Pituitary Adenomas: Early Postoperative MR Imaging After Transsphenoidal Resection
Pyeong-Ho Yoona,
Dong-Ik Kima,
Pyoung Jeona,
Seung-Ik Leea,
Seung-Koo Leea and
Sun-Ho Kima
a From the Department of Diagnostic Radiology (P-H.Y., D-I.K., P.J., S-I.L., S-K.L.), Yonsei University College of Medicine and the Department of Neurosurgery (S-H.K.), Yonsei University College of Medicine, Seodaemoonku, Seoul 120-752, Korea.
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FIG 1. No enhancement of early postoperative sella in a 29-year-old woman with nonfunctioning tumor.
A, Preoperative image of the sella (TR/TE/excitations = 550/12/2) shows pituitary tumor with suprasellar extension. Normal pituitary gland cannot be seen because of compression by the tumor.
B, Immediate 1-day postoperative image (400/16/1) before contrast material infusion shows pituitary mass composed of fat (black arrow) and hemorrhage (white arrow) at the operative site.
C, After contrast infusion, there is no abnormal enhancement in the pituitary mass.
D, After 6 months, the normal pituitary gland is reexpanded (550/12/2).
E, There is no change on 30-month follow-up MR image (400/12/2).
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FIG 2. Peripheral enhancement of an early postoperative sella in a 35-year-old man with nonfunctioning tumor.
A, Preoperative image of the sella (TR/TE/excitations = 700/12/2) shows pituitary tumor with suprasellar extension. Normal pituitary gland cannot be seen because of compression by the tumor.
B, Immediate 2-day postoperative image before contrast infusion (400/16/1) shows pituitary mass composed of fat and hemorrhage at the operative site.
C, After contrast infusion, there is a peripheral enhancing rim around the postoperative pituitary mass.
D, Immediate postoperative T2-weighted image (3500/95/2) shows hemorrhage as low signal intensity suggesting intracellular deoxyhemoglobin.
E, After 6 months, the hemorrhage is totally absorbed (500/9/2).
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FIG 3. Nodular enhancement of early postoperative sella in a 62-year-old woman with nonfunctioning tumor.
A, Preoperative image of the sella (TR/TE/excitations = 550/12/2) shows pituitary tumor with suprasellar extension.
B, Immediate 1-day postoperative image before contrast infusion (400/14/1) shows pituitary mass composed of hemorrhage at the operative site. Intrasellar packing material (fat) was not used in this patient.
C, After contrast infusion, there is nodular enhancing region at the left periphery of the pituitary mass (arrow).
D, After 6 months, a small residual tumor is seen (700/12/2).
E, This residual tumor is slowly growing on 24-month follow-up MR images (433/10/2). This case was diagnosed by growth of the tumor on follow-up MR imaging.
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FIG 4. Combined enhancement of early postoperative sella in a 60-year-old man with nonfunctioning tumor.
A, Preoperative image of the sella (TR/TE/excitations = 600/16/1) shows pituitary tumor with suprasellar extension.
B, Immediate 1-day postoperative image before contrast infusion (400/14/1) shows pituitary mass composed of fat (white arrow) and hemorrhage (black arrow) at the operative site.
C, After contrast infusion, there are nodular enhancing regions (arrows) at both lateral portions of the postoperative pituitary mass with peripheral enhancing rim.
D, After 6 months, residual tumor was seen with increase in tumor size (550/12/2).
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FIG 5. Immediate MR scan following surgery confirmed residual tumor in a 27-year-old woman with growth hormone-secreting tumor.
A, Preoperative image of the sella (TR/TE/excitations = 550/12/2) shows pituitary tumor in the inferior portion of the pituitary gland (white arrow).
B and C, Immediate 1-day postoperative image before and after contrast medium infusion (400/14/1) shows pituitary mass composed of fat and nodular enhancing tissue (arrowhead).
D, A second operation was performed to remove the residual tumor, and this scan (400/14/1) was performed 2 days following surgery.
E, After contrast medium infusion, there is no abnormal enhancing lesion in this area (550/12/2).
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