Sellarsuprasellar tumours pituitary adenoma

Asymmetrical fossa expansion gives the appearance of a 'double floor'

effect on the lateral view 1

A-P view

NEURORADIOLOGICAL INVESTIGATION

LARGE TUMOURS

Large tumours //

cause expansion or if \\

Asymmetrical fossa expansion gives the appearance of a 'double floor'

effect on the lateral view 1

A-P view

CT scan with contrast enhancement demonstrates tumours filling the pituitary fossa and expanding into the suprasellar compartment, but MRI gives more anatomical detail, clearly delineating any suprasellar extension and the effect on adjacent structures.

Microadenoma

Carotid artery within cavernous sinus

MRI is marginally better than CT scanning in the detection of microadenomas but both have false positives and false negatives.

Angiography or MRI may be required before transphenoidal operation to exclude the presence of an incidental medially projecting aneurysm.

Saggital T1 weighted MRI with gadolinium showing a large pituitary tumour of mixed intensity with suprasellar extension.

MICROADENOMAS Coronal CT Scanning with contrast may demonstrate a low density region within the gland tissue (or may show deviation of the pituitary stalk from the midline). Tumours > 5 mm diameter produce these characteristic appearances. Tumours under this size are difficult to detect.

Coronal view of same patient showing relationships of the tumour to the carotid arteries and the cavernous sinus.

Pituitary stalk (undeviated) Normal gland Sphenoid sinus

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