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Research ArticleBRAIN

Correlation of High Signal Intensity of the Pituitary Stalk in Macroadenoma and Postoperative Diabetes Insipidus

Naokatsu Saeki, Seiichiro Hoshi, Souichi Sunada, Kenro Sunami, Hisayuki Murai, Motoo Kubota, Ichiro Tatsuno, Toshihiko Iuchi and Akira Yamaura
American Journal of Neuroradiology May 2002, 23 (5) 822-827;
Naokatsu Saeki
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Seiichiro Hoshi
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Souichi Sunada
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Kenro Sunami
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Hisayuki Murai
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Motoo Kubota
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Ichiro Tatsuno
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Toshihiko Iuchi
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Akira Yamaura
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    Fig 1.

    Case 5, group A. Images in a 63-year-old man with a nonfunctioning adenoma show that the HSI (arrow) was present both before and 2 weeks after surgery.

    A–C, At 2 weeks after surgery, ovoid HSI is visible at the level of the diaphragm sellae on sagittal (A), coronal (B), and axial (C) sections.

    D–F, Before surgery, linear HSI is visible at the posterolateral surface of adenoma, above the indentation formed by a diaphragma sellae, on the sagittal (D), coronal (E), and axial (F) sections.

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    Fig 2.

    Case 16, group A. In this patient, a 35 year–old woman with a nonfunctioning adenoma, MR studies were repeated at 3, 12, and 24 months after surgery and showed essentially the same findings, including HSI (arrow).

    A and B, At 2 years after surgery, HSI is visible at the tip of pituitary stalk at the level of the diaphragma sellae on the coronal (A) and sagittal (B) sections.

    C–F, Before surgery, linear HSI is visible at the posterior surface of adenoma, above the indentation formed by the diaphragma sellae, on the sagittal (C), coronal (D), contrast-enhanced sagittal (E), and axial (F) sections. HSI is identifiable at the stalk stump. The enhanced image shows HSI with more remarkable enhancing effect due to normal pituitary tissue; this finding suggests its connection to the pituitary stalk.

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    Fig 3.

    Case 17, group A. Images in a 74 year-old-woman with a growth hormone–secreting adenoma show HSI (arrow).

    A, Coronal section 6 months after surgery. Postoperatively, the adenoma was debulked, and the HSI was below the chiasm and deviated to the left. It was continuous with the proximal portion of the pituitary stalk.

    B, Coronal section before surgery. Preoperatively, an ovoid HSI is visible on the supradiaphragmatic level on the left side. The optic chiasm is compressed superiorly.

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    Fig 4.

    Sagittal sections obtained before surgery show HSI (arrows).

    A, Case 9, group A 39-year-old woman with nonfunctioning adenoma. HSI was noted in both supra- and intrasellar areas. The indentation at the level of the diaphragma sellae was noted but not prominent.

    B, Case 14, group A. A 54-year-old woman with nonfunctioning adenoma. HSI was noted close to the median eminence. Indentation of diaphragma sellae was not evident in this case.

Tables

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    TABLE 1:

    Clinical features of 22 patients with pituitary adenoma

    Case No./Patient Age (y)/Patient SexSigns and Symptoms*Adenoma Type†Height × Width × Thickness (mm)HSI Site§HSI Shape‖Postoperative MR Study Interval (mo)Postoperative HSIPostoperative DI
    Group A
     1/63/MVFDNF31 × 28 × 33SDOvoid5YesNo
     2/63/FHeadacheNF20 × 18 × 19SDRound36YesNo
     3/61/MVFDNF39 × 26 × 30SDOvoid6YesNo
     4/55/MVFDNF32 × 26 × 25SDLinear10YesNo
     5/63/MVFDNF26 × 22 × 20SDLinear0.5YesNo
     6/35/MImpotencePRL35 × 25 × 22SDLinear44YesNo
     7/74/FVFDNF35 × 22 × 26SDRound5YesNo
     8/59/FVFDNF38 × 31 × 23SDLinear3YesNo
     9/39/FVFDNF27 × 21 × 18ISLinear21YesNo
     10/39/FVFDPRL22 × 18 × 18SDLinear44YesNo
     11/17/FVFDPRL27 × 18 × 18SDLinear48YesNo
     12/72/FVFDNF29 × 26 × 24SDLinear32YesNo
     13/61/FVFDNF34 × 26 × 24SDLinear31YesNo
     14/54/FVFDNF24 × 20 × 18MELinear1YesNo
     15/28/FAmenorrheaPRL22 × 18 × 15SDLinear26YesNo
     16/35/FVFDNF29 × 26 × 20SDLinear24YesNo
     17/74/FAcromegalyGH24 × 23 × 21SDOvoid6YesNo
     18/33/FVFDPRL52 × 38 × 36NoneNA27YesNo
    Group B
     19/60/MVFDNF19 × 18 × 20NoneNA4NoNo
     20/70/MVFDNF‡22 × 20 × 18NoneNA7NoYes
     21/48/FVFDNF29 × 20 × 20NoneNA27NoYes
     22/30/MVFDNF34 × 30 × 26NoneNA22NoYes
    • * VFD indicates visual field defect.

    • † GH indicates growth hormone–secreting adenoma; NF, nonfunctioning adenoma; and PRL, prolactinoma.

    • ‡ Pituitary apoplexy.

    • § IS indicates intrasellar; ME, median eminence; SD, supradiaphragmatic.

    • ‖ NA indicates not applicable.

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    TABLE 2:

    Cases of pre- and postoperative HSI and postoperative DI

     Postoperative HSIPreoperative HSIPermanent DI
    PresentAbsentPresentAbsent
    Present171018
    Absent0431
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American Journal of Neuroradiology: 23 (5)
American Journal of Neuroradiology
Vol. 23, Issue 5
1 May 2002
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Cite this article
Naokatsu Saeki, Seiichiro Hoshi, Souichi Sunada, Kenro Sunami, Hisayuki Murai, Motoo Kubota, Ichiro Tatsuno, Toshihiko Iuchi, Akira Yamaura
Correlation of High Signal Intensity of the Pituitary Stalk in Macroadenoma and Postoperative Diabetes Insipidus
American Journal of Neuroradiology May 2002, 23 (5) 822-827;

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Correlation of High Signal Intensity of the Pituitary Stalk in Macroadenoma and Postoperative Diabetes Insipidus
Naokatsu Saeki, Seiichiro Hoshi, Souichi Sunada, Kenro Sunami, Hisayuki Murai, Motoo Kubota, Ichiro Tatsuno, Toshihiko Iuchi, Akira Yamaura
American Journal of Neuroradiology May 2002, 23 (5) 822-827;
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