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Published online before print December 20, 2002, 10.1148/radiol.2262011616

(Radiology 2003;226:359.)

A more recent version of this article appeared on February 1, 2003
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© RSNA, 2002

Neuroradiology

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

Naokatsu Saeki, MD, Michihiro Hayasaka, MD, Hisayuki Murai, MD, Motoo Kubota, MD, Ichiro Tatsuno, MD, Jun-ichi Takanashi, MD, Takashi Uno, MD, Toshihiko Iuchi, MD and Akira Yamaura, MD

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).

PURPOSE: To evaluate the disappearance or relocation patterns of posterior pituitary bright spot (PPBS) in the infundibuloneurohypophyseal (INH) system and endocrinologic implications in large pituitary adenomas.

MATERIALS AND METHODS: Sixty-nine patients with adenoma and supradiaphragmatic extension were classified into PPBS-visible and PPBS-nonvisible groups on the basis of findings at preoperative T1-weighted magnetic resonance (MR) imaging. The adenoma shapes were classified into hourglass type with indentation and barrel type without indentation at the diaphragmatic level.

RESULTS: The PPBS-visible group included 55 (80%) patients. PPBS most commonly occurred at the distal pituitary stalk immediately above the diaphragm in 48 patients with hourglass-type adenoma. In the remaining seven patients with barrel-type adenoma, PPBS occurred in the sella or in varying sites along the pituitary stalk. Postoperatively, two patients, whose PPBS became nonvisible, developed persistent diabetes insipidus. The PPBS-nonvisible group included 14 (20%) patients. Five had hourglass-type and nine had barrel-type adenoma. Occurrence of the barrel type was marked. In these patients, four developed postoperative permanent diabetes insipidus.

CONCLUSION: The diaphragm, a probable major anatomic determinant of indentation, may serve as a transportation blockade and facilitate proximal accumulation of PPBS material, as evidenced in the hourglass-type adenoma. PPBS was more commonly nonnvisible in the barrel-type adenoma. The presence of PPBS in the INH system indicates its functional maintenance in large adenomas.

© RSNA, 2002

Index terms: Diabetes insipidus • Pituitary, MR, 145.121411, 145.121416, 145.12143 • Pituitary, neoplasms, 145.371






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