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

M Tosaka,H Kohga,M Mori,N Saito,Y Yoshimoto,K Hashimoto,R Yamaguchi,J Hirato,N Sato,M Yamada,H Fujimaki

doi:10.3174/ajnr.a0692

Abstract

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. 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. 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). 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.

Highlights

MethodsTwenty-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
AND PURPOSE: Intratumoral hemorrhage occurs frequently in pituitary macroadenoma and manifests as pituitary apoplexy and recent or old silent hemorrhage
T2*-weighted GE MR imaging could detect intratumoral hemorrhage in pituitary adenomas as various dark appearances. This technique might be useful for the assessment of recent and old intratumoral hemorrhagic events in patients with pituitary macroadenomas

Summary

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. Patients This prospective study included only patients with surgically proved presence of macroadenoma. The trans-sphenoidal approach is the most common surgical technique even for large or giant adenomas; adenomas with extensive suprasellar or lateral extensions cannot be totally removed by a single trans-sphenoidal approach.[18] Gross total or subtotal removal was achieved in 27 of the 36 cases of macroadenoma based on postoperative MR imaging.[19] Partial removal was achieved in 9 cases, which were excluded because of the large discrepancy in the area of evaluation of the tumor between the imaging and surgical or histologic studies. We excluded 2 cases of recurrent pituitary adenoma to eliminate the artificial change caused by previous surgery

Results

Discussion

Conclusion