy cases (mean 71.75 +/- 19.0 minutes; p < 0.001). Relative overall costs for iCT/EM technique and intraoperative C-arm fluoroscopy were comparable; increased costs for navigation equipment were offset by savings in operating room costs for shorter procedures. 3
8. Locatelli M, Di Cristofori A, Draghi R, et al. Is Complex Sphenoidal Sinus Anatomy a Contraindication to a Transsphenoidal Approach for Resection of Sellar Lesions? Case Series and Review of the Literature. [Review]. World Neurosurg. 100:173-179, 2017 Apr. Review/Other-Dx 243 Patients To assess the occurrence of intraoperative and postoperative complications, length of surgery, and patient neurologic and endocrinologic outcomes in patients undergoing transsphenoidal surgery. Successful treatment using a transsphenoidal approach with neuronavigation and Doppler ultrasound was achieved in 15 patients with a low degree of pneumatization of the SS. A pituitary adenoma was present in 13 of 15 patients. Endocrinologic and neurosurgical outcomes were similar to patients with normal pneumatization of the SS, showing a cure of disease in 6 of 9 patients with functioning adenomas and an improvement of symptoms in cases of nonfunctioning adenomas. 4
9. Kupferman ME, Hanna E. Robotic surgery of the skull base. [Review]. Otolaryngol Clin North Am. 47(3):415-23, 2014 Jun. Review/Other-Dx N/A To highlight current pre-clinical research and applications of robotic surgery to the skull base. No results stated in abstract. 4
10. Garcia-Garrigos E, Arenas-Jimenez JJ, Monjas-Canovas I, et al. Transsphenoidal Approach in Endoscopic Endonasal Surgery for Skull Base Lesions: What Radiologists and Surgeons Need to Know. [Review]. Radiographics. 35(4):1170-85, 2015 Jul-Aug.Radiographics. 35(4):1170-85, 2015 Jul-Aug. Review/Other-Dx N/A To review the Transsphenoidal Approach in Endoscopic Endonasal Surgery for Skull Base Lesions. No results stated in the abstract. 4
11. Miki Y, Kanagaki M, Takahashi JA, et al. Evaluation of pituitary macroadenomas with multidetector-row CT (MDCT): comparison with MR imaging. Neuroradiology. 2007;49(4):327-333. Observational-Dx 33 consecutive patients To determine whether MDCT could provide preoperative information in addition to that provided by MRI in pituitary macroadenoma. MDCT more clearly demonstrated the lateral tumor margin than MRI (P=0.002). No significant differences in visualization of the normal pituitary gland were noted between MDCT and dynamic MRI (P=0.7). MDCT more clearly demonstrated sellar floor erosion or destruction at the sphenoid sinus than MRI (P<0.001). MRI was superior to MDCT for visualizing the adjacent optic pathways (P<0.001). 2
12. Glastonbury CM, Osborn AG, Salzman KL. Masses and malformations of the third ventricle: normal anatomic relationships and differential diagnoses. Radiographics. 2011; 31(7):1889-1905. Review/Other-Dx N/A Auhtors present a practical review of congenital anomalies and acquired pathologic processes of the third ventricle, with a focus on those lesions that are unique to the third ventricle. MR imaging is recommended to best delineate the entire extent of a lesion involving the third ventricle and to further characterize it. To this end, sagittal MR imaging is often the most useful in determining from which direction a mass involves the third ventricle. 4
13. Patel SN, Youssef AS, Vale FL, Padhya TA. Re-evaluation of the role of image guidance in minimally invasive pituitary surgery: benefits and outcomes. Comput Aided Surg. 16(2):47-53, 2011. Observational-Dx 120 patients To evaluate the utility of performing endonasal transsphenoidal pituitary surgery with computer-based neuronavigation, and to examine the efficacy of computer-based neuronavigation compared to fluoroscopy. Our results indicate that image guidance reduces the overall operating room time and complication rate. Average preparation time for fluoroscopy and computer-based neuronavigation was 70.3 and 67.3 min, respectively (p = 0.3299). Average surgical time with fluoroscopy and BrainLAB was 131 and 107.9 min, respectively (p = 0.0079). The results were also analyzed with regard to other parameters such as associated complications, age and diagnoses. 4
14. Isik S, Berker D, Tutuncu YA, et al. Clinical and radiological findings in macroprolactinemia. Endocrine. 2012; 41(2):327-333. Observational-Dx 337 patients To investigate the clinical and radiological features of patients with macroprolactinemia. The mean PRL levels (ng/ml) in the macroPRL and monoPRL groups were similar (168.0 ± 347.0 vs. 238.8 ± 584.9, P = 0.239). Frequency of amenorrhea, infertility, irregular menses, gynecomastia, and erectile dysfunction were also similar in both groups. More patients in the macroPRL group were asymptomatic compared to the monoPRL group (30.2 vs. 12.0%, P = 0.006). Compared to the macroPRL group, the monoPRL group had a higher frequency of galactorrhea (39.2 vs. 57.1%, P = 0.04) and abnormal MRI findings (65.3 vs. 81.1%, P = 0.02). Elevated macroPRL levels should be considered a pathological biochemical variant of hyperprolactinemia that may present with any of the conventional symptoms and radiological findings generally associated with elevated PRL levels. 4
15. Chakeres DW, Curtin A, Ford G. Magnetic resonance imaging of pituitary and parasellar abnormalities. Radiol Clin North Am. 1989; 27(2):265-281. Review/Other-Dx N/A Article demonstrates the normal anatomy and the wide array of pathology that can be visualized by MRI. MR has become the imaging modality of choice for most of the disorders within and about the sella. 4
16. Pisaneschi M, Kapoor G. Imaging the sella and parasellar region. Neuroimaging Clin N Am. 2005; 15(1):203-219. Review/Other-Dx N/A The anatomy of the sella and parasellar region is discussed. Pertinent ophthalmologic findings and syndromes relating to this anatomic region are described. No results stated in abstract. 4
17. Spampinato MV, Castillo M. Congenital pathology of the pituitary gland and parasellar region. [Review] [43 refs]. Top Magn Reson Imaging. 16(4):269-76, 2005 Jul. Review/Other-Dx N/A To review the pathogenesis, clinical presentation, and imaging features of common and rare congenital disorders of the region of the sella turcica. No results listed in the abstract. 4
18. Wu LM, Li YL, Yin YH, et al. Usefulness of dual-energy computed tomography imaging in the differential diagnosis of sellar meningiomas and pituitary adenomas: preliminary report. PLoS ONE. 9(3):e90658, 2014. Observational-Dx 51 patients To quantitatively assess the imaging characteristics of sellar lesion in dual-energy computed tomography (CT) imaging for differentiation of sellar meningiomas and pituitary adenomas during the arterial phase (AP) and venous phase (VP). Contrast was administered in this study. NICs, lambdaHU, and mean CT values in patients with sellar meningiomas differed significantly from those in patients with pituitary adenomas: Mean NICs were 43.52 mg/mL+/-1.35 versus 9.23 mg/mL +/-2.44, respectively, during the AP and 52.13 mg/mL +/-1.04 versus 24.37 mg/mL +/-2.23 respectively, during the VP. lambdaHU were -3.03+/-3.42 versus -0.53+/-0.23, respectively, during the AP and -2.96+/-0.41 versus -0.47+/-0.25, respectively, during the VP. Mean CT values were 193.63+/-2.08 versus 63.98+/-2.85, respectively, during the AP and 203.98+/-0.18 versus 77.66+/-0.91, respectively, during the VP. The combination of NIC and Mean CT value during VP had highest sensitivity (90.9%) and specificity (100%) among all phases. 3
19. Guitelman M, Garcia Basavilbaso N, Vitale M, et al. Primary empty sella (PES): a review of 175 cases. [Review]. Pituitary. 16(2):270-4, 2013 Jun. Observational-Dx 175 patients To retrospectively assess clinical features, radiological findings and the biochemical endocrine function from the records of patients with a diagnosis of PES. One hundred seventy-five patients (150 females) were studied. The mean age at diagnosis was 48.2 +/- 14 year. Most diagnoses were made by magnetic resonance imaging (n = 172). In most patients, the pituitary function was assessed by basal pituitary hormones measurements. Pituitary scans were ordered for different reasons: headache (33.1 %), endocrine disorders (30.6 %), neurological symptoms (12.5 %), visual disturbances (8.75 %), abnormalities on sella turcica radiograph (8.75 %) and others (6.25 %). Multiple pregnancies were observed in 58.3 % of women; headaches, obesity, and hypertension were found in 59.4, 49.5, and 27.3 % of the studied population, respectively. Mild hyperprolactinemia (<50 ng/ml) was present in 11.6 % of women and 17.3 % of men. Twenty-eight percent of our patients had some degree of hypopituitarism. In the male population, hypopituitarism represented 64 % of cases, whereas it accounted for 22 % of all females. 4
20. Macpherson P, Teasdale E, Hadley DM, Teasdale G. Invasive v non-invasive assessment of the carotid arteries prior to trans-sphenoidal surgery. Neuroradiology. 1987; 29(5):457-461. Observational-Dx 47 patients To compare the results of sinography, direct coronal CT and axial and coronal MRI, with the surgical findings. The results of cavernous sinography, dynamic contrast enhanced CT and MRI showed good correlation with each other and with the appearances found at operation. CT and MRI are therefore reliable preliminary screening methods for identifying the small proportion of patients on whom other imaging techniques need to be performed. 3
21. Heshmati HM, Fatourechi V, Dagam SA, Piepgras DG. Hypopituitarism caused by intrasellar aneurysms. Mayo Clinic Proceedings. 76(8):789-93, 2001 Aug.Mayo Clin Proc. 76(8):789-93, 2001 Aug. Review/Other-Dx 4087 patients To determine the prevalence, clinical presentation, and outcome of hypopituitarism due to an intrasellar aneurysm. RESULTS:Of 4087 patients with a diagnosis of hypopituitarism, 7 had hypopituitarism due to an intrasellar aneurysm, accounting for a prevalence of 0.17%. Adrenal, thyroid, and gonadal deficiencies were observed in 7, 6, and 5 patients, respectively. The prolactin level was increased in the 2 patients in whom it was measured. No patient had diabetes insipidus. All had visual impairment. In 5 patients an intrasellar aneurysm of the internal carotid artery was diagnosed preoperatively based on 1 or more imaging procedures. In the other 2 patients (1 with an internal carotid artery aneurysm and 1 with an anterior cerebral artery aneurysm), the diagnosis was made at surgical exploration. Four patients underwent a surgical procedure: 2 had direct packing of the aneurysm, and 2 had a bypass with proximal carotid occlusion or aneurysm trapping. Pituitary function remained unchanged postoperatively. 4
22. Weir B.. Pituitary tumors and aneurysms: case report and review of the literature. [Review] [70 refs]. Neurosurgery. 30(4):585-91, 1992 Apr.Neurosurgery. 30(4):585-91, 1992 Apr. Review/Other-Dx N/A To review the case report and literature of pituitary tumors and aneurysms. No results stated in the abstract. 4
23. Abele TA, Yetkin ZF, Raisanen JM, Mickey BE, Mendelsohn DB. Non-pituitary origin sellar tumours mimicking pituitary macroadenomas. [Review]. Clin Radiol. 67(8):821-7, 2012 Aug. Review/Other-Dx N/A The purpose of this article is to review the imaging features of non-pituitary-origin sellar tumours, focusing on characteristics that may distinguish them from pituitary macroadenomas. Article discusses MR imaging with contrast No results stated in the abstract 4
24. Akhare PJ, Dagab AM, Alle RS, Shenoyd U, Garla V. Comparison of landmark identification and linear and angular measurements in conventional and digital cephalometry. Int J Comput Dent. 16(3):241-54, 2013. Observational-Dx 50 cephalometric radiographs To compare the reliability of landmark identification and linear and angular measurements in conventional versus digital cephalometry. A statistically significant difference for interobserver errors between the two methods was noted only for 5 out of 19 cephalometric landmarks. The most accurately identified landmark in conventional and digitized method was Sella (S), followed by Nasion (N). Landmarks requiring further scrutiny in digital images were Porion (P) Articulare, ANS, UM, and LM. 3
