American Journal of Neuroradiology 2007;28:2023.
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American Journal of Neuroradiology
DOI 10.3174/ajnr.A0692
BRAIN
Assessment of Hemorrhage in Pituitary Macroadenoma by T2*-Weighted Gradient-Echo MR Imaging
From the Departments of Neurosurgery (M.T., H.F., R.Y., H.K., N.S., Y.Y.), Diagnostic Radiology and Nuclear Medicine (N.S.), Human Pathology (J.H.), and Medicine and Molecular Science (K.H., M.Y., M.M.), Gunma University Graduate School of Medicine, Gunma, Japan.
Please address correspondence to Masahiko Tosaka, MD, PhD, Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan; e-mail: nstosaka{at}med.gunma-u.ac.jp
BACKGROUND AND PURPOSE: Intratumoral hemorrhage occurs frequently in pituitary macroadenoma and manifests as pituitary apoplexy and recent or old silent hemorrhage. T2*-weighted gradient-echo (GE) MR imaging is the most sensitive sequence for the detection of acute and old intracranial hemorrhage. T2*-weighted GE MR imaging was used to investigate intratumoral hemorrhage in pituitary macroadenomas.
MATERIALS AND METHODS: Twenty-five consecutive patients who underwent total or subtotal resection of pituitary macroadenoma with heights from 17 to 53 mm, including 1 patient with classic pituitary apoplexy, underwent MR imaging before surgery, including T2*-weighted GE MR imaging. For histologic assessment of the hemorrhage in whole surgical specimens, we used hematoxylin-eosin staining.
RESULTS: T2*-weighted GE MR imaging detected various types of dark lesions, such as "rim," "mass," "spot," and "diffuse" and combinations, indicating clinical and subclinical intratumoral hemorrhage in 12 of the 25 patients. The presence of intratumoral dark lesions on T2*-weighted GE MR imaging correlated significantly with the hemorrhagic findings on T1- and T2-weighted MR imaging (P < .02 and <.01, respectively), and the surgical and histologic hemorrhagic findings (P < .001 and <.001, respectively).
CONCLUSION: T2*-weighted GE MR imaging could detect intratumoral hemorrhage in pituitary adenomas as various dark appearances. Therefore, this technique might be useful for the assessment of recent and old intratumoral hemorrhagic events in patients with pituitary macroadenomas.