Abstract
The aim of this study was to assess the diagnostic value of non-contrast pituitary MRI in children with growth or puberty disorders (GPDs) and to determine the criteria indicating the necessity to perform post-contrast examination. A retrospective study included re-analysis of 567 contrast-enhanced pituitary MRIs of children treated in a tertiary reference center. Two sets of sequences were created from each MRI examination: Set 1, including common sequences without contrast administration, and Set 2, which included common pre- and post-contrast sequences (conventional MRI examination). The differences in the visibility of pituitary lesions between pairs of sets were statistically analyzed. The overall frequency of Rathke’s cleft cysts was 11.6%, ectopic posterior pituitary 3.5%, and microadenomas 0.9%. Lesions visible without contrast administration accounted for 85% of cases. Lesions not visible before and diagnosed only after contrast injection accounted for only 0.18% of all patients. Statistical analysis showed the advantage of the antero-posterior (AP) pituitary dimension over the other criteria in determining the appropriateness of using contrast in pituitary MRIs. The AP dimension was the most significant factor in logistic regression analysis: OR = 2.23, 95% CI, 1.35–3.71, p-value = 0.002, and in ROC analysis: AUC: 72.9% with a cut-off value of 7.5 mm, with sensitivity/specificity rates of 69.2%/73.5%. In most cases, the use of gadolinium-based contrast agent (GBCA) in pituitary MRI in children with GPD is unnecessary. The advantages of GBCA omission include shortening the time of MRI examination and of general anesthesia; saving time for other examinations, thus increasing the availability of MRI for waiting children; and acceleration in their further clinical management.
Highlights
IntroductionThe step in pituitary imaging strategies was the application of various 3-D imaging techniques (e.g., T2 SPACE, GRASP, TWIST or IT-TWIST) to obtain increased sensitivity of multiplanar imaging, thinner layers, and even higher resolution while reducing artifacts [4,5,6,7,8,9,10]
Reducing the procedure time would increase the number of good-quality examinations performed on conscious young patients, where, for the normal duration of magnetic resonance imaging (MRI), some would need to be sedated
Shortening the examination time is important for health policy due to its economic aspects
Summary
The step in pituitary imaging strategies was the application of various 3-D imaging techniques (e.g., T2 SPACE, GRASP, TWIST or IT-TWIST) to obtain increased sensitivity of multiplanar imaging, thinner layers, and even higher resolution while reducing artifacts [4,5,6,7,8,9,10]. They have been mainly used far on adult patients and most of them require gadolinium administration
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