The various MRI patterns of pituitary apoplexy

The aim of this study was to describe the various MRI features, in correlat ion to surgical and pathological findings, in patients who presented with p ituitary apoplexy (PA), Eleven patients presenting with PA, were evaluated with various MR protocols including spin-echo (SE) T1-weighted sequences in 9 of 11 patients, post gadolinium SE T1-weighted sequences in only 8 of 11 patients, and with T2-weighted SE sequences in 2 of 11 patients. All patie nts had transsphenoidal pituitary surgery after MR studies. The severity of presenting symptoms ranged from headaches to coma, Ten patients had pituit ary macroadenoma; one had a non-hemorrhagic metastatic lesion into a non-ad enomatous pituitary gland. Of the 11 patients, one was studied at the acute stage of PA (1-day after onset), 9 of the subacute period, (3-15 days afte r onset), and one at the late stage (5 months after onset). Images compatib le with intratumoral hemorrhage were found in all macroadenomas; whereas th e metastatic pituitary lesion did not show evidence of bleeding. All gadoli nium-enhanced studies showed partial tumoral enhancement. The SE T2-weighte d studies demonstrated areas of low and high signal intensities in keeping with the presence of blood degradation contents. Pituitary apoplexy present with different MR features, including hemorrhagic and non-hemorrhagic char acteristics on T1-weighted images. Gadolinium-enhanced images do not provid e complementary diagnostic information when the presence of blood is assess ed on plain images.