Ectopic posterior pituitary high signal in preoperative and postoperative macroadenomas: dynamic MR imaging.
OBJECTIVE
In patients with macroadenoma, posterior pituitary high signal (PPHS) on T1-weighted magnetic resonance (MR) imaging is sometimes observed in an ectopic location. The present study compared incidences of ectopic PPHS before and after macroadenoma surgery using MR imaging, including dynamic MR imaging to ascertain whether this ectopic change is irreversible.


METHODS
MR imaging was performed preoperatively in 111 cases of macroadenoma, and then repeated more than 1-year postoperatively in 47 patients. Enhancement of PPHS was assessed using dynamic MR imaging. Areas of enhanced hyperintensity were considered true PPHS, and the relationship between presence and location of true PPHS and adenoma volume was analyzed. Moreover, changes in the presence and location of true PPHS were ascertained among the patients who underwent postoperative follow-up MR imaging.


RESULTS
Preoperatively, PPHS was seen only in the normal location in 29 patients (Group A: 26.1%). High signal was detected only in an ectopic location in 58 patients, and early enhancement of this ectopic high signal was confirmed by dynamic MR imaging in 56 patients (Group B: 50.5%). No PPHS was observed in 24 patients (Group C: 21.6%). Adenoma volume was significantly greater for Group B than for Group A (p<0.001). Among the Group B patients who underwent MR imaging postoperatively (n=31), the location of PPHS was not changed, except for two patients in whom PPHS was absent. Postoperatively, PPHS was not observed in the normal location in any patient in the Group B.


CONCLUSIONS
Greater volume of adenoma is associated with a higher incidence of ectopic PPHS, and the ectopic change is irreversible.
Takahashi
Takahiro
T
Department of Nuclear Medicine and Diagnostic Imaging, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto 606-8507, Japan.
Miki
Yukio
Y
Takahashi
Jun A
JA
Kanagaki
Mitsunori
M
Yamamoto
Akira
A
Fushimi
Yasutaka
Y
Okada
Tsutomu
T
Haque
Tabassum Laz
TL
Hashimoto
Nobuo
N
Konishi
Junji
J
Togashi
Kaori
K
D000236:Adenoma / Q000473:pathology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010904:Pituitary Gland, Posterior / Q000473:pathology; D010911:Pituitary Neoplasms / Q000473:pathology* / Q000601:surgery; D011446:Prospective Studies
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA