Correlation of High Signal Intensity of the Pituitary Stalk in Macroadenoma and Postoperative Diabetes Insipidus
Naokatsu Saekia,
Seiichiro Hoshic,
Souichi Sunadac,
Kenro Sunamic,
Hisayuki Muraia,
Motoo Kubotaa,
Ichiro Tatsunob,
Toshihiko Iuchid and
Akira Yamauraa
a Department of Neurosurgery Chiba University School of Medicine Japan
b the Second Department of Internal Medicine Chiba University School of Medicine Japan
c Chiba University School of Medicine; the Division of Neurosurgery Kawatetsu, Chiba Hospital
d the Division of Neurosurgery, Chiba Cancer Center, Japan
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FIG 1. Case 5, group A. Images in a 63-year-old man with a nonfunctioning adenoma show that the HSI (arrow) was present both before and 2 weeks after surgery.
A–C, At 2 weeks after surgery, ovoid HSI is visible at the level of the diaphragm sellae on sagittal (A), coronal (B), and axial (C) sections.
D–F, Before surgery, linear HSI is visible at the posterolateral surface of adenoma, above the indentation formed by a diaphragma sellae, on the sagittal (D), coronal (E), and axial (F) sections.
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FIG 2. Case 16, group A. In this patient, a 35 year–old woman with a nonfunctioning adenoma, MR studies were repeated at 3, 12, and 24 months after surgery and showed essentially the same findings, including HSI (arrow).
A and B, At 2 years after surgery, HSI is visible at the tip of pituitary stalk at the level of the diaphragma sellae on the coronal (A) and sagittal (B) sections.
C–F, Before surgery, linear HSI is visible at the posterior surface of adenoma, above the indentation formed by the diaphragma sellae, on the sagittal (C), coronal (D), contrast-enhanced sagittal (E), and axial (F) sections. HSI is identifiable at the stalk stump. The enhanced image shows HSI with more remarkable enhancing effect due to normal pituitary tissue; this finding suggests its connection to the pituitary stalk.
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FIG 3. Case 17, group A. Images in a 74 year-old-woman with a growth hormone–secreting adenoma show HSI (arrow).
A, Coronal section 6 months after surgery. Postoperatively, the adenoma was debulked, and the HSI was below the chiasm and deviated to the left. It was continuous with the proximal portion of the pituitary stalk.
B, Coronal section before surgery. Preoperatively, an ovoid HSI is visible on the supradiaphragmatic level on the left side. The optic chiasm is compressed superiorly.
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FIG 4. Sagittal sections obtained before surgery show HSI (arrows).
A, Case 9, group A 39-year-old woman with nonfunctioning adenoma. HSI was noted in both supra- and intrasellar areas. The indentation at the level of the diaphragma sellae was noted but not prominent.
B, Case 14, group A. A 54-year-old woman with nonfunctioning adenoma. HSI was noted close to the median eminence. Indentation of diaphragma sellae was not evident in this case.
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