25. Bresson D, Herman P, Polivka M, Froelich S. Sellar Lesions/Pathology. [Review]. Otolaryngol Clin North Am. 49(1):63-93, 2016 Feb. Review/Other-Dx N/A To provide an overview of sellar diseases with emphasis on their most useful characteristics to clinical practice. No results stated in the abstract. 4
26. Famini P, Maya MM, Melmed S. Pituitary magnetic resonance imaging for sellar and parasellar masses: ten-year experience in 2598 patients. J Clin Endocrinol Metab. 96(6):1633-41, 2011 Jun. Observational-Dx 2598 pituitary records To identify the frequency and diagnosis of pituitary masses in an identified patient population undergoing sellar imaging because diagnoses of pituitary-related masses are not all ultimately made by pathological analysis of surgical specimens and to identify indications for pituitary imaging and the prevalence of incidentalomas, hypopituitarism, and neuroophthalmic symptoms associated with nonadenomatous lesions, as identified by MRI. The most common indications for pituitary imaging, excluding known mass follow-up, were for evaluation of hyperprolactinemia or hypogonadism. A normal pituitary gland was reported in 47%of subjects undergoing pituitary MRI. The most common pituitary adenomas initially identified by MRI included prolactinoma (40%), nonfunctioning adenoma (37%), and GH adenoma (13%).Nonadenomatoussellar masses accounted for 18%of visible lesions, of which the most common were Rathke’s cleft cyst (19%), craniopharyngioma (15%), and meningioma (15%). Metastases accounted for 5% of nonpituitary lesions and breast cancer was the most common primary source. 4
27. Hess CP, Dillon WP. Imaging the pituitary and parasellar region. Neurosurg Clin N Am. 2012;23(4):529-542. Review/Other-Dx N/A To review the radiologic evaluation of lesions within the sella and suprasellar cistern, focusing on common masses and pseudomasses of the pituitary and sellar region that neurosurgeons are most likely to encounter in clinical practice. No results stated in abstract. 4
28. Dietemann JL, Cromero C, Tajahmady T, et al. CT and MRI of suprasellar lesions. J Neuroradiol. 1992; 19(1):1-22. Review/Other-Dx N/A Review of CT and MRI in suprasellar lesions. CT and MRI features of craniopharyngioma are compared; CT is more reliable than MRI in detecting calcifications; with both methods it may be difficult to visualize the cystic components. Glioma of the chiasma is readily diagnosed by MRI, provided the tumor is not too large. Non-thrombosed suprasellar aneurysms have typical features at CT and MRI. Cystic lesions are easily identified by MRI. The CT and MRI images of inflammatory lesions are not very typical. 4
29. Aleksandrov N, Audibert F, Bedard MJ, Mahone M, Goffinet F, Kadoch IJ. Gestational diabetes insipidus: a review of an underdiagnosed condition. J Obstet Gynaecol Can. 2010; 32(3):225-231. Review/Other-Dx 50 studies To review the etiology, diagnosis, and management of diabetes insipidus during pregnancy. Gestational diabetes insipidus is underdiagnosed because polyuria is often considered normal during pregnancy. Clinicians caring for pregnant women should consider screening for gestational diabetes insipidus, because it could be associated with serious underlying pathology. 4
30. Argyropoulou M, Perignon F, Brauner R, Brunelle F. Magnetic resonance imaging in the diagnosis of growth hormone deficiency. J Pediatr. 1992; 120(6):886-891. Observational-Dx 46 patients To examine role of MRI in the diagnosis of growth hormone (GH) defiency. All patients with pituitary stalk interruption had a pituitary height at less than -2 SD for age; three had no visible anterior pituitary lobe. By contrast, the pituitary height was less than normal in only 10 patients (60%) with normal pituitary anatomy. Growth hormone deficiency was transient in one of the seven patients with normal pituitary anatomy and height. The group with pituitary stalk interruption had the first symptom of growth hormone deficiency at an earlier age (2.8 +/- 0.6 vs 5.5 +/- 1.2 years; p < 0.001), were of smaller stature (-4 +/- 0.2 vs -3 +/- 0.2 SD; p < 0.01) and had lower GH peak response to provocative testing (3 +/- 0.4 vs 5 +/- 0.5 ng/ml; p < 0.001) than did the group with normal pituitary anatomy. Their pituitary gland was also shorter (2.5 +/- 0.2 vs 3.5 +/- 0.2 mm; p < 0.01). All the patients with multiple pituitary deficiencies except one (n = 19) belonged to this group. - Authors conclude that the evaluation of the shape and height of the pituitary gland by MRI is an additional tool for the diagnosis of growth hormone deficiency. The presence of pituitary stalk interruption confirms this diagnosis and is predictive of multiple anterior pituitary deficiencies. The lack of a significant increase in perinatal abnormalities in this group and the association of pituitary stalk interruption with microphallus and with facial or sella abnormalities suggest that this appearance may have an early antenatal origin. The finding of a familial case of pituitary stalk interruption suggests a genetic origin. 4
31. Batista DL, Riar J, Keil M, Stratakis CA. Diagnostic tests for children who are referred for the investigation of Cushing syndrome. Pediatrics. 2007; 120(3):e575-586. Observational-Dx 125 consecutive children Retrospective review to identify the tests that most reliably and efficiently diagnose pituitary or adrenal tumors in a large cohort of pediatric patients with Cushing syndrome. A midnight cortisol value of > or = 4.4 microg/dL confirmed the diagnosis of Cushing syndrome in almost all children, with a sensitivity of 99% and a specificity of 100%. Suppression of morning cortisol levels > 20% in response to an overnight, high-dosage dexamethasone test excluded all patients with adrenal tumors and identified almost all patients with pituitary tumors (sensitivity: 97.5%; specificity: 100%). Study suggests that among children who were referred for the evaluation of possible Cushing syndrome, a single cortisol value at midnight followed by overnight high-dosage dexamethasone test led to rapid and accurate confirmation and diagnostic differentiation, respectively, of hypercortisolemia caused by pituitary and adrenal tumors. 4
32. Bihan H, Christozova V, Dumas JL, et al. Sarcoidosis: clinical, hormonal, and magnetic resonance imaging (MRI) manifestations of hypothalamic-pituitary disease in 9 patients and review of the literature. Medicine (Baltimore) 2007; 86(5):259-268. Review/Other-Dx 9 patients To investigate pituitary dysfunction and perform imaging of the hypothalamic-pituitary area in patients both immediately following diagnosis and after treatment. There was no correlation between the number of hormonal dysfunctions and the area of the hypothalamic-pituitary axis involved as assessed by MRI. Hormonal deficiencies associated with hypothalamic-pituitary sarcoidosis frequently include hypogonadism (all patients) and to a lesser degree diabetes insipidus (7/9 patients). MRI abnormalities improved or disappeared in 7 cases under corticosteroid treatment, but most endocrine defects were irreversible despite regression of the granulomatous process. Most cases presented with multivisceral localizations and an abnormally high proportion of sinonasal localizations. 4
33. Bozzola M, Mengarda F, Sartirana P, Tato L, Chaussain JL. Long-term follow-up evaluation of magnetic resonance imaging in the prognosis of permanent GH deficiency. Eur J Endocrinol. 2000; 143(4):493-496. Observational-Dx 60 patients To define which MRI anatomical abnormalities of the hypothalamo-pituitary area can be considered as a prognostic marker of permanent GH deficiency (GHD). No additional hormone deficiencies were observed in 55 out of 60 patients initially classified as having isolated GHD (IGHD) with a normal (15 cases) or reduced (40 cases) pituitary gland size, without other MRI abnormalities. The remaining five children, who had initially shown an apparently IGHD in spite of pituitary stalk agenesis (PSA) and ectopia of the posterior pituitary (PPE) developed a multiple pituitary hormone deficiency (MPHD) over time. In 33 MPHD patients with (25 cases) or without (8 cases) MRI abnormalities, the associated hormone deficiencies were confirmed during follow-up. The IGHD patients showing PSA and PPE inevitably develop additional hormone deficiencies, while IGHD subjects having no MRI abnormalities maintain IGHD. Moreover, the anatomical abnormalities of the hypothalamo-pituitary area can be considered as a prognostic marker of permanent GHD. 4
34. Castro LH, Ferreira LK, Teles LR, et al. Epilepsy syndromes associated with hypothalamic hamartomas. Seizure. 2007; 16(1):50-58. Review/Other-Dx N/A To examine seizure type, spread pattern in non-gelastic seizures and their relationship with the epileptic syndrome in HH. Only four seizure types were seen: gelastic seizures, complex partial seizures, tonic seizures and secondarily generalized tonic-clonic seizures. An individual patient presented either complex partial seizures or tonic seizures, but not both. Gelastic seizures progressed to complex partial seizures or tonic seizures, but not both. Ictal patterns in gelastic seizures/tonic seizures and in gelastic seizures/complex partial seizures overlapped, suggesting ictal spread from the HH to other cortical regions. Ictal SPECT patterns also showed gelastic seizures/tonic seizures overlap. Patients with gelastic seizures-complex partial seizures presented a more benign profile with preserved cognition and clinical-EEG features of temporal lobe epilepsy. Patients with gelastic seizures-tonic seizures had clinical-EEG features of symptomatic generalized epilepsy, including mental deterioration. Video-EEG and ictal SPECT findings suggest that all seizures in HH-related epilepsy originate in the HH, with two clinical epilepsy syndromes: one resembling temporal lobe epilepsy and a more catastrophic syndrome, with features of a symptomatic generalized epilepsy. The epilepsy syndrome may be determined by HH size or by seizure spread pattern. 4
35. Cortet-Rudelli C, Sapin R, Bonneville JF, Brue T. Etiological diagnosis of hyperprolactinemia. Ann Endocrinol (Paris). 2007; 68(2-3):98-105. Review/Other-Dx N/A Review etiological diagnosis of hyperprolactinemia. Etiological diagnosis of hyperprolactinemia is straightforward in most cases, but is based upon careful semiologic, clinical and laboratory analysis in order to allow judicious use of MRI, the reference morphological examination method. 4
36. Delman BN, Fatterpekar GM, Law M, Naidich TP. Neuroimaging for the pediatric endocrinologist. Pediatr Endocrinol Rev. 2008; 5 Suppl 2:708-719. Review/Other-Dx N/A Review the normal anatomy of the sella and the imaging patterns in and about the normal pituitary gland. Microadenomas are well-resolved by MRI as areas with reduced or delayed enhancement relative to the normal gland. 4
37. Donadio F, Barbieri A, Angioni R, et al. Patients with macroprolactinaemia: clinical and radiological features. Eur J Clin Invest. 2007; 37(7):552-557. Observational-Dx 135 consecutive hyperprolactinaemic patients To investigate the clinical and neuroradiological characteristics of patients with and without macroprolactinaemia and to evaluate the impact of macroprolactin determination on the diagnostic work-up of hyperprolactinaemic patients. Macroprolactin, entirely explaining biochemical hyperprolactinaemia, was found in 42.2% of patients, a third of whom presented with signs and symptoms of hyperprolactinaemia. Determination of macroprolactin changed the initial diagnosis in a consistent proportion of patients. In particular, idiopathic hyperprolactinaemia, initially diagnosed in 41 patients, was then excluded in 28 of them. Diagnosis of prolactin-secreting pituitary microadenoma shifted to non-secreting pituitary microadenoma in 10 of 49 patients, while in all patients with prolactin-secreting pituitary macroadenoma or hyperprolactinaemia due to stalk deafferentation the presence of macroprolactin was excluded and the initial diagnosis confirmed. Finally, macroprolactin was present in the majority of patients with MRI scans suggestive for primary empty sella (4 of 5 women) or pituitary hyperplasia (12 of 17 women, 3 of 3 men). Collectively, about half of subjects with macroprolactinaemia showed variable MRI abnormalities. - The presence of macroprolactin was a relevant cause of misdiagnosis in patients with hyperprolactinaemia. However, due to the unexpected high frequency of pituitary abnormalities observed in the present series, authors suggest that the diagnostic algorithm of hyperprolactinaemic states should include both polyethylene glycol precipitation test and MRI imaging. 4
