Clinical question: Pituitary microadenoma. Signs and symptoms: Cushing's disease. Pre- and post enhanced pituitary MRI:Examination is degraded due to motion artifact. Multiple sequences were repeated however without significant improvement.Within these limitations there is no convincing evidence of a pituitary mass. However suboptimal quality of images precludes detection of subtle small pituitary lesions. Pituitary gland demonstrate fairly homogeneous pattern of enhancement and with normal enhancement of the pituitary stock in midlinePituitary gland measures approximately 3.2 mm in the midline.No detectable abnormality within the basal cistern or the hypothalamic region. No detectable abnormality of the cavernous sinuses.Extensive sphenoid and ethmoid sinus disease with intense mucosal enhancement is noted.Additional axial fat sat post enhanced images of entire brain is also acquired which demonstrate a small right posterior temporal-occipital cortical enhancement (series 1701 image 11 through 13) which could represent a focus of enhancing subacute stroke or infection/inflammatory process. There are no prior exams for comparison. Follow-up with dedicated brain MRI with contrast is recommended. There is no additional detectable foci of parenchymal or leptomeningeal enhancement.
1.Suboptimal exam due to motion artifact without improvement after repeat sequences.2.Within this limitation there is no convincing evidence of pituitary mass. Please see above comments.3.Incidental note is made of a small focus of cortical or leptomeningeal enhancement in the right posterior temporal/occipital region. Finding could represent an enhancing subacute ischemic stroke or representing a focus of leptomeningeal enhancement of unknown etiology. Recommend follow-up with dedicated pre and postcontrast enhanced brain MRI. 