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1. Shah S, Waldman AD, Mehta A. Advances in pituitary imaging technology and future prospects. Best Pract Res Clin Endocrinol Metab. 2012; 26(1):35-46. Review/Other-Dx N/A Review advances in pituitary imaging technology. Multiple advances in pituitary imaging technology have been made in the past half-century. MRI is now established as the imaging modality of choice, and produces high quality images of the gland and adjacent structures, especially at 3T. 4
2. Doraiswamy PM, Krishnan KR, Figiel GS, et al. A brain magnetic resonance imaging study of pituitary gland morphology in anorexia nervosa and bulimia. Biol Psychiatry. 1990; 28(2):110-116. Observational-Dx 18 patients and 13 healthy volunteers To measure the dimensions of the pituitary gland, on brain MR images, in patients with eating disorders compared with healthy controls, and to document whether macroscopic pituitary, pathology, such as adenoma, cyst, or empty sella, occurs more frequently in anorexia nervosa and/or bulimia. The incidence of the posterior pituitary bright spot and the potential clinical correlates of the pituitary measurements were also examined. None of the 18 patients with anorexia or bulimia had any radiological evidence suggestive of pituitary macroadenoma, cyst, or empty sella. Measurements revealed that the anorectics and bulimics had smaller pituitary gland cross-sectional areas (p< 0.05) and smaller pituitary gland heights, compared with healthy controls. These preliminary findings in anorectics and bulimics are suggestive of pituitary atrophy secondary to nutritional or endocrine alterations, rather than a primary pituitary pathology. 4
3. 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
4. Lieberman S. Diseases of the pituitary. In: Fishman MC, et al, ed. Medicine. Philadelphia, Pa.: Lippincott-Raven Publishers; 1996:165 Review/Other-Dx N/A Book chapter. N/A 4
5. 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
6. 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
7. 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
8. 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
9. 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
10. 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
11. Flanagan EP, Hunderfund AL, Giannini C, Meissner I. Addition of magnetic resonance imaging to computed tomography and sensitivity to blood in pituitary apoplexy. Arch Neurol. 2011; 68(10):1336-1337. Review/Other-Dx 1 patient To examine findings of CT and MRI on a 63-year-old man presented after being awoken by a severe headache followed by vomiting. CT of the head performed 10 hours after symptom onset revealed a suprasellar mass. MRI was performed 24 hours after CT and demonstrated blood in the mass consistent with pituitary apoplexy. Subsequent examinations revealed bitemporal hemianopia confirmed by formal perimetry. 4
12. 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
13. 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
14. De Herder WW, Lamberts SW. Imaging of pituitary tumours. Baillieres Clin Endocrinol Metab. 1995; 9(2):367-389. Review/Other-Dx N/A Review role of imaging in pituitary tumors. For pituitary tumors, second generation CT, dynamic CT and MRI provide information about the extent of the tumor and its anatomical relations with the surrounding tissues. Sometimes these techniques can distinguish primary anterior pituitary lesions from primary parasellar lesions with presentations in the sellar region. In general, contrast-enhanced MRI and dynamic CT are more sensitive than conventional CT for the diagnosis of pituitary microadenomas, as well as for the precise delineation of the parasellar invasion of macroadenomas. 4
15. 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
16. Donovan JL, Nesbit GM. Distinction of masses involving the sella and suprasellar space: specificity of imaging features. AJR. 1996; 167(3):597-603. Review/Other-Dx N/A Review the imaging findings of the various sellar and suprasellar lesions reported in the literature to determine the value of these features in making a distinction between lesions in the two locations. MRI is the most helpful imaging study in identifying key distinguishing features, with CT and angiography contributing useful information only in certain situations. 4
17. Elster AD. Imaging of the sella: anatomy and pathology. Semin Ultrasound CT MR. 1993; 14(3):182-194. Review/Other-Dx N/A Review imaging of the sella. Modern radiologic techniques like CT and MRI have provided new insights into the morphologic changes of the gland that occur both in health and in a variety of diseases. 4
18. Glick RP, Tiesi JA. Subacute pituitary apoplexy: clinical and magnetic resonance imaging characteristics. Neurosurgery. 1990; 27(2):214-218; discussion 218-219. Review/Other-Dx 7 patients To examine MRI in the diagnosis of cases of "subacute" pituitary apoplexy, that is, intra-adenomatous pituitary hemorrhage associated with clinical symptoms atypical of acute pituitary apoplexy. MRI scan is an invaluable tool in identifying this subacute form of intra-adenomatous pituitary hemorrhage and has proven especially useful as a means of therapeutic planning and follow-up care in patients presenting with symptoms not typical of classic pituitary apoplexy. 4
19. Goldstein SJ, Lee C, Carr WA, Rosenbaum HD, Tibbs PA, Walsh JW. Magnetic resonance imaging of the sella turcica and parasellar region. A clinical-radiographic evaluation with computed tomography. Surg Neurol. 1986; 26(4):330-337. Observational-Dx 25 patients To assess the relative merits of MR and CT in the radiologic diagnosis of sellar disease. 22 MR scans were of diagnostic value equivalent to that of the corresponding CT studies. In two small meningiomas, an empty sella, and a sphenoid-middle fossa tumor, MR technology failed to delineate the pathologic process adequately. In the remaining five patients, MR either more convincingly demonstrated the pathologic anatomy or yielded diagnostic information not present in the CT study. In view of the absence of ionizing radiation, high degree of tissue contrast and spatial resolution, and multiplanar capability, MR scanning will probably become the initial imaging modality of choice in patients suspected of harboring sellar and parasellar tumors. 3
20. Guy RL, Benn JJ, Ayers AB, et al. A comparison of CT and MRI in the assessment of the pituitary and parasellar region. Clin Radiol. 1991; 43(3):156-161. Observational-Dx 40 patients Prospective study to compare high resolution thin slice, contrastenhanced, axial CT with unenhanced MRI at 1.5T in the assessment of the pituitary and parasellar region. MRI was superior to CT for the identification of the posterior pituitary and pituitary stalk and was better at showing the cystic nature of tumours. Visualization of the optic chiasm and assessment of displacement of the optic chiasm and the carotid arteries were also better with MRI. - CT was equally good at showing cavernous sinus displacement or invasion, sphenoid sinus invasion and erosion of the floor of the sella turcica and was the only technique able to show calcification of the gland. More focal abnormalities were seen in the pituitary gland with CT than with unenhanced MRI, but there was a higher false positive rate for microadenoma detection with CT. - MRI not only gives more information overall than CT but it is a more reliable technique between different observers for the assessment of the pituitary and parasellar region. 3
21. Naheedy MH, Haag JR, Azar-Kia B, Mafee MF, Elias DA. MRI and CT of sellar and parasellar disorders. Radiol Clin North Am. 1987; 25(4):819-847. Review/Other-Dx N/A Review CT and MRI with visualized anatomic structures of parasellar regions. A closer look at how CT and MRI are used to delineate the different pathologic processes of the sellar and parasellar regions is also reviewed. CT and MRI are valuable tools in the imaging of these regions. 4
22. Sade B, Mohr G, Vezina JL. Distortion of normal pituitary structures in sellar pathologies on MRI. Can J Neurol Sci. 2004; 31(4):467-473. Observational-Dx 100 patients with sellar lesions and 102 controls To assess the displacement patterns and shifts of the normal pituitary gland in sellar pathologies on MRI and to determine if the position of the bright spot (BS) represents a predicting factor for the position of the residual adenohypophysis (RAH) in pathological conditions. The BS was visible in 91.2% of 102 cases in the control group, as compared to 75 of the 100 patients with sellar lesions. Location of RAH was identified in 58% of the patients, and RAH enhanced more than the lesion in all cases after contrast infusion. The RAH was identified in 65.3% of the 75 "BS positive" patients, as compared to 36% of the 25 "BS negative". The normal residual gland was visualized intra-operatively in 63.5% of the 52 operated patients: in 37 "BS positive" patients, it was visualized intra-operatively in 81.1% and in 28 "RAH positive" patients, it was identified in 82.1%.The BS can be identified in the majority and RAH in more than half of the cases with pituitary lesions on MRI. Positions of both the BS and RAH help predict the location of the normal residual gland during surgery and, therefore, may contribute to preserving the pituitary function. 4
23. 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
24. 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
25. 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
26. 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
27. 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
28. 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
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. 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
31. 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
32. 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
33. 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
34. 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
35. 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
36. 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
37. 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
38. 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
39. 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
40. 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
41. 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
42. 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
43. 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
