Do We Need Gadolinium-Based Contrast Agents for Routine MRI Surveillance of Unoperated Pituitary Macroadenoma?

Coronal T2WI versus T1C show the different grades of cavernous sinus invasion using the Knosp classification; grade 0, the lesion does not extend beyond the medial carotid line (red line); grade 1, the lesion extends to the medial line but does not reach the intercarotid line (blue line); grade 2, the tumor extends beyond the intercarotid line but does not extend beyond the lateral line (yellow line); grade 3, the tumor extends to the lateral line more so on the left (yellow line); and grade 4, there is complete encasement of the cavernous carotid artery.

Coronal T2WI versus T1C show the optic pathway (depicted by yellow arrows) compression classification. A, There is no contact. B, The pituitary macroadenoma is abutting the left aspect of the optic chiasm without displacement. C, There are mass effect and displacement of the optic pathway.