Pre- and postoperative magnetic resonance imaging appearance of the normal residual pituitary gland following macroadenoma resection: Clinical implications

Abstract

Background:To assess the relationship between the preoperative magnetic resonance imaging (MRI) appearance of the normal residual pituitary gland (NRPG) and pituitary functional outcome following transsphenoidal resection of pituitary macroadenomas.Methods:We retrospectively reviewed the medical records of 100 consecutive patients with a pituitary macroadenoma, who underwent transsphenoidal resection. The preoperative configuration of the displaced NRPG was stratified as superior, superolateral or lateral. The extent of postoperative restitution of the NRPG was divided into four groups: Group 1 — normal residual gland or almost normal; Group 2 — more than 50% restitution; Group 3 — less than 50% of the normal residual gland; and Group 4 — barely visible or absent residual gland. The pre- and postoperative NRPG appearance was correlated with pituitary functional status.Results:Preoperatively, the NRPG was identifiable in 79 patients, with extrasellar displacement in 53%. The displacement pattern was superior in 8%, superolateral in 32%, and lateral in 58% of the patients. If the NRPG was displaced laterally, the ipsilateral cavernous sinus was not invaded by the pituitary macroadenoma. Partial or complete pituitary function was lost in 6 / 23 (26.1%) patients with superior or superolateral displacement of the NRPG, compared to only 1 / 36 (2.8%) patients without superior displacement of the NRPG (P = 0.025). Progressive postoperative reconstitution of the NRPG was related to the preservation of the pituitary hormonal axis (Pearson Chi-Square P < 0.001).Conclusions:Progressive displacement of the NRPG preoperatively, and lack of restitution of the NRPG on postoperative MRI appeared to correlate with the postoperative pituitary functional loss.

High resolution pituitary gland MRI at 7.0 tesla: a clinical evaluation in Cushing’s disease

“…This is important as there is evidence that a precise localization is associated with a more favourable outcome of surgery [ 5 , 20 ]. However, other studies could not demonstrate that the cure rate is higher in patients in whom the lesion is actually visualized before surgery [ 4 , 18 , 21 ]. Nevertheless, it is obvious that in patients with no visible lesion on MRI, a more extensive surgical procedure is needed [ 4 ].…”

“…Therefore, final diagnosis is often based on central venous sampling and magnetic resonance imaging (MRI) [ 3 ]. In case a pituitary origin of Cushing’s syndrome is confirmed, the treatment of choice is surgical removal of the lesion, for which visualization of the lesion is crucial [ 4 – 6 ]. Consequently, it is important to visualize the pituitary gland with the highest possible spatial resolution, which enables correct delineation of small anatomical structures and pathological lesions.…”

Deep learning-based thin-section MRI reconstruction improves tumour detection and delineation in pre- and post-treatment pituitary adenoma

“…In the management of growth hormone-releasing or adrenocorticotropic hormone (ACTH) secreting tumour, precise detection and localisation of adenoma is essential 3 – 5 . In addition, to selectively remove the tumour, avoid the risk of residual tumour, and preserve functioning normal tissue, surgeons must precisely distinguish normal pituitary stalk and gland from pituitary adenoma 6 , 7 . Therefore, dedicated high-resolution magnetic resonance imaging (MRI) protocols have been proposed to detect pituitary adenoma and accurately guide surgical removal 8 – 11 .…”

Challenges in the Management of a 7-Year-Old Child with Thyrotropin-Secreting Pituitary Adenoma and the Review of the Literature

“…The longest periods of follow-up in paediatric TSHomas were reported as 7 and 8 years of follow-up with no recurrence after TSS and radiotherapy in 1 patient with macroadenoma and one with microadenoma until now, respectively [7,18]. Although MRI is an excellent method for pituitary imaging, postsurgical evaluation of the pituitary gland and detection of recurrent/residual pituitary adenoma can be inaccurate, as seen in our case, due to alteration of anatomical structure and implanted tissues [33,34]. Therefore, additional modalities to detect functional tissue are required, and somatostatin receptor imaging can detect tumoral tissue since most pituitary adenomas are somatostatin receptor rich [35][36][37].…”