38. Dutta P, Bhansali A, Singh P, Rajput R, Khandelwal N, Bhadada S. Congenital hypopituitarism: clinico-radiological correlation. J Pediatr Endocrinol Metab. 2009; 22(10):921-928. Observational-Dx 31 patients To describe clinico-radiological correlates in patients with non-tumoral hypopituitarism. - 20 (66%) children had vertex presentation, nine breech, and two children were delivered by lower segment Cesarean section (LSCS). Seven (78%) out of nine in the breech delivery group, 14 (70%) out of 20 in the vertex group and one out of two (50%) in the LSCS group had multiple pituitary hormone deficiencies (MPHD) (p = 0.665). Hypoplastic pituitary gland and posterior pituitary abnormalities were more frequent in patients with isolated growth hormone deficiency (IGHD) as opposed to MPHD (87.5% vs 65.2%, p = 0.08, 63% vs 47%, p = 0.64), whereas empty sella and stalk abnormalities were found more frequently in MPHD than in the IGHD group (76% vs 50%, p = 0.45 and 82.6% vs 37.5%, p = 0.01). Higher frequency of MR abnormalities was found in those with a peak GH response of < 3 ng/ml irrespective of the number of other pituitary hormone deficiencies (82.6% vs 37.5%, p = 0.02). Sixteen patients had MRI tetrad and it was more prevalent in the IGHD than in the MPHD group (75% and 44%, p = 0.01) and correlated with the severity of GH deficiency (r = 0.57, p = 0.01). The imaging abnormalities were also more prevalent in children with breech as compared to vertex presentation and correlated with severity of GH deficiency (100% vs 60%, p = 0.03, r = 0.52). - Imaging abnormalities are frequent in patients with non-tumoral hypopituitarism and correlate best with severity of GH deficiency rather than number of hormone deficiencies and breech presentation. 3
39. Ebner FH, Kuerschner V, Dietz K, Bueltmann E, Naegele T, Honegger J. Reduced intercarotid artery distance in acromegaly: pathophysiologic considerations and implications for transsphenoidal surgery. Surg Neurol. 2009; 72(5):456-460; discussion 460. Observational-Dx 45 patients with acromegaly and 45 controls. To evaluate the significance of reduced intercarotid artery distance in the C5 segment in acromegalic patients and the implications for transsphenoidal surgery. The mean distance between the inner wall was 1.64 +/- 0.40 cm in the acromegalic patients and 1.90 +/- 0.26 cm in the control group (P = .0005). The distance between the outer wall (OW) measured 3.01 +/- 0.39 and 2.97 +/- 0.33 cm in the acromegalics and in the control group, respectively (P = .6230). The difference in the diameter of the ICA was statistically significant (P < .0001) between patients and control group. Within the patient group, the distance between the IW of both ICA was significantly smaller in the subgroup with arterial hypertension (P = .0256). - Narrowing of the inner borders of the CS between the right and left side is a statistically significant parameter in acromegaly. Attention should be given to an altered vascular course of the ICAs when planning and performing transsphenoidal microsurgery in acromegalic patients. A preoperative skull base CT may furnish important anatomical information and further reduce the risk of vascular injury. 3
40. Escourolle H, Abecassis JP, Bertagna X, et al. Comparison of computerized tomography and magnetic resonance imaging for the examination of the pituitary gland in patients with Cushing's disease. Clin Endocrinol (Oxf). 1993; 39(3):307-313. Observational-Dx 42 patients To compare the diagnostic accuracy of computerized tomography (CT) and magnetic resonance imaging (MRI) to identify the presence, evaluate the size, and assess the topographic characteristics of pituitary corticotroph adenomas. Lesions compatible with an adenoma were identified in 29 patients by MRI and in 21 patients by CT (69 vs 50%, P < 0.02). Seven macroadenomas were identified as well by the two methods. Eight of the 22 microadenomas detected by MRI were not identified by CT. Evidence for intracavernous tumour extension was found in nine patients: it was more frequently detected by MRI (8 patients) than by CT (4 patients). Fourteen patients with positive MRI had a pituitary examination: in one case the adenoma could not be reached because of purely suprasellar location; of the other 13 all were found by the surgeon and the surgical outcome was successful in 12 cases. MRI is superior to CT for the examination of the pituitary gland in patients with Cushing's disease. 3
41. Friedman TC, Zuckerbraun E, Lee ML, Kabil MS, Shahinian H. Dynamic pituitary MRI has high sensitivity and specificity for the diagnosis of mild Cushing's syndrome and should be part of the initial workup. Horm Metab Res. 2007; 39(6):451-456. Observational-Dx 87 consecutive patients Retrospective chart reviw to determne the usefulness of dynamic pituitary MRI in the initial diagnosis of Cushing's syndrome. - 23 of 24 patients had a MRI consistent with a pituitary lesion (21 with a microadenoma, two with pituitary asymmetry). In contrast, only 3 of 20 patients (2 patient did not have MRIs) in the Cushing's excluded group had a pituitary lesion on dynamic MRI. Dynamic pituitary MRI had the highest sensitivity and NPV of any testing modalities and its specificity and PPV were similar to that of other tests. - Authors conclude that almost all patients in this series with Cushing's syndrome have a lesion on dynamic pituitary MRI, a rate much higher than the 50-60% rate reported for non-dynamic MRIs. The false positive rate of 16% in our group of Cushing's excluded patients is similar to the literature value of 10% seen in normal volunteers and is acceptable since MRI is not used solely as a determinant for the diagnosis. While a negative MRI will miss those patients with adrenal or ectopic Cushing's syndrome, those patients can usually be diagnosed by other testing. Thus this preliminary study implies that dynamic pituitary MRI adds valuable information to assist in the diagnosis of Cushing's syndrome and should be ordered as part of the initial workup. 3
42. Garel C, Leger J. Contribution of magnetic resonance imaging in non-tumoral hypopituitarism in children. Horm Res. 2007; 67(4):194-202. Review/Other-Dx N/A Article summarizes the main points of the MRI technique, and describes the normal appearance of the hypothalamo-pituitary axis as a function of age and pubertal status. An accurate description of hypothalamo-pituitary axis abnormalities is necessary for accurate diagnosis and prognosis evaluation, with certain features suggestive of particular diseases and some prognostic data correlated with phenotype. 4
43. Glezer A, Paraiba DB, Bronstein MD. Rare sellar lesions. Endocrinol Metab Clin North Am. 2008; 37(1):195-211, x. Review/Other-Dx N/A Review the characteristics of rare sellar masses that provide clues to their differential diagnosis. Sellar masses are associated most commonly with pituitary adenomas. Many other neoplastic, inflammatory, infectious, and vascular lesions, however, may affect the sellar region and mimic pituitary tumors. These lesions must be considered in a differential diagnosis. 4
44. Jagannathan J, Kanter AS, Sheehan JP, Jane JA, Jr., Laws ER, Jr. Benign brain tumors: sellar/parasellar tumors. Neurol Clin. 2007; 25(4):1231-1249, xi. Review/Other-Dx N/A Review diagnosis and management of sellar lesions. The diagnosis of sellar lesions involves a multidisciplinary effort; detailed endocrinologic, ophthalmologic, and neurologic tests are critical. The management of pituitary tumors varies. For most tumors, transsphenoidal resection remains the mainstay of treatment. Less invasive modalities, such as endoscopic transsphenoidal surgery, specific chemotherapeutic drugs, and stereotactic radiosurgery, show promise as adjuvant treatment modalities. 4
45. Johnson MR, Hoare RD, Cox T, et al. The evaluation of patients with a suspected pituitary microadenoma: computer tomography compared to magnetic resonance imaging. Clin Endocrinol (Oxf). 1992; 36(4):335-338. Observational-Dx 19 patients Prospective study to compare the ability of MRI and CT to predict the position of a tumor within the pituitary fossa and to assess the clarity of the image generated by the two modalities in patients with suspected pituitary microadenomas. The joint opinions of A and B of the CT scans were correct in 10/19, and those of B and C of the MRI scans were correct in 17/19 cases, P = 0.008. Observer agreement was used to assess the clarity of the image. A and B agreed about the site of the tumour on the CT scan in 14 of 19 cases (Kappa statistic 0.556); B and C agreed on the MRI scans in 19/19 cases (Kappa statistic 1), P = 0.025. After the exclusion of five cases found to be macroadenomas at surgery, the joint opinions of A and B of the CT scans were correct in 8/14, and those of B and C of the MRI scans were correct in 12/14 cases, P = 0.133. A and B agreed about the site of the tumour on the CT scan in 12/14 cases (Kappa statistic 0.653), B and C agreed on the MRI scans in 14/14 cases (Kappa statistic 1, no significant difference). 2
46. Kumar J, Kumar A, Sharma R, Vashisht S. Magnetic resonance imaging of sellar and suprasellar pathology: a pictorial review. Curr Probl Diagn Radiol. 2007; 36(6):227-236. Review/Other-Dx N/A Article presents MRI characteristics and differential diagnoses of common and some rare lesions at sellar and suprasellar locations. MRI is the modality of choice for evaluating this region. 4
47. Kunii N, Abe T, Kawamo M, Tanioka D, Izumiyama H, Moritani T. Rathke's cleft cysts: differentiation from other cystic lesions in the pituitary fossa by use of single-shot fast spin-echo diffusion-weighted MR imaging. Acta Neurochir (Wien). 2007; 149(8):759-769; discussion 769. Observational-Dx 29 patients To retrospectively investigate the usefulness of single-shot fast spin-echo (SSFSE) diffusion-weighted MR imaging (DWI) in the diagnosis of a Rathke's cleft cyst. SSFSE provides diffusion-weighted images without significant susceptibility artifacts. DWI-SSFSE revealed Rathke's cleft cysts as hypointense relative to the normal brain parenchyma in all cases. The mean value of ADC for Rathke's cleft cysts was 2.12 x 10(-3) mm(2)/sec. Both the ADC and relative ADC of the Rathke's cleft cysts were significantly increased compared to those of the cystic components of craniopharyngiomas and haemorrhagic components of pituitary adenomas in the subacute phase (P < 0.05). There was not a statistically significant difference between Rathke's cleft cysts and cystic components of pituitary adenomas (P < 0.05). - DWI-SSFSE with ADC values provides objective information in the differential diagnosis of Rathke's cleft cysts from other sellar cystic lesions. In addition, DWI-SSFSE with ADC values is useful for differentiating Rathke's cleft cysts from craniopharyngiomas and haemorrhagic pituitary adenomas. 4
