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Abnormal Perfusion of the Pituitary Gland Secondary to Dural Arteriovenous Fistulas in the Cavernous Sinus: Dynamic MR Findings

Yoshinori Shigematsua, Yukunori Korogia, Mika Kitajimaa, Akihiko Ishiia, Luxia Lianga, Masayuki Yamuraa, Kouich Kawanakaa and Mutsumasa Takahashia

a From the Department of Radiology, Kumamoto University School of Medicine, Japan



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  		FIG 1. ROIs on a coronal dynamic image. The ROIs were located at the center and bilateral peripheral areas of the anterior pituitary gland for dynamic curve analyses.



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  		FIG 2. Images in a 50-year-old woman with a dural AVF draining into the right cavernous sinus (case 7).

A, Digital subtraction angiogram reveals the AVF draining into the right cavernous sinus.

B–E, Pretreatment dynamic MR images. In phase 0 (B) and in the first (C), second (D), and third (E) phases, the enhancement of the right side of the pituitary gland is delayed (arrow in C–E).

F–I, Posttreatment dynamic MR images in phase 0 (F) and in the first (G), second (H), and third (I) phases. After treatment of the disease, the pituitary gland is symmetrically enhancing on both the right and left sides, and the height of the pituitary gland decreased from 7 to 5 mm. Part of the posterior pituitary gland is seen as a hyperintense area in phase 0.



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  		FIG 3. Dynamic curves in a 50-year-old woman with a dural AVF draining into the right cavernous sinus (case 7).

A, Pretreatment dynamic curves. The three ROIs were located at the center and bilateral peripheral areas of the pituitary gland (Fig 1). On the right side of the pituitary gland, the peak of the enhancement was not found within the imaging time before treatment.

B, Posttreatment dynamic curves. On the right side, the peak-enhanced phase was shortened and found within the 10 phases.



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  		FIG 4. Images in a 62-year-old woman with a dural AVF draining into the left cavernous sinus (case 6).

A, Digital subtraction angiogram reveals the AVF draining into the left cavernous sinus.

B–E, Pretreatment dynamic MR images of the anterior pituitary gland. In phase 0 (B) and in the first (C), second (D), and third (E) phases, the enhancement of the left side of the pituitary gland is delayed (arrow in C–E). In phase 0, the left cavernous sinus is already enhancing because of the AVFs, but no enhancement can be seen in the pituitary gland; this is why this image was defined as phase 0.

F–I, Posttreatment dynamic MR images in phase 0 (F) and in the first (G), second (H), and third (I) phases. After treatment of the disease, the laterality of the enhancement on early dynamic images became less prominent, and the height of the pituitary gland decreased from 8 to 7 mm. In this case only, the laterality of the enhancement somewhat remained after treatment (arrow in G).



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  		FIG 5. Dynamic curves in a 62-year-old woman with a dural AVF draining into the left cavernous sinus (case 6).

A, Pretreatment dynamic curves. The peaks of the dynamic curves were in phase 9 for the central area, phase 6 for the right side, and out of the imaging time for the left side.

B, Posttreatment dynamic curves. The peaks of the dynamic curves are shortened at both the central and bilateral peripheral areas of the pituitary gland.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X