44. Lee CT, Tung YC, Tsai WY. Etiology and clinical features of isosexual precocious puberty in Taiwanese girls: twenty-three years' experience in National Taiwan University Hospital. J Pediatr Endocrinol Metab. 2009; 22(10):947-953. Observational-Dx 460 girls To clarify the etiology and clinical features of Taiwanese girls with isosexual precocious puberty. Results showed 7% of 460 girls had gonadotropin-independent precocious puberty (GIPP). The other 93% patients had gonadotropin-dependent precocious puberty (GDPP) and 96% of them were idiopathic. Functional ovarian cyst and hypothalamic hamartoma were leading causes of GIPP and organic GDPP, respectively. - The presence of undetectable basal serum FSH and LH levels had a specificity of 95% in girls with GIPP. Among girls with GDPP, those aged < 5 years had a higher percentage of detected CNS lesions than older girls (8% vs 3%). Girls with organic CNS lesions also had more advanced bone age SDS (6.9 +/- 3.3 vs 3.3 +/- 1.9), larger uterine volume (13.8 +/- 12.1 vs 6.6 +/- 8.1 cm3), higher basal serum estradiol (33.5 +/- 17.1 vs 26.8 +/- 18.2 pg/ml), and higher peak LH level after GnRH stimulation (45.2 +/- 36.2 vs 25.8 +/- 27.3 U/l) than those with idiopathic GDPP. - GIPP is uncommon in Taiwanese girls with precocious puberty. Functional ovarian cyst and hypothalamic hamartoma are leading causes of GIPP and organic GDPP, respectively. The presence of neurological deficit, younger age at onset of puberty, presence of menstruation, rapid advance of bone age, markedly enlarged uterus, high serum estradiol, and high peak LH level after GnRH stimulation are suggestive of organic GDPP. 4
45. 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
46. 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
47. 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
48. 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
49. 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
50. 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
51. 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
52. 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
53. 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
54. 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
55. 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
56. 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
57. 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
58. Hirsch WL, Jr., Hryshko FG, Sekhar LN, et al. Comparison of MR imaging, CT, and angiography in the evaluation of the enlarged cavernous sinus. AJR. 1988; 151(5):1015-1023. Observational-Dx 21 patients To compare the efficacy of angiography, CT, and MR in the evaluation of panasellar lesions. 21 patients with enlargement of the cavernous sinus were studied with CT and MR imaging. 18 of the patients also had cerebral angiography. MR was superior to CT in differentiating parasellar aneurysms from neoplastic masses. MR was also superior to both CT and angiography in defining the relationships of cavernous sinus neoplasms to the internal carotid artery, pituitary gland, optic chiasm, infundibulum, and fifth cranial nerves. Only in the definition of bone erosion or hyperostosis was MR inferior to another method (CT). MR should be the initial diagnostic study in patients with symptoms of a parasellar mass, with supplementation when necessary by CT and angiography. 4
59. Jafar JJ, Crowell RM. Parasellar and optic nerve lesions: the neurosurgeon's perspective. Radiol Clin North Am. 1987; 25(4):877-892. Review/Other-Dx N/A To examine role of imaging in neuroradiologic evaluation of parasellar lesions. CT and MRI are used in the assessment of these lesions to establish the diagnosis and to assist the neurosurgeon in defining the precise location. Careful neuroradiologic assessment and close cooperation between the neurosurgeon and the neuroradiologist have much bearing on the surgical planning and eventual outcome of the patient. 4
60. 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
61. Kasperlik-Zaluska A, Walecki J, Brzezinski J, et al. MRI versus CT in the diagnosis of Nelson's syndrome. Eur Radiol. 1997; 7(1):106-109. Observational-Dx 13 patients To evaluate the utility of MRI and CT in the diagnosis of Nelson's syndrome, i. e. pituitary tumours in patients bilaterally adrenalectomized for Cushing's disease. CT and MRI revealed no changes in the pituitary gland in 6 patients. In the remaining 7 patients only three CT scans were suggestive of a pituitary adenoma. MRI studies with administration of gadodiamide confirmed the CT diagnosis of Nelson's tumour in 3 patients and disclosed microadenomas in a further 4 patients. Neurosurgical treatment in 4 patients confirmed the MRI findings. Additionally CT and MRI examinations were performed in 5 patients suspected of a recurrent Nelson's tumour 3-11 years after neurosurgery. MRI visualized recurrent adenomas in 3 patients that were not well seen by CT scans. 4
62. Levine PA, Paling MR, Black WC, Cantrell RW. MRI vs. high-resolution CT scanning: evaluation of the anterior skull base. Otolaryngol Head Neck Surg. 1987; 96(3):260-267. Review/Other-Dx N/A Review article comparing MRI with CT in the evaluation of the anterior skull base. MRI provides improved imaging of the CNS, but, while recent articles maintain the superiority of MRI head and neck imaging, the advantages to the clinician are less clear. 4
63. L'Huillier F, Combes C, Martin N, Leclerc X, Pruvo JP, Gaston A. MRI in the diagnosis of so-called pituitary apoplexy: seven cases. J Neuroradiol. 1989; 16(3):221-237. Review/Other-Dx 7 patients Authors describe cases of pituitary adenoma with acute neurological symptoms, which were examined by MRI. CT was positive in all 7 cases, but less contributive than T1-weighted MRI both for tumoral volume determination and detection of intratumoral haemorrhage. Although theoretical problems may arise concerning the diagnosis of acute intratumoral bleeding at an early stage, the authors emphasize the value of MRI in showing the extension of the tumor into the retroclival cistern and the cavernous sinus, especially when surgery is not performed in the acute period. 4