48. Li G, Shao P, Sun X, Wang Q, Zhang L. Magnetic resonance imaging and pituitary function in children with panhypopituitarism. Horm Res Paediatr. 2010; 73(3):205-209. 20197674 Observational-Dx 125 patients with MPHD and 90 controls To explore the relationship between MRI findings and multiple pituitary-target hormones in patients with panhypopituitarism or multiple pituitary hormone deficiency (MPHD). - MRI stage was significantly positively correlated with the number of pituitary hormone deficiencies (r = 0.9, p < 0.001). MRI stage was negatively correlated with peak GH, IGF-1, FT(4), cortisol and anterior pituitary height (r = -0.43, -0.47, -0.67, -0.54, and -0.49, respectively, p < 0.01). Diabetes insipidus patients could be stratified according to their MRI stage; diabetes insipidus was found mainly in patients with absence of the posterior pituitary bright spot or small ectopic posterior pituitary bright spot on MRI. - An abnormal MRI finding is evidence of MPHD and, correspondingly, there is a noteworthy correlation between MRI and pituitary function. 3
49. Longui CA, Rocha AJ, Menezes DM, et al. Fast acquisition sagittal T1 magnetic resonance imaging (FAST1-MRI): a new imaging approach for the diagnosis of growth hormone deficiency. J Pediatr Endocrinol Metab. 2004; 17(8):1111-1114. Observational-Dx 17 controls and 31 patients To evaluate a new simplified protocol of image acquisition (FAST1-MRI) for the diagnosis of growth hormone deficiency (GHD). Complete diagnostic concordance observed between images obtained from FAST1 and routine MRI studies. Hypothyroidism was the most common hormonal dysfunction associated with GHD and was observed in 10 out of 13 patients with pituitary insufficiency. 4
50. Lundin P, Bergstrom K, Thuomas KA, Lundberg PO, Muhr C. Comparison of MR imaging and CT in pituitary macroadenomas. Acta Radiol. 1991;32(3):189-196. Observational-Dx 65 patients To retrospectively compare MRI and CT in patients with pituitary macroadenomas. MR was superior to CT except in the demonstration of bone changes and tumour calcification. The superiority of MR was most pronounced regarding cavernous sinus invasion, tumour relationship to the carotid arteries and optic chiasm, and tumour haemorrhage. Extensive bone changes were visualized with both methods; erosions were often seen only with CT. MR is the preferable method for evaluation of pituitary macroadenomas. CT is useful as a supplementary modality when detailed information on bone anatomy is required, particularly if a transsphenoidal surgical approach is contemplated. 3
51. Maghnie M, Triulzi F, Larizza D, et al. Hypothalamic-pituitary dwarfism: comparison between MR imaging and CT findings. Pediatr Radiol. 1990; 20(4):229-235. Observational-Dx 33 patients To compare MR imaging and CT fidnings in patients with idiopathic growth hormone deficiency. Both MR and CT were positive in the evaluation of the sella. MR imaging exhibited a higher degree of accuracy than CT in the evaluation of pituitary gland, pituitary stalk and brain anomalies. 4
52. Maiya B, Newcombe V, Nortje J, et al. Magnetic resonance imaging changes in the pituitary gland following acute traumatic brain injury. Intensive Care Med. 2008; 34(3):468-475. Observational-Dx 41 patients with moderate or severe TBI and 43 controls Retrospective, case-control study was conducted to examine the anatomical changes in the pituitary gland following acute moderate or severe traumatic brain injury (TBI). - Patient demographics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Injury Severity Score (ISS), post-resuscitation Glasgow Coma Score (GCS), Glasgow Outcome Score (GOS), mean intracranial pressure (ICP), mean cerebral perfusion pressure (CPP), CT data, pituitary gland volumes and structural lesions in the pituitary on MRI scans. - The pituitary glands were significantly enlarged in the TBI group (the median and interquartile range were as follows: cases 672 mm3 (range 601-783 mm3) and controls 552 mm3 (range 445-620 mm3); p value<0.0001). APACHE II, GCS, GOS and ICP were not significantly correlated with the pituitary volume. Twelve of the 41 cases (30%) demonstrated focal changes in the pituitary gland (haemorrhage/haemorrhagic infarction (n=5), swollen gland with bulging superior margin (n=5), heterogeneous signal intensities in the anterior lobe (n=2) and partial transection of the infundibular stalk (n=1). - Acute TBI is associated with pituitary gland enlargement with specific lesions, which are seen in approximately 30% of patients. MRI of the pituitary may provide useful information about the mechanisms involved in post-traumatic hypopituitarism. 4
53. Mehta A, Hindmarsh PC, Mehta H, et al. Congenital hypopituitarism: clinical, molecular and neuroradiological correlates. Clin Endocrinol (Oxf). 2009; 71(3):376-382. Observational-Dx 170 patients Retrospective analysis to determine: (i) MR abnormalities associated with optic nerve hypoplasia (ONH), (ii) whether the MR abnormalities could predict endocrine dysfunction, (iii) whether the MR abnormalities could predict the extent of hypopituitarism and (iv) the concordance of the phenotype with the genotype. The presence of ONH was significantly associated with an absent septum pellucidum [odds ratio (OR) 31.5, 95% CI 7.3-136.6, P < 0.001], an abnormal corpus callosum (OR 10.5, 95% CI 3.8-28.6, P < 0.001) and stalk abnormalities (OR 2.3, 95% CI 1.2-4.2, P = 0.009). The risk of hypopituitarism was 27.2 times greater in patients with an undescended posterior pituitary (95% CI 3.6-205.1, P < 0.001). Anterior pituitary hypoplasia (OR 3.1, 95% CI 1.3-7.0, P = 0.006) and an absent pituitary stalk (P < 0.001) were also significantly associated with hypopituitarism. With respect to the type or severity of hypopituitarism, CPHD was more often associated with an abnormal corpus callosum (OR 6.1, 95% CI 1.4-27.4, P = 0.008) and stalk abnormalities (OR 2.8, 95% CI 1.3-6.1, P = 0.006). Male to female ratio was significantly greater in patients with normal optic nerves (3.3:1) as compared with those with ONH (1.2:1). Data suggest that individuals presenting with ONH are at high risk for neuroradiologic and endocrine abnormalities. 4
54. Molitch ME, Gillam MP. Lymphocytic hypophysitis. Horm Res. 2007; 68 Suppl 5:145-150. Review/Other-Dx N/A Review diagnosis and management of lymphocytic hypophysitis. A definitive diagnosis requires tissue biopsy. A presumptive clinical diagnosis can be made based on a history of gestational or postpartum hypopituitarism, a contrast-enhancing sellar mass with imaging features characteristic of lymphocytic hypophysitis, a pattern of pituitary hormone deficiency with early loss of adrenocorticotrophic hormone and thyroid-stimulating hormone unlike that typically found with macroadenomas, relatively rapid development of hypopituitarism and a degree of pituitary failure disproportionate to the size of the mass. 4
55. Murad-Kejbou S, Eggenberger E. Pituitary apoplexy: evaluation, management, and prognosis. Curr Opin Ophthalmol. 2009; 20(6):456-461. Review/Other-Dx N/A To review the current standard of care in the diagnosis and treatment of pituitary apoplexy and to determine any updated clinical management strategies. MRI is the most sensitive sequence for the detection of acute and old intracranial hemorrhage. Patients often require emergent intravenous fluids, blood transfusions, and high-dose corticosteroids. Patients who remain clinically and neurologically unstable require urgent transsphenoidal surgical decompression as definitive treatment. In patients with pituitary apoplexy, improvement in visual field defects, visual acuity, and diplopia is typically observed after emergent application of therapy, often including medical and surgical treatment. Some patients may require long-term hormonal therapy after surgery. 4
56. Pellini C, di Natale B, De Angelis R, et al. Growth hormone deficiency in children: role of magnetic resonance imaging in assessing aetiopathogenesis and prognosis in idiopathic hypopituitarism. Eur J Pediatr. 1990; 149(8):536-541. Observational-Dx 30 GHD patients and 15 controls To examine role of MRI in assessing morphostructural abnormalities of the hypothalamus-pituitary region in growth hormone deficient (GHD) in children. MRI demonstrated a significantly small sella and pituitary volume compared to controls and normal literatures values. In 20 patients the structures were extremely small and an abnormal development of the pituitary stalk was observed, and in 18 of these patients the bright spot indicating the neurohypophysis was dislocated to the distal part of the maldeveloped stalk, although these children had a normal fluid balance. From a functional point of view hypothalamus and pituitary defects were equally distributed between the two morphological groups. The patients with multiple endocrine defects had the smallest pituitary volume and abnormal stalk. 4
57. Rambaldini GM, Butalia S, Ezzat S, Kucharczyk W, Sawka AM. Clinical predictors of advanced sellar masses. Endocr Pract. 2007; 13(6):609-614. Observational-Dx 152 patients Retrospective study to identify clinical variables associated with the presence of a structurally advanced sellar mass (ASM). - Of the 152 sellar masses, 142 (93%) were pituitary adenomas. An ASM was noted in 85 of the 152 patients (56%). In the final multivariate model, male sex (odds ratio [OR], 6.23; 95% CI, 2.84 to 13.56; P<0.001) and self-reported visual field defect (OR, 3.62; 95% CI, 1.07 to 12.25; P = 0.039) were significantly independently associated with the presence of an ASM. The presence of new or changed headaches also tended to be associated with an ASM (OR, 2.11; 95% CI, 0.96 to 4.64; P = 0.063). Age and self-reported galactorrhea were not independently associated with the presence of an ASM and were conditionally removed from the final model. - In patients with suspected sellar or pituitary disease, male sex and self-reported visual field defects independently predict the presence of an ASM. New or changed headaches also tend to be related to the presence of an ASM. The presence of predictors of an ASM should prompt expedited sellar MRI and biochemical evaluation. 4
58. Rao VJ, James RA, Mitra D. Imaging characteristics of common suprasellar lesions with emphasis on MRI findings. Clin Radiol. 2008; 63(8):939-947. Review/Other-Dx N/A Review imaging features of common suprasellar lesions with emphasis on MRI features. MRI has largely replaced CT as a diagnostic tool for these lesions, although CT can provide complementary information in some conditions. 4
59. Rennert J, Doerfler A. Imaging of sellar and parasellar lesions. Clin Neurol Neurosurg. 2007; 109(2):111-124. Review/Other-Dx N/A Overview of the most relevant MRI and CT characteristics together with clinical findings of pituitary tumors, vascular, inflammatory and infectious lesions found in the sellar/parasellar region in order to propose an appropriate differential diagnosis. The diagnosis of sellar lesions involves a multidisciplinary effort, and detailed endocrinologic, ophthalmologic and neurologic testing are essential. CT and, mainly, MRI are the imaging modalities to study and characterize normal anatomy and the majority of pathologic processes in this region. 4
60. Sahdev A, Reznek RH, Evanson J, Grossman AB. Imaging in Cushing's syndrome. Arq Bras Endocrinol Metabol. 2007; 51(8):1319-1328. Review/Other-Dx N/A Review the adrenal appearances in ACTH-dependent and ACTH-independent Cushing's syndrome. Also, a discussion on the use of MRI and CT for the detection and management of pituitary ACTH secreting adenomas is included. CT of the chest, abdomen and pelvis with intravenous injection of contrast medium is the most sensitive imaging modality for the identification of the ectopic ACTH source and detecting adrenal pathology. MRI is used for characterizing adrenal adenomas, problem solving in difficult cases and for detecting ACTH-secreting pituitary adenomas. 4
61. Schneider HJ, Aimaretti G, Kreitschmann-Andermahr I, Stalla GK, Ghigo E. Hypopituitarism. Lancet. 2007; 369(9571):1461-1470. Review/Other-Dx N/A Review diagnosis of hypopituitarism. Identification of growth hormone and corticotropin deficiency generally requires a stimulation test, whereas other deficiencies can be detected by basal hormones in combination with clinical judgment. 4
