Pituitary magnetic resonance imaging for sellar and parasellar masses: ten-year experience in 2598 patients

Abstract

Context: Sellar and parasellar masses present with overlapping clinical and radiological features ranging from asymptomatic incidental presentations and hormonal effects to compressive local mass effects. Pituitary masses are diagnosed with increased frequency with magnetic resonance imaging (MRI) advancements and availability, but indications and diagnostic outcomes of MRI screening for sellar lesions are not defined. Although pituitary adenomas are the most frequently encountered sellar mass lesions, other etiologies should be considered in the differential diagnosis of a sellar mass.

Setting: The study was conducted at a tertiary pituitary center.

Patients: This study was a retrospective review of 2598 subjects undergoing at least one pituitary MRI scan from 1999 to 2009.

Main outcome measure: Prevalence and diagnosis of specific sellar and parasellar masses as screened by pituitary MRI.

Results: The most common indications for pituitary imaging, excluding known mass follow-up, were for evaluation of hyperprolactinemia or hypogonadism. A normal pituitary gland was reported in 47% of subjects undergoing pituitary MRI. The most common pituitary adenomas initially identified by MRI included prolactinoma (40%), nonfunctioning adenoma (37%), and GH adenoma (13%). Nonadenomatous sellar masses accounted for 18% of visible lesions, of which the most common were Rathke's cleft cyst (19%), craniopharyngioma (15%), and meningioma (15%). Metastases accounted for 5% of nonpituitary lesions and breast cancer was the most common primary source.

Conclusions: Half of all pituitary MRI scans performed in a large patient population yielded no visible lesion. Nonadenomatous pituitary lesions should be considered in the diagnosis of sellar masses observed on MRI, and a high clinical suspicion is required to exclude the presence of a nonfunctioning pituitary adenoma.

Fig. 1.

Screening results of pituitary MRI scans performed in 2598 patients between January 1999 and November 2009. After review and analysis of records, a normal pituitary was diagnosed in 1242 subjects, an abnormal pituitary in 1356 subjects, and 159 masses could not be assessed.