 There are postsurgical changes of pituitary tumor resection via transsphenoidal approach. Please note lack of contrast significantly limits definitive assessment for residual tumor. Small defect is noted in the right aspect of the sella compatible with site of resection. There remains soft tissue within the remainder of the sella and extending superiorly into the suprasellar cistern with isointense T1 signal and hypointense T2 signal, signal features which are similar to the preoperative noncontrast sequences. Susceptibility effect is also noted within the suprasellar component of the lesion which appears to be present preoperatively on outside MRI from 10/16/2015 with differences in technique limiting direct comparison. Residual lesion again abuts the left aspect of the cavernous sinus without gross evidence of invasion. No significant mass effect on the optic chiasm. Normal T1 hyperintensity of the neurohypophysis is again not identified. Remainder of the brain demonstrates no pathologic signal abnormality. The ventricles and sulci are within normal limits. There is no mass effect or midline shift. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is partial opacification of the paranasal sinuses with fluid levels consistent with recent surgery.
Postoperative changes of pituitary tumor resection. There is at least partial tumor resection with soft tissue defect noted in the right aspect of the sella. There remains lobulated soft tissue in the suprasellar cistern and left aspect of the sella which is suspected to represent residual tumor but not definitively evaluated in the absence of contrast. Correlate with intraoperative assessment of extent of surgical resection. Alternatively, if patient's GFR is greater than 30 and no other contraindications, would suggest obtaining post gadolinium sequences of the sella with half dose contrast for confirmation.