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Posterior Pituitary Bright Spot in Large Adenomas: MR Assessment of Its Disappearance or Relocation along the Stalk¹

¹ From the Departments of Neurological Surgery (N.S., M.H., H.M., M.K., A.Y.), Pediatrics (J.T.), and Radiology (T.U.) and the Second Department of Internal Medicine (I.T.), Chiba University School of Medicine, Inohana 1-8-1, Chuo-ku, Chiba 260-8670, Japan; and Division of Neurosurgery, Chiba Cancer Center, Japan (T.I.). Received October 1, 2001; revision requested December 17; final revision received May 30, 2002; accepted June 10. Address correspondence to N.S. (e-mail: saeki@med.m.chiba-u.ac.jp).

View larger version (160K): [in a new window]   Figure 1. A, Coronal and, B, sagittal MR images (400/11) of a nonsecreting hourglass-type adenoma in a 43-year-old woman in the PPBS-visible group. PPBS (large arrow) occurs above the indentation (small arrows) at or around the diaphragmatic level. C, Coronal and, D, sagittal MR images (500/9) of a nonfunctioning barrel-type adenoma in a 35-year-old man in the PPBS-nonvisible group. No indentation was visible coronally or sagittally at the diaphragmatic level (arrows).

View larger version (157K): [in a new window]   Figure 2. Nonsecreting barrel-type adenoma in a 25-year-old woman in the PPBS-nonvisible group. A, Coronal and, B, transverse MR images (400/11) obtained before surgery. C, D, Two coronal and, E, one transverse MR image (500/9) obtained after surgery. A large area of high signal intensity (*), presumably caused by pituitary apoplexy, was present in the tumor, and PPBS on the adenoma surface was difficult to identify before surgery. No indentation was observed. After surgery, a small PPBS (large arrow in C and arrow in D and E) was evident at the tip of the pituitary stalk (small arrow in C) at the level of the diaphragma sellae in the coronal sections.

View larger version (38K): [in a new window]   Figure 3. Schematic demonstrates locations of PPBS in 55 patients in the PPBS-visible group with sagittal sections. Forty-eight (A, B) hourglass and seven (C-F) barrel types were present. PPBS was visible (A) as a linear or ovoid area on the posterior adenoma surface in the distal pituitary stalk at the supradiaphragmatic portion in 42 patients, (B) both in the sella and along the distal pituitary stalk in the remaining six patients, (C) in the sella in two patients, (D) along the whole pituitary stalk in two patients, (E) in the sella and along the distal pituitary stalk in two patients, and (F) at the distal pituitary stalk in one patient. In hourglass-type adenomas, PPBS is commonly relocated immediately above the diaphragmatic level, whereas in the barrel type, it is present in the sella or in varying sites along the pituitary stalk.

View larger version (109K): [in a new window]   Figure 4. Nonsecreting hourglass-type adenoma in a 38-year-old man in the PPBS-visible group. (A), Coronal, (B) sagittal, and (C) transverse MR images (400/11) obtained before surgery. (D), Coronal, (E) sagittal, and (F) transverse MR images (500/9) obtained 1 month after surgery. Before surgery, a short and linear PPBS (large arrow in A and B and arrow in C) was visible at the right lateral and posterior surface of the adenoma, above the indentation (small arrow in A and B) at the diaphragmatic level. After surgery, the PPBS (large arrow in D and F and arrow in E) was visible at the diaphragmatic level and was at the distal tip (small arrow in D and F) of the pituitary stalk.

View larger version (161K): [in a new window]   Figure 5. Nonsecreting pituitary barrel-type adenoma in a 45-year-old woman in the PPBS-visible group. (A), Sagittal and (B) transverse MR images (400/11) obtained before surgery. (C), Sagittal and (D) transverse MR images (400/11) obtained after surgery. Preoperatively, a linear PPBS (arrow in A and B) was visible in the sella. No indentation was noted in the sagittal section. Postoperatively, the adenoma was debulked, and the surgical packing (arrow in C and D) was present in the sella. The PPBS was difficult to identify.

View larger version (154K): [in a new window]   Figure 6. Nonsecreting barrel-type adenoma in a 52-year-old woman in the PPBS-visible group. (A), Sagittal and (B) coronal MR images (400/11) before surgery. (C), Sagittal and (D) coronal MR images (500/9) obtained 1 year after surgery. Before surgery, a long and linear PPBS (arrow in A) was visible above the diaphragmatic level along the posterior surface of the adenoma in the sagittal section. Coronally, the PPBS (arrow in B) was visible at the proximal pituitary stalk close to the median eminence. No marked indentation was observed sagittally and coronally. After surgery, a linear PPBS (large arrow in C and D) was visible at the level of the diaphragma sellae at the distal end of the pituitary stalk (small arrow in C and D).