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AJNR - American Journal of Neuroradiology

Published ahead of print on September 26, 2007
doi: 10.3174/ajnr.A0692

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Assessment of Hemorrhage in Pituitary Macroadenoma by T2*-Weighted Gradient-Echo MR Imaging

M. Tosaka^a, N. Sato^b, J. Hirato^c, H. Fujimaki^a, R. Yamaguchi^a, H. Kohga^a, K. Hashimoto^d, M. Yamada^d, M. Mori^d, N. Saito^a and Y. Yoshimoto^a

^a Departments of Neurosurgery, Gunma University Graduate School of Medicine, Gunma, Japan
^b Departments of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
^c Department of Human Pathology, Gunma University Graduate School of Medicine, Gunma, Japan
^d Departments of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Gunma, Japan

View larger version (112K): [in this window] [in a new window]   Fig 1. Patient 1. A 65-year-old woman presented with classic pituitary apoplexy manifesting as a sudden onset of severe headache, nausea, vomiting, and visual disturbance. Also, she became drowsy because of severe dehydration and hyponatremia. A, Sagittal T1-weighted MR image showing low- to isointense masses in the nonenhanced pituitary lesion with diffuse high signal intensity. B, Sagittal T2-weighted MR image showing dark masses in the mixed high signal intensity area. C, Coronal T2*-weighted gradient-echo image showing dark masses indicating hematoma (white arrows). D, Photomicrograph showing hemorrhage and a small amount of chromophobic adenoma (H&E, original magnification x40).

View larger version (103K): [in this window] [in a new window]   Fig 2. Patient 2. A 30-year-old man presented with subacute hematoma manifesting as right temporal hemianopia and progressive right visual disturbance. He occasionally had a mild headache but no sudden and eventful headaches. His serum prolactin level was 533.2 ng/mL. A, Coronal T1-weighted MR image showing a large pituitary lesion containing a large area of high signal intensity. B, Coronal T2-weighted MR image showing a large area of low signal intensity with a marked low signal intensity rim. C, Coronal T2*-weighted GE image showing low intensity hematomas with a clear dark rim (white arrow), and a dark mass in the solid portion of the tumor (white arrowhead). D, Photomicrograph showing hemorrhage in chromophobic adenoma (H&E, original magnification x40).

View larger version (104K): [in this window] [in a new window]   Fig 3. Patient 3. A 43-year-old man had typical cysts in a nonfunctioning adenoma. A, Coronal T1-weighted MR image showing a large pituitary lesion. B, Coronal T2-weighted MR image showing the equivocal hypointense rim of a cyst (white arrowheads). C, Coronal T2*-weighted GE image showing the faint hypointense rim of a cyst (white arrows). D, Photomicrograph showing hemorrhage in chromophobic adenoma (H&E, original magnification x40).

View larger version (102K): [in this window] [in a new window]   Fig 4. Patient 4. A 39-year-old woman had a solid nonfunctioning pituitary adenoma without cyst or hematoma. She had no past or present headache. A, Coronal T1-weighted MR image showing the isointense tumor. B, Coronal T2-weighted MR image showing the mixed high signal intensity pituitary lesion. C, Coronal T2*-weighted GE image showing diffuse dark appearance of the adenoma. D, Photomicrograph showing hemorrhage in chromophobic adenoma (H&E stain, original magnification x40).