Imaging

Pituitary Tumor

Preliminary Diagnosis: Pituitary Tumor

I. What imaging technique is first-line for a pituitary tumor?

MRI with contrast and with dynamic phase imaging is the first line modality.

II. Describe the advantages and disadvantages of this technique for diagnosing a pituitary tumor.

Advantages

  • Diagnostic in the appropriate clinical setting.

  • Can localize the exact area of anatomic abnormality better than any other modality.

  • Can evaluate the extent of tumor local invasion in case of pituitary macroadenoma.

  • Does not utilize ionizing radiation.

Disadvantages

  • Expensive.

  • Time consuming.

  • Requires significant patient cooperation to minimize motion artifact.

  • Patients with severe claustrophobia may require sedation.

III. What are the contraindications for the first-line imaging technique?

  • Patients with poor renal function (i.e., GFR < 30) cannot undergo MR contrasted study.

  • Patients with non-MR compatible metals and foreign bodies cannot be scanned.

IV. What alternative imaging techniques are available?

CT with contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing a pituitary tumor.

CT with contrast

Advantages

  • Quick and inexpensive.

  • Can accurately demonstrate both a small adenoma and large macroadenoma.

  • Requires less patient cooperation and is less susceptible to motion artifact.

Disadvantages

  • Does not provide same level of anatomic detail as MRI.

  • Not as sensitive at detecting microadenomas as MRI.

  • Exposes the patient to ionizing radiation.

VI. What are the contraindications for the alternative imaging techniques?

CT with contrast

  • Contraindicated for pregnant patients.

  • Relative contraindication in patients with contrast allergy.

  • Relative contraindication in patients with renal failure.

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