64. 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
65. 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
66. 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
67. 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
68. 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
69. 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
70. Nichols DA, Laws ER, Jr., Houser OW, Abboud CF. Comparison of magnetic resonance imaging and computed tomography in the preoperative evaluation of pituitary adenomas. Neurosurgery. 1988; 22(2):380-385. Observational-Dx 20 patients To compare MRI and CT in the preoperative evaluation of pituitary adenomas. MRI was superior to CT for detecting the extrasellar extent of tumor. Within the sella turcica, MRI and CT were equivalent with regard to lesion detection, except for 1 patient in whom CT was able to detect a surgically confirmed 3-mm microadenoma that was not visualized on the MRI examination. 3
71. Rodriguez O, Mateos B, de la Pedraja R, et al. Postoperative follow-up of pituitary adenomas after trans-sphenoidal resection: MRI and clinical correlation. Neuroradiology. 1996; 38(8):747-754. Observational-Dx 16 patients To correlate the morphological changes seen on MRI studies of the sellar region after trans-sphenoidal resection of pituitary adenomas with clinical and hormonal studies. Tumour remnants were noted in the immediate postoperative period in macroadenomas. Compression of the infundibulum was the only reliable indicator of possible involvement. Optic chiasm compression, defined as close contact between the chiasm and the tumour, was the only morphological finding that indicated visual impairment. There was no standard repneumatisation pattern in the sphenoid sinus, since mucosal changes resembling sinusitis were one of the postsurgical changes. MRI was not useful for follow-up of microadenomas. 3
72. 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
73. 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
74. 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
75. 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
76. Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA. 2006; 295(19):2286-2296. Review/Other-Dx N/A To summarize existing evidence regarding the epidemiology, pathophysiology, diagnosis, and management of spontaneous spinal CSF leaks and intracranial hypotension. Spontaneous intracranial hypotension is not rare but it remains underdiagnosed. The spectrum of clinical and radiographic manifestations is varied, with diagnosis largely based on clinical suspicion, cranial MRI, and myelography. Numerous treatment options are available, but much remains to be learned about this disorder. 4
77. Sato N, Endo K, Ishizaka H, Matsumoto M. Serial MR intensity changes of the posterior pituitary in a patient with anorexia nervosa, high serum ADH, and oliguria. J Comput Assist Tomogr. 1993; 17(4):648-650. Review/Other-Dx 1 patient A case with anorexia nervosa, high serum antidiuretic hormone, and oliguria who underwent three cerebral MR studies over the course of treatment is presented. The first MR examination showed absence of posterior pituitary high signal and early enhancement of the posterior pituitary lobe on dynamic MRI. In subsequent MR examinations posterior pituitary high signal became evident in concomitance with clinical improvement. This case suggests that posterior pituitary high signal changes may reflect reaccumulation of antidiuretic hormone granules and that dynamic MR of the posterior pituitary lobe may be useful for assessing the vascularity of the posterior pituitary lobe and/or the reversibility of its function. 4
78. Terano T, Seya A, Tamura Y, Yoshida S, Hirayama T. Characteristics of the pituitary gland in elderly subjects from magnetic resonance images: relationship to pituitary hormone secretion. Clin Endocrinol (Oxf). 1996; 45(3):273-279. Observational-Dx 59 elderly and 14 healthy subjects To clarify the morphological characteristics of the pituitary gland by MRI in elderly subjects and to relate them to pituitary hormone secretion. Pituitary height, width and volume in the elderly subjects were less than those in the young subjects. Empty sella was more frequently observed in the elderly subjects (19%), especially women, than in the young ones. However, no relation was observed between the pituitary size or volume and basal levels of anterior pituitary hormones. Posterior pituitary bright signal(PBS) on T1-weighted MRI, which is thought to reflect its storage of the neurophysin-peptide complex, was not detected in 29% of the elderly subjects while it could be detected in all the young subjects. None of the elderly subjects showed clinical signs or symptoms of diabetes insipidus. Fasting plasma osmolarity and arginine vasopressin (AVP) in the elderly subjects were significantly higher than in the young subjects. Moreover, plasma AVP was significantly higher in the elderly subjects without the PBS than in those with the PBS. It is suggested that the excessive release of AVP from the posterior pituitary as a result of persistently raised plasma osmolality in the elderly subjects may lead to depletion of the neurosecretory granules in the posterior pituitary gland and may result in disappearance of the posterior pituitary bright signal on T1-weighted MRI. 4