62. Cottier JP, Destrieux C, Brunereau L, et al. Cavernous sinus invasion by pituitary adenoma: MR imaging. Radiology. 215(2):463-9, 2000 May.Radiology. 215(2):463-9, 2000 May. Observational-Dx 106 patients To define magnetic resonance (MR) imaging criteria for the diagnosis of cavernous sinus invasion by pituitary adenoma. Invasion of the cavernous sinus was certain (PPV, 100%) if the percentage of encasement of the internal carotid artery (ICA) by tumor was 67% or greater. It was highly probable if the carotid sulcus venous compartment was not depicted (PPV, 95%) or the line joining the lateral wall of the intracavernous and supracavernous ICAs was passed by the tumor (PPV, 85%). It was definitely not invaded (NPV, 100%) if the percentage of encasement of the intracavernous ICA was lower than 25% or the line joining the medial wall of the intracavernous and supracavernous ICAs was not passed by the tumor. 2
63. Micko AS, Wohrer A, Wolfsberger S, Knosp E. Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification. Journal of Neurosurgery. 122(4):803-11, 2015 Apr.J Neurosurg. 122(4):803-11, 2015 Apr. Observational-Dx 137 pituitary macroadenomas To reevaluate the existing parasellar classifications using an endoscopic technique and to evaluate the clinical and radiological outcomes associated with each grade. The authors found a 16% rate of CS invasion during surgery for these macroadenomas. Adenomas radiologically classified as Grade 1 were found to be invasive in 1.5%, and the GTR/ER rate was 83%/88%. For Grade 2 adenomas, the rate of invasion was 9.9%, and the GTR/ER rate was 71%/60%. For Grade 3 adenomas, the rate of invasion was 37.9%, and the GTR/ER rate was 75%/33%. When the superior compartment of the CS (Grade 3A) was involved, the authors found a rate of invasion that was lower (p < 0.001) than that when the inferior compartment was involved (Grade 3B). The rate of invasion in Grade 3A adenomas was 26.5% with a GTR/ER rate of 85%/67%, whereas for Grade 3B adenomas, the rate of surgically observed invasion was 70.6% with a GTR/ER rate of 64%/0%. All of the Grade 4 adenomas were invasive, and the GTR/ER rate was 0%. A comparison of microscopic and endoscopic techniques revealed no difference in adenomas with Grade 1 or 4 parasellar extension. In Grade 2 adenomas, however, the CS was found by the endoscopic technique to be invaded in 9.9% and by microscopic evaluation to be invaded in 88% (p < 0.001); in Grade 3 adenomas, the difference was 37.9% versus 86%, respectively (p = 0.002). Grade 4 adenomas had a statistically significant lower rate of GTR than those of all the other grades. In case of ER only, Grade 1 adenomas had a statistically significant higher rate of remission than did Grade 3B and Grade 4 adenomas. 2
64. Macpherson P, Hadley DM, Teasdale E, Teasdale G. Pituitary microadenomas. Does Gadolinium enhance their demonstration? Neuroradiology. 1989; 31(4):293-298. Observational-Dx 10 patients Patients were examined with dynamic contrast enhanced CT and pre and post Gadolinium-DTPA (Gd-DTPA) enhanced MRI to detemine whether the use of Gadolinium enhanced the demonstration of pituitary microadenomas. Excluding one false positive case, CT and unenhanced MRI were comparable in the detection of microadenoma. Post Gd-DTPA examination gave more clear evidence of the actual adenoma in two patients and aided in the demonstration of a third. However, in two others all imaging techniques failed to demonstrate the microadenoma subsequently found at surgery. On the post enhancement MRI it was easier to assess the relationship of a tumour to the cavernous sinus and to visualise the relationships of the parasellar carotid arteries. 4
65. Tripathi S, Ammini AC, Bhatia R, et al. Cushing's disease: pituitary imaging. Australas Radiol. 1994; 38(3):183-186. Review/Other-Dx 14 patients To compare MRI with CT in patients with ACTH-dependent hypercortisolism. CT revealed pituitary macroadenomas in two patients, pituitary hyperplasia in one and a suspicion of pituitary microadenoma in one. Thirteen patients underwent MRI. One with a macroadenoma diagnosed on CT did not undergo MRI. The MRI revealed a pituitary macroadenoma in one, microadenoma in three and hyperplasia in two cases. MRI following gd-DTPA enhancement revealed four more pituitary microadenomas. Patients with ACTH-dependent hypercortisolism should undergo MRI of the pituitary gland to identify/localize corticotroph pituitary adenomas. The study should include gd-DTPA enhancement in cases where the scan is normal. 4
66. Deipolyi AR, Hirsch JA, Oklu R. Bilateral inferior petrosal sinus sampling. J Neurointerv Surg. 2011. Review/Other-Dx N/A Review the anatomic and technical considerations essential for safe and reliable practice. BIPSS is highly accurate and safe when performed by experienced interventionalists. 4
67. Lopez J, Barcelo B, Lucas T, et al. Petrosal sinus sampling for diagnosis of Cushing's disease: evidence of false negative results. Clin Endocrinol (Oxf). 1996; 45(2):147-156. Observational-Dx 32 patients To evaluate the results of inferior petrosal sinus (IPS) sampling in patients with Cushing's disease, and compare them with both imaging findings and transsphenoidal examination. Transsphenoidal examination of the pituitary gland revealed a microadenoma in 27 cases. Radiological imaging showed a signal compatible with a microadenoma in 22 cases (68.8%), and correctly located the tumor at the side found at surgery in 14 of the 22 cases with positive transsphenoidal findings (MRI 13 cases, CT 1 case, overall 63.6%). Successful bilateral catheterization was accomplished in 30 patients (93.8%). Samples before and after corticotropin-releasing hormone (CRH) stimulation were drawn in 24 cases. No major complications were observed with the technique. IPS catheterization correctly predicted Cushing's disease (by means of a significant IPS: P ACTH ratio) in 27 of the 30 patients (90%) with basal sampling, and in 23 of the 24 cases with samples drawn before and after CRH administration (95.8%). Taking into account the 12 patients with a lateral microadenoma shown at transsphenoidal examination, IP sinus ACTH ratio was in agreement with the side recorded by the neurosurgeon in 8/12 cases (66.7%). MRI correctly located the tumor in 8/12 patients (66.7%). One patient showed no significant IPS: P ACTH ratio in any set of samples. 4
68. Shi X, Sun Q, Bian L, et al. Assessment of Bilateral Inferior Petrosal Sinus Sampling in the diagnosis and surgical treatment of the ACTH-dependent Cushing's syndrome: A comparison with other tests. Neuro Endocrinol Lett. 2011; 32(6):865-873. Observational-Dx 119 patients Retrospective analysis was performed to investigate the efficacy and lateralized accuracy of diagnostic and therapeutic of Bilateral inferior petrosal sinus sampling (BIPSS) in ACTH-dependent Cushing's disease (CS). In patients with proven pituitary cases, stringent response criteria in MRI and high dose dexamethasone suppression test (HDDST) were fully by 51.6% and 60.3% respectively. While BIPSS, gave direct evidence of CD in 90.6% of these cases. The sensitivity for a basal IPS/P gradient greater than 2 was 89.1%, with 100% specificity and a diagnostic accuracy of 87.5%. A subgroup of 14 patients (all were CD) had contradictory responses to routine test with HDDST; while the sensitivity, specificity and accuracy of BIPSS were 100% respectively. Compared with the MRI and DST, we accepted ROC curve analysis showed that BIPSS performance is the best efficacy diagnosis tool in CS. In total, 57 of 64 patients with CD had an IPS/P gradient greater than 2, resulting in the sensitivity, specificity and diagnostic accuracy are 90.5%, 100%, 95.2% respectively. Additionally, the accuracy value of BIPSS in indicating dominant side should also be stressed in adenoma lateralization of CD. Finally, BIPSS test contributed most in the remission efficacy of TSS; then remission rate of underwent BIPSS group is 92.2% compared to the rate of 80% in without BIPSS group (p<0.01), Compared with other noninvasive tests, turn out the highest accuracy rate in remission. Conclusions: The application of BIPSS is associated with efficacy and accuracy of ACTH-dependent CS and lateralization of CD, what's more, all above, we can conclude that BIPSS is associated with the surgical therapy in CD patients. Therefore, BIPSS dedicate to the diagnosis, treatment and intraoperation administration of ACTH-dependent CS. 3
69. Isaacs RS, Donald PJ. Sphenoid and sellar tumors. Otolaryngol Clin North Am. 1995; 28(6):1191-1229. Review/Other-Dx N/A Review diagnostic and therapeutic approach to sella and sphenoid. Role of imaging is crucial in sphenoid and sellar tumors. 4
70. Bonneville JF, Cattin F, Dietemann JL. Hypothalamic-pituitary region: computed tomography imaging. Baillieres Clin Endocrinol Metab. 1989; 3(1):35-71. Review/Other-Dx N/A Review role of CT in the diagnosis of pituitary lesions. Since the CT findings are often non-specific to tissues, clinical endocrinological correlation is essential. The technique also allows consistent assessment of the extent of the disease to permit better treatment planning and effective follow-up of patients after therapy. 4
71. Carr DH, Sandler LM, Joplin GF. Computed tomography of sellar and parasellar lesions. Clin Radiol. 1984; 35(4):281-286. Observational-Dx 50 patients Describe findings in patients examined by CT of the pituitary fossa. The appearances in 43 were judged to be abnormal, four were normal and three were 'doubtful'. Abnormal features included deviation of the pituitary stalk (7), localised increased enhancement after intravenous injection of contrast medium (18) and extrasellar extension of tumour (11). The CT scans enabled diagnoses of pituitary microadenoma, empty sella and combinations of the two to be made. Modern CT scanners (third or fourth generation) provide detailed information enabling the optimum assessment and treatment of sellar and parasellar lesions. 4
72. Harrison MJ, Morgello S, Post KD. Epithelial cystic lesions of the sellar and parasellar region: a continuum of ectodermal derivatives? J Neurosurg. 1994; 80(6):1018-1025. Review/Other-Dx 19 lesions Retrospective review of the clinical presentation, radiological findings, and histology was performed, and a survey of the literature pertinent to the classification, clinical presentation, and embryology of epithelial cystic lesions of the sellar and parasellar region. Imaging studies were generally useful in distinguishing these tumors, with the exception of Rathke's cleft cysts, suprasellar epidermoid cysts, and craniopharyngiomas, which frequently could not be differentiated. Based on the current findings and a review of the literature, it is suggested that these lesions represent a continuum of ectodermally derived cystic epithelial lesions. 4
73. Hershey BL. Suprasellar masses: diagnosis and differential diagnosis. Semin Ultrasound CT MR. 1993; 14(3):215-231. Review/Other-Dx N/A Review diagnosis and differential diagnosis of suprasellar masses. MRI is the study of choice for evaluating suprasellar masses, although CT may provide complementary information. 4
74. Kakite S, Fujii S, Kurosaki M, et al. Three-dimensional gradient echo versus spin echo sequence in contrast-enhanced imaging of the pituitary gland at 3T. Eur J Radiol. 79(1):108-12, 2011 Jul. Observational-Dx 33 patients To clarify whether a three-dimensional-gradient echo (3D-GRE) or spin echo (SE) sequence is more useful for evaluating sellar lesions on contrast-enhanced T1-weighted MR imaging at 3.0 Tesla (T). At 3.0 T, 3D-GRE provided significantly better images than the SE sequence in terms of the border of sellar lesions, delineation of cranial nerves, and overall image quality; there was no significant difference regarding the boundary edge of the cavernous sinus and pituitary gland. In addition, the 3D-GRE sequence showed fewer pulsation artifacts but more susceptibility artifacts. 3
