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MR Imaging Study of Edema-like Change along the Optic Tract in Patients with Pituitary Region Tumors

Naokatsu Saekia, Yoshio Uchinoa, Hisayuki Muraia, Motoo Kubotaa, Kouichi Isobeb, Takashi Unob, Kenro Sunamic and Akira Yamauraa

a Departments of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
b Radiology, Chiba University Graduate School of Medicine, Chiba, Japan
c Neurosurgery Kawatetsu Chiba Hospital, Chiba, Japan



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  		FIG 1. Images from the case of a 59-year-old man with a giant pituitary adenoma.

A, Midsagittal contrast-enhanced T1-weighted MR image obtained before treatment. A huge tumor (arrowhead) is visible in and on the sella turcica.

B, Axial heavily T2-weighted MR image obtained one section above the level of the optic tract before treatment. Tumor (arrowhead) is visible in the third ventricle. Edema-like changes are visible bilaterally and are more prominent on the left side of the brain (right side of the figure) (large arrows). Large Virchow-Robin spaces related to anterior perforated substance are also visible (small arrows).

C, Coronal heavily T2-weighted MR image obtained before treatment. Large Virchow-Robin space (large arrow) is located on the right optic tract (small arrow). Medium sized arrow and arrowhead indicate the edema-like change on the left side and the tumor, respectively.



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  		FIG 2. Images from the case of a 33-year-old woman with craniopharyngioma.

A, Axial contrast-enhanced T1-weighted MR image obtained before treatment. Arrow and arrowhead indicate edema-like change and tumor, respectively.

B, Coronal contrast-enhanced T1-weighted MR image obtained before treatment. High and low signal mass (arrowhead) is visible at the suprasellar cistern. Low signal edema-like change (arrow) is noted along the left optic tract.

C, Axial heavily T2-weighted MR image obtained before treatment. Arrows indicate edema-like change.

D, Coronal heavily T2-weighted MR image obtained before treatment. Edema-like changes (large arrows) are visible bilaterally along the optic tract and are more prominent on the left side of the brain (right side of the figure). Optic tracts are difficult to differentiate from edema-like changes. On the right side, a curvilinear high signal intensity (small arrow), originating from the edema-like change, is visible.

E, Axial heavily T2-weighted MR image obtained one section above the level of the optic tract 3 months after surgery (at level similar to that shown in C). Edema-like change has disappeared on the right side of the brain. Large Virchow-Robin spaces (arrow, right side of brain), which are present under normal conditions, are visible on the same side. Edema-like change (arrow, left side of brain) seems to remain on the left side.

F, Coronal heavily T2-weighted MR image obtained 3 months after surgery (at level similar to that shown in D). Large Virchow-Robin space (large arrow, right side of brain) is visible on the right optic tract (small arrow). Edema-like change (large arrow, left side of brain) remains on the left side.



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  		FIG 3. Images from the case of an 11-year-old boy with a germ cell tumor.

A, Axial contrast-enhanced T1-weighted MR image obtained before treatment. Edema-like change along the optic tract is visible bilaterally (arrows). Arrowhead indicates slightly hyperintense mass.

B, Coronal contrast-enhanced T1-weighted MR image obtained before treatment. Round and almost high signal mass (arrowhead) is visible at the suprasellar region. Edema-like change along the optic tract is visible on the right side of the brain (left side of the figure) (arrow).

C, Axial heavily T2-weighted MR image obtained before treatment. Large arrows, small arrows, and arrowheadindicate edema-like changes, Virchow-Robin spaces, and tumor, respectively. Findings concur with those in D.

D, Coronal heavily T2-weighted MR image obtained before treatment. Edema-like changes (large arrows), more prominent on the right side of the brain (left side of the figure), are visible along the optic tracts. Tumor (arrowhead) is visible. Large Virchow-Robin spaces associated with anterior perforated substance are visible.

E, Axial heavily T2-weighted MR image obtained 2 months after treatment (at level similar to that shown in C). Large Virchow-Robin spaces associated with anterior perforated substance (small arrows) are visible.

F, Coronal heavily T2-weighted MR image obtained 2 months after treatment (at level similar to that shown in D). Edema-like change has disappeared bilaterally, although the tumor (arrowhead) remains in the third ventricle. Normally present large Virchow-Robin spaces (large arrows) are visible. The optic tracts (small arrows) are also visible. Large arrows and arrowhead indicate Virchow-Robin spaces and tumor, respectively.



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  		FIG 4. Images from the case of a 62-year-old man with malignant lymphoma.

A, Axial contrast-enhanced T1-weighted MR image obtained before treatment. Thick arrows, thin arrow, and arrowhead indicate edema-like change, incidentally found venous angioma, and tumor, respectively.

B, Coronal contrast-enhanced T1-weighted MR image obtained before treatment. High and low signal mass (arrowhead) is visible in the third ventricle. Low signal edema-like changes (arrows) are noted along the optic tracts. A venous angioma was incidentally found in the left anterior basal ganglia, as in A.

C, Axial heavily T2-weighted MR image obtained before treatment. Tumor (arrowhead) is visible. Marked edema-like changes are visible in the hypothalamus and midbrain and along the optic tracts (arrows).

D, Coronal heavily T2-weighted MR image obtained before treatment. Tumor (arrowhead) is visible. Marked edema-like changes are visible in the hypothalamus and midbrain and along the optic tracts (arrows).

E, Axial heavily T2-weighted MR image obtained before treatment. Edema-like changes (large arrows) extend as far as the basal ganglia and the internal capsule. The venous angioma (small arrow) is visible in the left anterior basal ganglia.

F, Coronal heavily T2-weighted MR image obtained before treatment. Edema-like changes (large arrows) extend as far as the basal ganglia and the internal capsule. Marked edema-like change is visible in the hypothalamus and midbrain (small arrow).





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X