Prolactinomas. Clinical presentation, radiologic assessment, and therapeutic options

Enhanced resolution of pituitary fossa by three-dimensional fat-suppressed gradient-echo magnetic resonance: before and after gadolinium enhancement

In imaging small anatomical parts such as the pituitary fossa, thin sections enhance the spatial resolution. Gradient recalled images (GRASS) using three-dimensional volume data produce ultrathin contiguous sections with a high signal-to-noise ratio. In this study, conventional spin-echo magnetic resonance images (MRIs) of the pituitary fossa were compared to three-dimensional gradient recalled MRI in 5 volunteers and 10 patients suspected of having pituitary gland abnormalities. Utility of fat suppression was also assessed, along with gadolinium enhancement. Conventional spin-echo and three-dimensional spoiled GRASS images, three-dimensional spoiled GRASS images without and with fat suppression (Group II), and three-dimensional spoiled GRASS images with fat suppression before and after gadolinium enhancement were compared. Three-dimensional spoiled GRASS images provided better delineation of the pituitary fossa structures. There was differential enhancement between the normal gland and pituitary tumors. The fat suppression technique following gadolinium administration helped separate the high signal of tumor from the high signal of the clivus marrow. In conclusion, T1-weighted three dimensional gradient-echo images with fat suppression following gadolinium enhancement appear promising in evaluation.

Correlation study of serum prolactin levels, pituitary weights, number and ultrastructure of pituitary lactotrophs in female Long-Evans rats

Twenty-five female, 23-month-old Long-Evans rats were sacrificed for investigation of correlations between serum prolactin levels, pituitary weights, numbers and ultrastructural features of pituitary lactotrophs. Serum prolactin levels measured by radioimmunoassay varied from 7.1 ng/ml to 1,534.0 ng/ml. Pituitary weights ranged from 16.0 mg to 255.0 mg. Serum prolactin levels were increased when pituitary weights were high; statistical analysis revealed a correlation between the two. No significant correlation was evident between serum prolactin levels and lactotroph percentage and ultrastructure. Light microscopy revealed a large number of lactotrophs in almost every pituitary. Values for nuclear, cell and cytoplasmic areas, nuclear/cytoplasmic ratios and nucleolar diameters remained similar in the lactotrophs of all animals. Electron microscopy disclosed no lactotroph damage or vascular injury. Ultrastructural morphometry of lactotrophs in the pituitaries studied showed no major differences in cytoplasmic volume densities of endoplasmic reticulum, Golgi complex, mitochondria, secretory granules and lysosomes as well as secretory granule diameters. It is reasonable to conclude that elevations of serum prolactin levels are due to an increase in pituitary mass, resulting from accumulation of lactotrophs. Thus hyperprolactinemia appears to be secondary to an increase in the number of lactotrophs and not hyperactivity of individual cells.

Magnetic resonance imaging of estrogen-induced pituitary hypertrophy in rats

Estrogen-induced pituitary hypertrophy has been studied using magnetic resonance imaging in a group of 15 control and 30 experimental rats. Following the subcutaneous implantation of an estrogen pellet, differences in the anatomical appearance of the pituitary gland of the implanted rats can be detected in as little as 16 days, when compared to the control animals. The gland in the experimental animals appears diffusely enlarged with rounded margins, when viewed in sagittal T1-weighted magnetic resonance images. Additionally, a uniform signal intensity is not detected in the hypertrophic pituitary glands of estrogen-implanted rats, while in the control rats this is a common finding. A satellite study of 300 animals (treated in a manner identical to that in the imaging study) demonstrates that the weights of excised pituitaries in estrogen-treated rats increases to a statistically significant level in the interval 18 to 35 days. Changes in the appearance and volume of the pituitary gland observed with magnetic resonance imaging seem to have promise for the early detection of pituitary lesions in rats.

Magnetic resonance imaging of the brain and spine

The efficacy of magnetic resonance imaging (MRI) in the diagnosis of diseases of the central nervous system is reviewed. MRI, computed tomography (CT) and certain radionuclide studies are compared in the evaluation of intracranial tumours, cerebral vascular disease, multiple sclerosis and other white matter diseases, dementia, head injury, infection, epilepsy, spinal lesions and in paediatric central nervous system disorders. The measurement of cerebrospinal fluid volumes and dynamics by MRI is discussed. MRI most clearly has advantages where CT is degraded by bone hardening and streak artefacts (spine, skull base, posterior and temporal fossa, sella and parasellar regions) and in diseases in which the X-ray attenuation of the suspected lesion differs little from normal parenchyma (paediatric brain disorders, demyelination and dysmyelination, early oedema associated with infarction, infection or low-grade infiltrating neoplasm, subacute and chronic haemorrhage and lesions in the spinal subarachnoid space and cord). Elsewhere MRI and CT should be seen as complementary rather than competitive methods of imaging. In spite of an absence of information about the contribution of MRI to management decisions and a lack of rigorous, prospective controlled trials, MRI will play an increasing role in the diagnosis of diseases of the central nervous system.