Sequence of enhancement of various portions of the pituitary gland on gadolinium-enhanced MR images: correlation with regional blood supply.

Abstract

In an effort to study the blood supply of the pituitary gland, we determined the sequence in which various portions of the gland enhanced on MR images obtained after administration of gadopentetate dimeglumine in seven healthy volunteers. The pituitary gland has a unique blood supply: the pars nervosa is supplied by the inferior hypophyseal arteries; the infundibular stem is supplied by the superior hypophyseal arteries, which are more distal than the inferior hypophyseal arteries; and the pars distalis is supplied indirectly by portal systems from the infundibular stem. Therefore, the expected sequence of contrast enhancement of the pituitary gland is: the pars nervosa first, the infundibular stem second, and the pars distalis last. However, it is difficult to evaluate the temporal sequence of contrast enhancement with "slow" conventional MR techniques, such as routine enhanced images acquired minutes after contrast administration. Accordingly, we used rapid enhanced gradient-echo sequences (14 sec/image) and the region-of-interest method to determine contrast enhancement for various portions of the gland. Enhancement-time curves were then plotted for each portion and compared to determine the sequence of enhancement. Our results show that the timing of contrast enhancement of various parts of the pituitary gland as demonstrated on MR imaging correlates closely with the expected perfusion sequence based on knowledge of regional vascular anatomy. Normal enhancement-time curves of different portions of the pituitary gland were established. This technique and baseline data can be used to evaluate patients with hypopituitarism caused by ischemia.