75. Nakazawa H, Shibamoto Y, Tsugawa T, et al. Efficacy of magnetic resonance imaging at 3 T compared with 1.5 T in small pituitary tumors for stereotactic radiosurgery planning. Jpn J Radiol. 32(1):22-9, 2014 Jan. Observational-Dx 14 pituitary tumors To determine the value of high-field magnetic resonance imaging and to clarify the characteristics of each image among three-dimensional gradient echo (3D-GRE), two-dimensional spin echo (2D-SE) and inversion recovery (2D-IR) sequences used as contrast-enhanced T1-weighted images for stereotactic irradiation treatment planning of sellar lesions. There was no significant difference in SNR between 1.5-T SPGR and 3-T FSPGR, while 3-T IR was superior to 1.5-T SE. The 2D-SE and -IR provided significantly better CNR than 3D-GRE between tumor and normal structures. 3
76. Hughes JD, Fattahi N, Van Gompel J, Arani A, Ehman R, Huston J 3rd. Magnetic resonance elastography detects tumoral consistency in pituitary macroadenomas. Pituitary. 19(3):286-92, 2016 Jun. Observational-Dx 10 patients To evaluate the feasibility and potential usefulness of MRE in patients undergoing transsphenoidal resection of PMA. MRE was accomplished in all patients with excellent resolution. By surgical categorization, six tumors were soft and four intermediate. The mean MRE value for soft tumors was 1.38 +/- 0.36 (1.08-1.87) kPa, while for intermediate tumors it was 1.94 +/- 0.26 (1.72-2.32) kPa (p = 0.020). 3
77. Heck A, Ringstad G, Fougner SL, et al. Intensity of pituitary adenoma on T2-weighted magnetic resonance imaging predicts the response to octreotide treatment in newly diagnosed acromegaly. Clin Endocrinol (Oxf). 77(1):72-8, 2012 Jul. Observational-Dx 45 patients To assess whether T2 signal intensity could determine long-term response to first-line SA treatment and to assess clinical and biochemical baseline characteristics, as well as histological subtype in relation to the magnetic resonance imaging (MRI) appearances. The results showed that 12 (27%) adenomas were hypointense, 15 (33%) isointense and 18 (40%) hyperintense. Median IGF-1 [ratio IGF-1/ULN; (upper limit of normal)] was 3.5 (2.3-4.9), 2.9 (2.6-3.8) and 1.9 (1.3-2.6), respectively (P = 0.006 for difference between groups). Median GH values (mug/l) of a 3- to 5-point profile were 17.5 (6.1-35), 9.3 (6.0-32.5) and 4.1 (1.5-8.3), (P = 0.025). Median IGF-1 reduction (% of baseline) after first-line SA treatment was 51 (49-70), 36 (19-74) and 13 (5-42) (P = 0.03); median reduction in GH (% of baseline) was 86 (72-94), 78 (62-85) and 46 (1-70) (P = 0.02). T2 hyperintensity was associated with sparse granulation pattern on immunohistochemistry. 2
78. Castillo M.. Pituitary gland: development, normal appearances, and magnetic resonance imaging protocols. [Review] [29 refs]. Top Magn Reson Imaging. 16(4):259-68, 2005 Jul. Review/Other-Dx N/A To review the normal anatomy of the pituitary gland, its origin, development, surrounding structures and vascular structures of the gland. No results in abstract. 4
79. Gao R, Isoda H, Tanaka T, et al. Dynamic gadolinium-enhanced MR imaging of pituitary adenomas: usefulness of sequential sagittal and coronal plane images. Eur J Radiol. 39(3):139-46, 2001 Sep. Observational-Dx 18 Patients To assess whether sequential dynamic MR images in the coronal and sagittal planes are useful in the detection of pituitary microadenomas. The sensitivities of dynamic enhanced MR imaging in the detection of microadenomas were 61.1% in sagittal direction, 72.2% in coronal direction respectively, and were superior to those of conventional noncontrast- and contrast-enhanced T1-weighted imaging (22.2–50%). The sensitivity of a combination of sagittal and coronal dynamic enhanced MR imaging for the detection of microadenomas was 88.9% and was superior to those of conventional noncontrast- and contrast-enhanced T1-weighted imaging combining sagittal and coronal directions (61.1%, 61.1%) (P0.05, P0.05, respectively). The specificity and accuracy of dynamic enhanced MR imaging with combination of sagittal and coronal images was 88.9% respectively. 2
80. Rand T, Lippitz P, Kink E, et al. Evaluation of pituitary microadenomas with dynamic MR imaging. Eur J Radiol. 41(2):131-5, 2002 Feb. Observational-Dx 30 Patients To evaluate the use of keyhole dynamic magnetic resonance (MR) imaging in the evaluation of women with borderline hyperprolactinemia. The probability for lesion presence showed a trend toward lower scores on standard SE sequences and higher scores with dynamic imaging (P=0.067). 3
81. Grober Y, Grober H, Wintermark M, Jane JA Jr, Oldfield EH. Comparison of MRI techniques for detecting microadenomas in Cushing's disease. J Neurosurg. 1-7, 2017 Apr 28. Observational-Dx 57 Patients To compare the accuracy of different MRI sequences, conventional T1- and T2-weighted imaging, DMRI and SGE after contrast, individually and combined, for detection and localization of pituitary ACTH-secreting microadenomas in a consecutive series of patients with Cushing’s disease. Forty-eight surgical specimens contained an adenoma (46 ACTH-staining adenomas, 1 prolactinoma, and 1nonfunctioning microadenoma). DMRI detected 5 adenomas that were not evident on CMRI, SGE detected 8 adenomasnot evident on CMRI, including 3 that were not evident on DMRI. One adenoma was detected on DMRI that was not detectedon SGE. McNemar’s test for efficacy between the different MRI sets for tumor detection showed that the additionof SGE to CMRI increased the number of tumors detected from 18 to 26 (p = 0.02) based on agreement of at least 2 of 3readers. 2
82. Chin BM, Orlandi RR, Wiggins RH, 3rd. Evaluation of the sellar and parasellar regions. Magn Reson Imaging Clin N Am. 2012;20(3):515-543. Review/Other-Dx N/A To review the anatomy and imaging evaluation of the sellar and parasellar regions. The sellar and parasellar regions are anatomically and pathologically complex areas. In daily practice, adenomas, meningiomas, or aneurysms are the most common diseases. However, with more than 30 different potential entities localizing to this region, knowledge of the anatomy and diseases in addition to clinical information is essential for expert imaging differential diagnosis and management guidance. 4
83. Briet C, Salenave S, Bonneville JF, Laws ER, Chanson P. Pituitary Apoplexy. [Review]. Endocr Rev. 36(6):622-45, 2015 Dec. Review/Other-Dx N/A To describe pituitary apoplexy and explain uses of Computed tomography or magnetic resonance imaging to confirm the diagnosis by revealing a pituitary tumor with hemorrhagic and/or necrotic components. No results stated in the abstract. 4
84. Tosaka M, Sato N, Hirato J, et al. Assessment of hemorrhage in pituitary macroadenoma by T2*-weighted gradient-echo MR imaging. AJNR Am J Neuroradiol. 28(10):2023-9, 2007 Nov-Dec. Observational-Dx 25 patients To evaluate T2*-weighted GE MR imaging for the detection of intratumoral hemorrhage in patients with pituitary macroadenomas. T2*-weighted GE MR imaging detected various types of dark lesions, such as "rim," "mass," "spot," and "diffuse" and combinations, indicating clinical and subclinical intratumoral hemorrhage in 12 of the 25 patients. The presence of intratumoral dark lesions on T2*-weighted GE MR imaging correlated significantly with the hemorrhagic findings on T1- and T2-weighted MR imaging (P < .02 and <.01, respectively), and the surgical and histologic hemorrhagic findings (P < .001 and <.001, respectively). 2
85. Sarwar KN, Huda MS, Van de Velde V, et al. The prevalence and natural history of pituitary hemorrhage in prolactinoma. J Clin Endocrinol Metab. 98(6):2362-7, 2013 Jun. Observational-Dx 368 Patients To characterize the prevalence, natural history, and risk factors associated with pituitary hemorrhage in a large clinic prolactinoma population. No intravenous contrast was administered Pituitary hemorrhage was found in 25 patients, giving an overall prevalence of 6.8%, and was significantly higher in macroprolactinoma (20.3%) compared to microprolactinoma (3.1%, P < .0001). Three patients had classical pituitary apoplexy. The majority of patients in the hemorrhage group had macroprolactinomas (16/25 [64%]) and were women (22/25 [88%]). The proportion of women with macroprolactinoma was higher in the hemorrhage group (14/16 macroprolactinomas [87.5%]) than in the nonhemorrhage group (36/63 macroprolactinomas [57.1%], P = .02). The majority of pituitary hemorrhages (92%) were treated conservatively with dopamine agonist therapy for hyperprolactinemia. Eighty-seven percent of patients had complete resolution of their hemorrhage within 26.6 +/- 23.3 (mean +/- SD) months. The presence of macroprolactinoma (odds ratio 9.00 [95%CI 3.79-23.88], P < .001) and being female (odds ratio 8.03 [95%confidence interval 1.22-52.95], P = .03) were independently associated with hemorrhage. 3
86. Bladowska J, Biel A, Zimny A, et al. Are T2-weighted images more useful than T1-weighted contrast-enhanced images in assessment of postoperative sella and parasellar region?. Med Sci Monit. 17(10):MT83-90, 2011 Oct. Observational-Dx 101 Patients To investigate the magnetic resonance features of the postoperative sella with fast spin echo (FSE) T2-weighted imaging (T2), evaluate the benefits of this sequence compared to the classically performed contrast-enhanced T1-weighted imaging (T1+C) on a 1.5T unit, and to assess whether T2 sequence could replace T1-weighted images after contrast administration. Contrast-enhanced T1-weighted imaging was significantly superior to T2-weighted imaging in assessment of infundibulum (p<0.05). There was no statistically significant difference for each of readers between T1- and T2-weighted images regarding to the following features: visualization of residual pituitary gland (p=0.062 and p=0.368), contours of pituitary (p=0.959 and p=0.265), optic chiasm (p=0.294 and p=0.843), and visualization of presence of residual tumor (p=0.204 and p=0.169). T2-weighted images were significantly superior to contrast-enhanced T1-weighted imaging with regard to visualization of contours of residual tumors (p<0.05). 3
87. Ziu M, Dunn IF, Hess C, et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Posttreatment Follow-up Evaluation of Patients With Nonfunctioning Pituitary Adenomas. [Review]. Neurosurgery. 79(4):E541-3, 2016 Oct. Meta-analysis 23 Studies To create evidence-based guidelines in an attempt to formulate guidance for post-treatment follow-up in a consistent, rigorous, and cost-effective way. Twenty-three studies met the inclusion criteria with respect to answering the questions on the post-treatment radiologic, endocrinologic, and ophthalmologic follow-up. Through this search, the authors formulated evidence-based guidelines for radiologic, endocrinologic, and ophthalmologic follow-up after surgical and/or radiation treatment. Inadequate
88. Kremer P, Forsting M, Ranaei G, et al. Magnetic resonance imaging after transsphenoidal surgery of clinically non-functional pituitary macroadenomas and its impact on detecting residual adenoma. Acta Neurochir (Wien). 144(5):433-43, 2002 May. Observational-Tx 50 Patients To study the changes of the sellar contents at the post-operative site over time and to assess the amount of residual adenoma tissue in clinically non-functional pituitary macroadenomas, prospective follow-up magnetic resonance imaging (MRI) was conducted after transsphenoidal surgery. The maximum size of tumour extension on coronal T1-weighted images ranged from 1.2 cm to 5.0 cm (mean 2.3 cm). Despite tumour resection, early post-operative images still showed a persistent mass in the sella in 83% that was usually caused by post-operative haemorrhage, fluid collection and implanted fat material. However, rapid improvement in visual symptoms was noted in 89%. Changes in the sellar region at the early post-operative site markedly hindered the interpretation of MR images for detecting residual tumour tissue, which was suspected in half of the patients (1 intrasellar, 13 suprasellar, and 11 parasellar). Regression of the post-operative mass in the sella was present 3 months after surgery, resulting in a 50% change in the volume of the coronal sellar extension, which also improved the reliability in interpreting the post-operative MR images. On the intermediate MR images residual tumour tissue was detected in 30% of the patients (4 intrasellar, 2 suprasellar and 9 parasellar). Because the suprasellar mass descended over time, an increasing rate of tumour remnant within the sella was seen 3 months following surgery. Before surgery the pituitary gland was visible superiorly or posterosuperiorly to the macroadenomas in 35 patients. However, at the early post-operative site the remaining gland was only visible in 12 patients. Under the condition that endocrinological function tests confirmed adequate hormonal function, the remaining gland was detectable by MRI in 36 patients 3 months after surgery. 2
