Dynamic gadolinium-enhanced MR imaging of pituitary adenomas: usefulness of sequential sagittal and coronal plane images

Abstract

Dynamic magnetic resonance (MR) imaging for pituitary adenomas is usually performed in a coronal direction; however, small lesions between slices, or lesions located at the anterior or posterior aspect of the pituitary gland might be overlooked on MR images in only the coronal direction. The purpose of our study was to evaluate whether consecutive dynamic MR images in the coronal and sagittal planes improve detection of pituitary adenomas. Eighteen patients with pituitary microadenomas and nine with healthy pituitary glands were included in this study. MR images were performed with 1.5 T superconductive units and commercially-available head coils. After a 5 ml gadolinium contrast injection, eight serial dynamic sagittal images were obtained. Within 3 or 6 min, this was followed by a 10-15 ml gadolinium injection and acquisition of eight serial dynamic coronal images. Dynamic MR images and conventional noncontrast- and contrast-enhanced sagittal and coronal T1-weighted images were evaluated independently in a blind fashion by two neuroradiologists regarding the depiction 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%) (P<0.05, P<0.05, respectively). The specificity and accuracy of dynamic enhanced MR imaging with combination of sagittal and coronal images was 88.9% respectively. Dynamic gadolinium-enhanced MR imaging, especially using both sagittal and coronal planes, was concluded to be useful for the detection of pituitary microadenomas.

A role for 11C-methionine PET imaging in ACTH-dependent Cushing's syndrome

“…Accordingly, more detailed sequences (e.g., dynamic and/or SPGR MRI) are often employed, leading to a reported improvement in sensitivity from 50-55% (SE) to 70-75% (dynamic) and 70-90% (SPGR), but with the important caveat of a high detection rate of incidental pituitary lesions (6,20,21,22). This presents a significant challenge, with the risk that a coincidental pituitary lesion will be erroneously identified as the source of excess ACTH, either in a patient with genuine CD due to a non-visualised microadenoma (illustrative case 5, Fig.…”

Using intraoperative dynamic contrast-enhanced T1-weighted MRI to identify residual tumor in glioblastoma surgery

“…To increase the information obtained from contrast-enhanced studies, a wide range of dynamic contrast-enhanced T1-weighted imaging sequences, protocols, image processing methods, and interpretation criteria have been developed and evaluated over the last 20 years. 9,10,20,30 Dynamic contrast-enhanced MRI provides a measurement of tissue permeability to the paramagnetic contrast agent. 5 A relatively low dose of Gd is administered (usually a single dose of 0.1 mmol/kg) and repeated acquisitions of a T1-weighted sequence covering the ROI are made at longer intervals before, during, and long after the injection of the paramagnetic contrast medium (typi-cally every 15-30 seconds, for as long as 300 seconds).…”

Latest diagnostic approaches to determine the cause of ACTH-dependent Cushing’s syndrome, in the South African setting

“…7 Imaging is usually performed in a coronal plane, but sensitivity is increased by employing a combination of sagittal and coronal planes. 8,9 Conventional T1 W and T2 W SE sequences in combination with DCE T1 W detect the microadenoma in approximately 70% of cases and improve on sensitivity in comparison with conventional MRI alone. 10,11 Limitations of DCE scanning include difficulty in distinguishing between a simple cyst and a microadenoma as well as the non-standardised dynamic image acquisition time frame.…”