Clinical question: History of pituitary tumor, evaluate for change or growth. Signs and symptoms: Headache. Pre- and postenhanced pituitary MRI:Examination demonstrates a well-demarcated round mass occupying the entire sella and with resultant mild expansion of the sella. It measures approximately 15 mm in craniocaudad and 16 mm in transverse axis and 19 mm on AP measured on post enhanced images. The mass is nearly identical to prior brain MRI exam from 10-15-2014 (no prior dedicated pituitary MRI). The lesion minimally bulges into the basal cistern however it is not in contact with the suprasellar visual complex. There is also no evidence of extension of the lesion into the cavernous sinuses. The lesion demonstrates mildly heterogeneous diffuse enhancement and highly suspected of a pituitary macroadenoma. There is mild deviation of the pituitary stalk to the right as result of this mass.Pre and post enhanced brain MRI:Negative diffusion-weighted images.Other than above detailed intrasellar pituitary lesion the overall anatomic cord morphology and signal intensity of brain parenchyma remains within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.Postenhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement. Above mentioned pituitary mass however demonstrate diffuse mildly heterogeneous enhancement.
1.Pre- and postenhanced pituitary MRI demonstrate uniformly enlarged pituitary gland with mild deviation of pituitary stock to the right and highly suggestive of a pituitary macroadenoma without interval change since prior brain MRI exam from 2014. No evidence of mass effect on the suprasellar visual complex or extension into the cavernous sinuses.2.Pre and post enhanced brain MRI is unremarkable other than above mentioned adenoma.3.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.