89. Yoon PH, Kim DI, Jeon P, Lee SI, Lee SK, Kim SH. Pituitary adenomas: early postoperative MR imaging after transsphenoidal resection. AJNR Am J Neuroradiol. 22(6):1097-104, 2001 Jun-Jul. Review/Other-Tx 83 Patients To establish the value of early postoperative MR imaging in differentiating residual tumor from postoperative surgical changes in the sella after transsphenoidal resection of pituitary adenomas. Postoperative changes included resorption of implanted material and re-expansion of the pituitary gland. In 22 patients, residual tumors were found, and all patients showed nodular or combined enhancement. The residual tumors were confirmed by immediate re-operation in three patients, by hormonal assay and follow-up MR images in 11 patients with functioning adenomas, and by growth of the tumor on follow-up MR images in eight patients with non-functioning adenomas. Forty-eight patients showed no enhancement and 13 patients showed peripheral rim enhancement. 4
90. Coulter IC, Mukerji N, Bradey N, Connolly V, Kane PJ. Radiologic follow-up of non-functioning pituitary adenomas: rationale and cost effectiveness. J Neurooncol. 93(1):157-63, 2009 May. Observational-Tx 49 Patients To review the radiologic follow- up schedules and attempt to devise a cost effective follow up regimen for use in routine clinical practice. The data was analysed using descriptive statistics and Kaplan–Meier survival analysis using SPSS ver 13.0 (SPSS Inc. Chicago, IL). The time in which the tumor size in the followed up patients reached a state of ‘no change’ which persisted for at least two further scans was calculated. 41 patients, followed up for a median duration of 70 months were ultimately analysed. 33 patients had surgery while eight were conservatively managed. The time taken by 50% of tumors to achieve a steady state of ‘no change’ in tumor size on scans was 30 months. 90% of tumours achieved this state in 88 months. Surgical management did not significantly influence the time required to attain the steady state on a Kaplan–Meier analysis (Log rank test P = 0.06). 3
91. Kilic T, Ekinci G, Seker A, Elmaci I, Erzen C, Pamir MN. Determining optimal MRI follow-up after transsphenoidal surgery for pituitary adenoma: scan at 24 hours postsurgery provides reliable information. Acta Neurochir (Wien). 143(11):1103-26, 2001 Nov. Observational-Dx 80 Pituitary Adenoma Cases To establish the value of postoperative MRI within 24 hours of pituitary surgery. In the MRI scans done 24 hours postsurgery, 23 of 25 patients were classed as ``N, +++.'' The same diagnosis was made at the 3-, 6- and 9-month MRI analyses, and r-MRI confirmed that this was the correct diagnosis in these cases. In the MRIs done 24 hours postoperatively, 24 out of 30 patients were classed as ``N, ++'' (n =3), or ``N, +++'' (n= 21), and the early postoperative diagnoses also held at the 3-, 6-and 9-month MRI scans. 3
92. Parrott J, Mullins ME. Postoperative imaging of the pituitary gland. [Review] [20 refs]. Top Magn Reson Imaging. 16(4):317-23, 2005 Jul. Review/Other-Dx N/A To describe how to recognize normal postoperative findings, to distinguish iatrogenic changes in the sella and surrounding regions from residual tumor, and to detect surgical or therapy-related complications when they are apparent on imaging. No results stated in the abstract. 4
93. Huang KT, Bi WL, Smith TR, Zamani AA, Dunn IF, Laws ER Jr. Intrasellar abscess following pituitary surgery. Pituitary. 18(5):731-7, 2015 Oct. Observational-Dx 5 Patients To review a series of patients with intrasellar abscess and identify defining characteristics of their presentation and management. All examined patients had a history of antecedent transsphenoidal pituitary surgery within the preceding 10 months. All presented with headaches, three with progressive visual loss, one with meningismus, one with fever in the setting of an active cerebrospinal fluid leak, and one with fever, meningismus, hypotension, and progressive somnolence. No patient presented with acute endocrine abnormalities. A majority did not initially have any diffusion restriction present on MRI, but in one case we were able to track the evolution of diffusion restriction over sequential MRI scans. Two patients had complete resolution of presenting symptoms, while three experienced improvement or stabilization of their neurologic deficit. There were no mortalities. 3
94. Ahmadipour Y, Lemonas E, Maslehaty H, et al. Critical analysis of anatomical landmarks within the sphenoid sinus for transsphenoidal surgery. Eur Arch Otorhinolaryngol. 273(11):3929-3936, 2016 Nov. Observational-Dx 125 patients To evaluate the reliability of these anatomical landmarks in a large population  examining patients diagnosed with pituitary adenoma and a control group without evidence of pathologies in the sellar region.for the surgeon's orientation. Image analysis of the anatomical landmarks included the minimal intercarotid distance (ICD), diameter of the sphenoid sinus (DSS), direction of the septum sinuum sphenoidalium (SSS), and the distance between vomer and clivus (VCD). The overall mean ICD was 16.2 mm, with patients suffering from adenomas showing a mean ICD of 15.8 mm compared with an average 16.5 mm in the control group. DSS was equal for both groups (adenoma group: mean 31.5 mm; controls: mean 31.3 mm). Mean VCD was 27.9 mm in patients with pituitary adenomas compared with 26.7 mm in controls. A septum of the sphenoid sinus located in the midline was found in overall 23 % only. SSS was directed into the bony shield of the internal carotid artery in 28 % of underlying tumors and in 37 % of the control group. This is the first detailed description of landmarks of the sphenoid sinus based on a large radiologic-anatomical analysis of CT scans yielding a wide variation and high inconsistency of these landmarks. 3
95. Chen X, Dai J, Ai L, et al. Clival invasion on multi-detector CT in 390 pituitary macroadenomas: correlation with sex, subtype and rates of operative complication and recurrence. AJNR Am J Neuroradiol. 32(4):785-9, 2011 Apr. Observational-Dx 390 patients To determine the frequency of clival invasion and the association of CT-detected invasion with patients’ clinical factors, surgical outcomes, and tumor subtypes. No intravenous contrast was administered in this study. After we corrected for multiple correlations, the most significant independent risk factor for clival invasion was female sex (OR  3.62, P  .014, multinomial logistic regression), followed by large tumor volume (OR  1.08, P  .001), and null-cell subtype (OR  5.47, P  .001). Larger tumor volume correlated with null-cell subtype (Mann-Whitney U test, P  .006), incidence of clival invasion (P  .001), and extent of clival invasion (P  .038). Clival invasion was associated with a significantly higher ratio of operative complications (15.63%, 2  7.067, P  .008) and recurrence (57.14%, 2  10.739, P  .001). 3
96. Eroukhmanoff J, Tejedor I, Potorac I, et al. MRI follow-up is unnecessary in patients with macroprolactinomas and long-term normal prolactin levels on dopamine agonist treatment. EUR. J. ENDOCRINOL.. 176(3):323-328, 2017 Mar. Observational-Dx 115 Patients To determine whether a regular MRI follow-up was necessary in patients with long-term normal prolactin levels under dopamine agonists. In total, 115 patients were included (63 men and 52 women; mean age at diagnosis: 36.3 years). Mean baseline prolactin level was 2224 +/- 6839 ng/mL. No significant increase of tumor volume was observed during the follow-up. Of the 21 patients (18%) who presented asymptomatic hemorrhagic changes of the macroprolactinoma on MRI, 2 had a tumor increase (2 and 7 mm in the largest size). Both were treated by cabergoline (1 mg/week) with normal prolactin levels obtained for 6 and 24 months. For both patients, no further growth was observed on MRI during follow-up at the same dose of cabergoline. 3
97. Hassan HA, Bessar MA, Herzallah IR, Laury AM, Arnaout MM, Basha MAA. Diagnostic value of early postoperative MRI and diffusion-weighted imaging following trans-sphenoidal resection of non-functioning pituitary macroadenomas. Clinical Radiology. 73(6):535-541, 2018 Jun.Clin Radiol. 73(6):535-541, 2018 Jun. Observational-Dx 30 patients To establish the value of early contrast-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in differentiating residual pituitary adenoma from postoperative surgical changes. Seventeen patients had postoperative surgical granulation tissue and 13 had residual adenoma based on the 6 months follow-up imaging. Mean ADC values of postoperative granulation tissue and residual adenoma were 1.476±0.476×10-3 mm2/s and 0.855±0.190×10-3 mm2/s, respectively, in the early postoperative period, and 1.357±0.416×10-3 mm2/s and 0.829±0.201×10-3 mm2/s, respectively, at the 6-month follow-up. ADC values of granulation tissue were significantly different from that of residual adenoma at both time points (p<0.001). Sensitivity, specificity, positive and negative predictive values of early MRI were 84.6%, 94.1%, 91.7%, and 88.9% respectively, and of early DWI were 91%, 97%, 94.3%, and 93%, respectively. 2
98. Debeneix C, Bourgeois M, Trivin C, Sainte-Rose C, Brauner R. Hypothalamic hamartoma: comparison of clinical presentation and magnetic resonance images. Horm Res. 2001; 56(1-2):12-18. Observational-Dx 19 patients To compare the clinical presentation and the MRI of patients with hypothalamic hamartoma(HH). All patients without neurological symptoms (group 1 and the asymptomatic patient) had pedunculated lesion (diameter 6.4 +/- 3.6 (3-15) mm), suspended from the floor of the third ventricle. All patients with neurological symptoms (groups 2 and 3) had sessile lesion (diameter 18.3 +/- 9.6 (10-38) mm, p = 0.0005 compared to the others), located in the interpeduncular cistern with extension to the hypothalamus. Seven patients were overweight. The growth hormone peak, free thyroxine, cortisol and prolactin concentrations, and the concomitant plasma and urinary osmolalities were normal in all the cases evaluated. The mean predicted or adult heights of 10 patients treated 5.2 +/- 3.3 years for central precocious puberty (CPP) with gonadotropin hormone releasing hormone (GnRH) analog were -0.3 +/- 1.7 SD, similar to their target height -0.1 +/- 0.9 SD. The clinical presentation of HH depends on its anatomy: small and pedunculated HH are associated with CPP, while large and sessile HH are associated with seizures. The hypothalamic-pituitary function in these cases is normal, which suggests that the absence of CPP is not due to gonadotropin deficiency. GnRH analog treatment preserves the growth potential in those with CPP. 4
