Assessment of hemorrhage in pituitary macroadenoma by T2*-weighted gradient-echo MR imaging

Abstract

Background and purpose: Intratumoral hemorrhage occurs frequently in pituitary macroadenoma and manifests as pituitary apoplexy and recent or old silent hemorrhage. T2*-weighted gradient-echo (GE) MR imaging is the most sensitive sequence for the detection of acute and old intracranial hemorrhage. T2*-weighted GE MR imaging was used to investigate intratumoral hemorrhage in pituitary macroadenomas.

Materials and methods: Twenty-five consecutive patients who underwent total or subtotal resection of pituitary macroadenoma with heights from 17 to 53 mm, including 1 patient with classic pituitary apoplexy, underwent MR imaging before surgery, including T2*-weighted GE MR imaging. For histologic assessment of the hemorrhage in whole surgical specimens, we used hematoxylin-eosin staining.

Results: T2*-weighted GE MR imaging detected various types of dark lesions, such as "rim," "mass," "spot," and "diffuse" and combinations, indicating clinical and subclinical intratumoral hemorrhage in 12 of the 25 patients. The presence of intratumoral dark lesions on T2*-weighted GE MR imaging correlated significantly with the hemorrhagic findings on T1- and T2-weighted MR imaging (P < .02 and <.01, respectively), and the surgical and histologic hemorrhagic findings (P < .001 and <.001, respectively).

Conclusion: T2*-weighted GE MR imaging could detect intratumoral hemorrhage in pituitary adenomas as various dark appearances. Therefore, this technique might be useful for the assessment of recent and old intratumoral hemorrhagic events in patients with pituitary macroadenomas.

Fig 1.

Patient 1. A 65-year-old woman presented with classic pituitary apoplexy manifesting as a sudden onset of severe headache, nausea, vomiting, and visual disturbance. Also, she became drowsy because of severe dehydration and hyponatremia. A, Sagittal T1-weighted MR image showing low- to isointense masses in the nonenhanced pituitary lesion with diffuse high signal intensity. B, Sagittal T2-weighted MR image showing dark masses in the mixed high signal intensity area. C, Coronal T2*-weighted gradient-echo image showing dark masses indicating hematoma (white arrows). D, Photomicrograph showing hemorrhage and a small amount of chromophobic adenoma (H&E, original magnification ×40).

Fig 2.

Patient 2. A 30-year-old man presented with subacute hematoma manifesting as right temporal hemianopia and progressive right visual disturbance. He occasionally had a mild headache but no sudden and eventful headaches. His serum prolactin level was 533.2 ng/mL. A, Coronal T1-weighted MR image showing a large pituitary lesion containing a large area of high signal intensity. B, Coronal T2-weighted MR image showing a large area of low signal intensity with a marked low signal intensity rim. C, Coronal T2*-weighted GE image showing low intensity hematomas with a clear dark rim (white arrow), and a dark mass in the solid portion of the tumor (white arrowhead). D, Photomicrograph showing hemorrhage in chromophobic adenoma (H&E, original magnification ×40).

Fig 3.

Patient 3. A 43-year-old man had typical cysts in a nonfunctioning adenoma. A, Coronal T1-weighted MR image showing a large pituitary lesion. B, Coronal T2-weighted MR image showing the equivocal hypointense rim of a cyst (white arrowheads). C, Coronal T2*-weighted GE image showing the faint hypointense rim of a cyst (white arrows). D, Photomicrograph showing hemorrhage in chromophobic adenoma (H&E, original magnification ×40).

Fig 4.

Patient 4. A 39-year-old woman had a solid nonfunctioning pituitary adenoma without cyst or hematoma. She had no past or present headache. A, Coronal T1-weighted MR image showing the isointense tumor. B, Coronal T2-weighted MR image showing the mixed high signal intensity pituitary lesion. C, Coronal T2*-weighted GE image showing diffuse dark appearance of the adenoma. D, Photomicrograph showing hemorrhage in chromophobic adenoma (H&E stain, original magnification ×40).