Normal Pituitary Stalk: High-Resolution MR Imaging at 3T

Satogami, Naoe; Miki, Yukio; Koyama, Takashi; Kataoka, Milliam L.; Togashi, Kaori

doi:10.3174/ajnr.a1836

Cited by 63 publications

(44 citation statements)

References 18 publications

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“…The shape, length and diameter of the pituitary stalk (PS) were measured proximally and distally from sagittal and coronal T1-weighted sequences (14). The stalk was considered enlarged when the diameter was greater than 3.25 mm in its proximal portion and/or 1.9 mm in its distal portion, as reported previously (9).…”

Section: Mri Evaluationmentioning

confidence: 99%

Pituitary stalk thickening: the role of an innovative MRI imaging analysis which may assist in determining clinical management

Sbardella

Joseph

Jafar-Mohammadi

et al. 2016

European Journal of Endocrinology

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Context: Disease processes that affect the pituitary stalk are broad; the diagnosis and management of these lesions remains unclear. Objective: The aim was to assess the clinical, biochemical and histopathological characteristics of pituitary stalk lesions and their association with specific MRI features in order to provide diagnostic and prognostic guidance. Design and methods: Retrospective observational study of 36 patients (mean age 37 years, range: 4-83) with pituitary stalk thickening evaluated at a university hospital in Oxford, UK, 2007UK, -2015. We reviewed morphology, signal intensity, enhancement and texture appearance at MRI (evaluated with the ImageJ programme), along with clinical, biochemical, histopathological and long-term follow-up data. Results: Diagnosis was considered certain for 22 patients: 46% neoplastic, 32% inflammatory and 22% congenital lesions. In the remaining 14 patients, a diagnosis of a non-neoplastic disorder was assumed on the basis of long-term follow-up (mean 41.3 months, range: 12-84). Diabetes insipidus and headache were common features in 47 and 42% at presentation, with secondary hypogonadism the most frequent anterior pituitary defect. Neoplasia was suggested on size criteria or progression with 30% sensitivity. However, textural analysis of MRI scans revealed a significant correlation between the tumour pathology and pituitary stalk heterogeneity in pre-and post-gadolinium T1-weighted images (sensitivity: 88.9%, specificity: 91.7%). Conclusions: New techniques of MRI imaging analysis may identify clinically significant neoplastic lesions, thus directing future therapy. We propose possible textural heterogeneity criteria of the pituitary stalk on pre-and postgadolinium T1 images with the aim of differentiating between neoplastic and non-neoplastic lesions with a high degree of accuracy.

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Section: Mri Evaluationmentioning

confidence: 99%

Pituitary stalk thickening: the role of an innovative MRI imaging analysis which may assist in determining clinical management

Sbardella

Joseph

Jafar-Mohammadi

et al. 2016

European Journal of Endocrinology

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“…30 Using 3-T MRI, highresolution anatomical and physiological images of the optic pathways can be obtained. 31 In addition, proton magnetic resonance spectroscopy can provide valuable information on biodistribution of metabolites such as N-acetylaspartate and choline-containing compounds. So, if the accuracy improves, it may become possible to distinguish between tumor and scar tissue.…”

Section: Survival and Local Controlmentioning

confidence: 99%

Hypofractionated stereotactic radiotherapy with CyberKnife for nonfunctioning pituitary adenoma: high local control with low toxicity

Iwata¹,

Sato²,

Tatewaki³

et al. 2011

Neuro-Oncology

117

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patients with nonfunctioning pituitary adenoma were treated with hypofractionated SRT. Forty-three patients were male, and 57 were female. The patient's ages ranged from 16 to 82 years (median, 59 years). Five patients were medically inoperable, and 1 refused surgery; the remaining 94 were recurrent cases or those receiving postoperative adjuvant SRT. No patients had a history of previous cranial radiotherapy. Tumor volume ranged from 0.7 to 64.3 mL (median, 5.1 mL). The marginal doses were 17.0 to 21.0 Gy for the 3-fraction schedule and 22.0 to 25.0 Gy for the 5-fraction schedule. Toxicities were evaluated with the Common Terminology Criteria for Adverse Events version 4.0. The median follow-up period for living patients was 33 months (range, 18 -118.5 months). The 3-year overall survival and local control rates were 98% and 98%, respectively. In-field and out-field tumor regrowth were observed in 3 and 2 patients, respectively. Transient cyst enlargement occurred in 3 cases. A post-SRT grade 2 visual disorder occurred in 1 patient. Symptomatic post-SRT hypopituitarism was observed in 3 of 74 patients who had not received hormone replacement therapy after surgery.CyberKnife SRT involving 21 Gy in 3 fractions or 25 Gy in 5 fractions is safe and effective for surgical treatment of nonfunctioning pituitary adenoma. Hypofractionated SRT appears useful for protecting the visual nerve and neuroendocrine function, especially for tumors located near the optic pathways and large tumors.Keywords: CyberKnife, hypofractionated stereotactic radiotherapy, nonfunctioning, optic pathway, pituitary adenoma. P ituitary adenoma (PA) is a benign tumor that occurs mainly in adults between 20 and 50 years of age and constitutes about 10 -20% of all intracranial tumors.1,2 PA is divided into functioning and nonfunctioning varieties, and the purpose and method of treatment differ for the two entities. Treatment for functioning PA aims to prevent the excessive secretion of anterior pituitary lobe hormone. On the other hand, treatment of nonfunctioning PA is typically intended to control tumor volume and prevent or reverse visual disorders and endocrinopathies. Tumors that cause visual symptoms are treated primarily with transsphenoidal surgery or craniotomy; and if patients are asymptomatic, a wait-and-see approach may be taken. Nonfunctioning PA is not necessarily treated by immediate radiotherapy (RT) after resection, unlike functioning PA. However, several studies have reported recurrences in about 20 -50% of cases treated with surgery alone. 3 -5 Radiotherapy is considered if residual or recurrent tumors invade the cavernous sinus or in cases in which repeated surgeries have resulted in fibrosis and Corresponding Author: Hiromitsu Iwata, MD, PhD, Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan (h-iwa-ncu@nifty.com). inoperability. In the past, conventional RT was used to treat such cases. 6 -8 Considering the proximity of organs at ri...

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“…Predominant posterior pituitary involvement is perhaps the most important distinguishing feature in differentiating metastasis from adenoma ( Figure 1a and e-g) [3,4,11]. There is some controversy as to what constitutes a thickened pituitary stalk, but recent MRI studies have determined that the normal adult anteroposterior diameter at the level of its insertion into the pituitary to be 2.3 ± 0.4 mm [12]. Cavernous sinus invasion also occurs more frequently in pituitary metastasis, but is only demonstrated in 6% to 10% of pituitary adenomas [13].…”

Section: Patientmentioning

confidence: 99%

Symptomatic Metastasis to the Pituitary Gland: A Report of Three Cases and Review of the Literature

Woo¹,

Li²

2015

J Neurol Disord

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Normal Pituitary Stalk: High-Resolution MR Imaging at 3T

Cited by 63 publications

References 18 publications

Pituitary stalk thickening: the role of an innovative MRI imaging analysis which may assist in determining clinical management

Pituitary stalk thickening: the role of an innovative MRI imaging analysis which may assist in determining clinical management

Hypofractionated stereotactic radiotherapy with CyberKnife for nonfunctioning pituitary adenoma: high local control with low toxicity

Symptomatic Metastasis to the Pituitary Gland: A Report of Three Cases and Review of the Literature

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