99. Freeman JL, Coleman LT, Wellard RM, et al. MR imaging and spectroscopic study of epileptogenic hypothalamic hamartomas: analysis of 72 cases. AJNR Am J Neuroradiol. 2004; 25(3):450-462. Observational-Dx 72 patients To detail the relationship of hypothalamic hamartomas to surrounding structures, to determine the frequency and nature of associated abnormalities, and to gain insight into mechanisms of epileptogenesis. Compared with normal gray matter, hypothalamic hamartomas were hyperintense on T2-weighted images (93%), hypointense on T1-weighted images (74%), and had reduced N-acetylaspartate and increased myoinositol content shown by MR spectroscopy. Hypothalamic hamartomas can be readily distinguished from normal hypothalamic gray and adjacent myelinated fiber tracts, best appreciated on thin T2-weighted images. MR imaging and spectroscopy suggest reduced neuronal density and relative gliosis compared with normal gray matter. Associated epileptogenic lesions are rare, supporting the view that the hypothalamic hamartoma alone is responsible for the typical clinical features of the syndrome. The intimate relationship to the mammillary body, fornix, and mammillothalamic tract suggests a role for these structures in epileptogenesis associated with hypothalamic hamartomas. 4
100. Grunt JA, Midyett LK, Simon SD, Lowe L. When should cranial magnetic resonance imaging be used in girls with early sexual development? J Pediatr Endocrinol Metab. 2004; 17(5):775-780. Observational-Dx 130 female patients To determine whether concise parameters can be established in girls who present with signs of early puberty before the age of 8 years, which would help to identify those in whom cranial MRI is indicated. The patients in each group who had one or more of the central nervous system (CNS) signs and symptoms of early sexual development that were evaluated were markedly different. In Group I, 89% (CI 52-99.7%) had positive signs and symptoms that were suspicious for an intracranial lesion. In Group II, 94% (CI 85-98%), 63 of 66 girls, had no CNS signs or symptoms. The use of cranial MRI in the evaluation of girls with early sexual development is excessive. Girls with signs of pubertal development before age 8 years should be evaluated and followed. Those with specific CNS signs and symptoms, menses, and girls with a rapid advance in sexual development should undergo cranial MRI. Using this approach, far fewer patients in our study would have had cranial MRI. 4
101. Iorgi ND, Allegri AE, Napoli F, et al. The use of neuroimaging for assessing disorders of pituitary development. Clin Endocrinol (Oxf). 2012; 76(2):161-176. Review/Other-Dx N/A Review use of neuroimaging for assessing disorders of pituitary development. MRI is the radiological examination method of choice for evaluating hypothalamo-pituitary-related endocrine disease and is considered essential in the assessment of patients with suspected hypothalamo-pituitary pathology. 4
102. Ng SM, Kumar Y, Cody D, Smith CS, Didi M. Cranial MRI scans are indicated in all girls with central precocious puberty. Arch Dis Child. 2003; 88(5):414-418; discussion 414-418. Observational-Dx 67 girls To assess the value of cranial MRI scans in the investigation of girls with central precocious puberty (CPP); and to determine the clinical predictors of abnormal cranial MRI scans in these patients. Intracranial abnormalities were present in 10 (15%) patients (MR+), while 57 (85%) had no abnormalities (MR-). There was no statistical difference between MR+ patients and MR- patients at presentation with respect to age of onset of puberty, pubertal stage, bone age advance, pelvic ultrasound findings, or height or body mass index standard deviation scores (SDS). Girls with CPP should have a cranial MRI scan as part of their assessment since clinical features, including age, are not helpful in predicting those with underlying pathology. Implementation of such an approach may have a substantial effect on clinical practice and healthcare cost. 4
103. Zucchini S, di Natale B, Ambrosetto P, De Angelis R, Cacciari E, Chiumello G. Role of magnetic resonance imaging in hypothalamic-pituitary disorders. Horm Res. 1995; 44 Suppl 3:8-14. Review/Other-Dx N/A Review role of MRI in hypothalamic-pituitary disorders. In pituitary dwarfism, MRI reveals severe sella/pituitary gland and stalk hypoplasia with or without posterior pituitary ectopia, and empty sella, and this more frequently in patients with MPHD. 4
104. Carel JC, Eugster EA, Rogol A, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. [Review] [125 refs]. Pediatrics. 123(4):e752-62, 2009 Apr. Review/Other-Dx N/A To discuss optimal use of gonadotropin-releasing hormone analogs in the treatment of central precocious puberty and other conditions. No results stated in abstract. 4
105. Chung EM, Biko DM, Schroeder JW, Cube R, Conran RM. From the radiologic pathology archives: precocious puberty: radiologic-pathologic correlation. Radiographics. 32(7):2071-99, 2012 Nov-Dec. Review/Other-Dx N/A To review the approach to imaging evaluation of precocious puberty and the clinical, pathologic, and imaging features of lesions that cause precocious puberty, with emphasis on radiologic-pathologic correlation. No results stated in abstract. 4
106. Choi KH, Chung SJ, Kang MJ, et al. Boys with precocious or early puberty: incidence of pathological brain magnetic resonance imaging findings and factors related to newly developed brain lesions. Ann. pediatr. endocrinol. metab.. 18(4):183-90, 2013 Dec. Observational-Dx 61 Boys To evaluate brain MRI findings in boys with testicular enlargement =4 mL before 10.9 years of age and analyze the characteristics related to the detection of organic CNS lesions at diagnosis and the later development of lesions during follow-up. Brain lesions in groups I and II were detected in 17 of 23 boys (74%) with central PP, 9 of 30 boys (30%) with EP, and 7 of 8 boys (88%) with peripheral PP. All brain lesions in boys with peripheral PP were germ cell tumors (GCT), and 3 lesions developed later during follow-up. Group I showed earlier pubertal onset (P<0.01) and greater bone age advancement (P<0.05) than group III. Group III had lower birth weight and fewer neurological symptoms than “Ia and II” (all P<0.05). 3
107. Kaplowitz PB.. Do 6-8 year old girls with central precocious puberty need routine brain imaging?. Int J Pediatr Endocrinol. 2016:9, 2016. Review/Other-Dx N/A To explore some of the findings which have been used to support brain imaging in all children with central precocious puberty to rule out the possibility of a CNS lesion such as a brain tumor, which might require intervention and why it might be time to revise this recommendation, at least for girls presenting with CPP at greater than 6 years of age. No results stated in abstract. 4
108. Klein DA, Emerick JE, Sylvester JE, Vogt KS. Disorders of Puberty: An Approach to Diagnosis and Management. [Review]. Am Fam Physician. 96(9):590-599, 2017 Nov 01. Review/Other-Dx N/A To discuss the symptoms, diagnosis, and management of disorders of puberty. No results in abstract 4
109. Mogensen SS, Aksglaede L, Mouritsen A, et al. Pathological and incidental findings on brain MRI in a single-center study of 229 consecutive girls with early or precocious puberty. PLoS ONE. 7(1):e29829, 2012. Observational-Dx 229 Girls To evaluate the outcome of brain MRI in girls referred with early signs of puberty in relation to age at presentation as well as clinical and biochemical parameters. Thirteen out of 208 (6.3%) girls with precocious puberty, but no other sign of CNS symptoms, had a pathological brain MRI. Importantly, all 13 girls were above 6 years of age, and 6 girls were even 8-9 years old. Twenty girls (9.6%) had incidental findings on brain MRI. Furthermore, 21 girls had known CNS pathology at time of evaluation. Basal LH was significantly higher in girls with newly diagnosed CNS pathology compared to girls with a non-pathological MRI (p = 0.025); no cut of value was found as values overlapped. 3
110. Pedicelli S, Alessio P, Scire G, Cappa M, Cianfarani S. Routine screening by brain magnetic resonance imaging is not indicated in every girl with onset of puberty between the ages of 6 and 8 years. J Clin Endocrinol Metab. 99(12):4455-61, 2014 Dec. Observational-Dx 182 girls To determine the prevalence and type of intracranial lesions in otherwise normal girls with central precocious puberty (idiopathic CPP) and to identify the clinical and biochemical predictors of brain abnormalities. Intravenous contrast was administered in this study. Brain MRI showed no alteration in 157 (86%), incidentalomas of the hypothalamic-pituitary area unrelated to CPP in 19 (11%), and hamartomas in six girls (3%). Girls with hamartomas were younger than 6 years and had significantly higher mean baseline and stimulated LH values (P.001), LH to FSH ratio (P.001), serum 17-estradiol levels (P.001), and uterine length (P.05). However, all the parameters overlapped extensively in girls with or without cerebral alterations. 3
111. Rieth KG, Comite F, Dwyer AJ, et al. CT of cerebral abnormalities in precocious puberty. AJR Am J Roentgenol. 148(6):1231-8, 1987 Jun. Review/Other-Dx 90 Children to detect cerebral causes of their precocious puberty No results stated in the abstract. 4
112. Carel JC, Leger J. Clinical practice. Precocious puberty. [Review] [55 refs]. N Engl J Med. 358(22):2366-77, 2008 May 29. Review/Other-Dx N/A To describe the symptoms, clinical testing, treatment and management of precocious puberty. No results stated in abstract. 4
113. Oatman OJ, McClellan DR, Olson ML, Garcia-Filion P. Endocrine and pubertal disturbances in optic nerve hypoplasia, from infancy to adolescence. Int J Pediatr Endocrinol. 2015(1):8, 2015. Observational-Dx 101 Patients To examine rates of endocrine dysfunction and pubertal disturbances in a pediatric population of ONH. During the study period, 101 patients underwent an endocrine evaluation (median age: 2.3 years [0.76 – 6.5]). Hypopituitarism was present in 73% of patients with growth hormone deficiency (56%) and hypothyroidism (54%) being the most common. Pubertal disturbances (n = 19) were common; micropenis in 31% (13/42) of males and 2% with precocious puberty. Half of adolescents (n = 4/8) were diagnosed with gonadotropin deficiency. Patients with MRI pituitary abnormalities were more likely to have endocrine dysfunction than those without (p = 0.004). The sensitivity and specificity of MRI pituitary abnormalities for hypopituitarism was 54% and 92%, respectively. 3
114. American College of Radiology. ACR–SPR Practice Parameter for the Safe and Optimal Performance of Fetal Magnetic Resonance Imaging (MRI). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/mr-fetal.pdf Review/Other-Dx N/A To promote safe and optimal performance of fetal magnetic resonance imaging (MRI). No abstract available. 4
115. American College of Radiology. ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Adolescents and Women with Ionizing Radiation. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/pregnant-pts.pdf Review/Other-Dx N/A To assist practitioners in providing appropriate radiologic care for pregnant or potentially pregnant adolescents and women by describing specific training, skills and techniques. No abstract available. 4
116. American College of Radiology. ACR-ACOG-AIUM-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetrical Ultrasound. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/us-ob.pdf Review/Other-Dx N/A To promote the safe and effective use of diagnostic and therapeutic radiology by describing the key elements of standard ultrasound examinations in the first, second, and third trimesters of pregnancy. No abstract available. 4
117. American College of Radiology. Manual on Contrast Media. Available at: http://www.acr.org/Quality-Safety/Resources/Contrast-Manual. Review/Other-Dx N/A Guidance document on contrast media to assist radiologists in recognizing and managing risks associated with the use of contrast media. N/A 4
118. Expert Panel on MR Safety, Kanal E, Barkovich AJ, et al. ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging. 37(3):501-30, 2013 Mar. Review/Other-Dx N/A To help guide MR practitioners regarding MR safety issues and provide a basis for them to develop and implement their own MR policies and practices. No abstract available. 4
119. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4