Radiological evaluation of pituitary lesions by CT, plain radiography and MRI

doi:10.21203/rs.3.rs-5111959/v1

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Radiological evaluation of pituitary lesions by CT, plain radiography and MRI

https://doi.org/10.21203/rs.3.rs-5111959/v1

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Background: The pituitary is an important endocrine gland located at the base of the brain. It is involved in nearly all processes of homeostasis, as well as growth and development. This gland commonly develops pathology, which may result in a mass effect on adjacent intracranial structures or be hormonally active.

Methods and materials: Study location: Al-Mouwasat University Hospital (Endocrine + Surgery + Radiology Departments)., Study type: A retrospective cross-sectional study, Study duration: From February 2020 to December 2023, focusing on cases that underwent MRI of the pituitary gland and radiological images.

Results: Number of patients who underwent lateral radiographs of the skull with a focus on the sella turcica: 250 patients: normal images (normal sella turcica) 82%, abnormal sella turcica 18%, enlargement of the sella turcica 42%, calcifications within the sella turcica 17%, destruction and erosion of the anterior clinical processes 5%, destruction and erosion of the posterior clinical processes 7%, destruction and erosion of the anterior and posterior clinical processes 22%, deformity of the sella turcica 13%, calcifications around the sella turcica 12%. We found that the tumor size of 1-1.5 cm was 40%, the tumor size of 1.5-2 cm was 42%, the tumor size of 2-3 cm was 18%, the rate of pituitary dwarfism was 18%, the small adenoma with low density appeared in 10%, and the large adenoma with high density appeared in 14%.

Conclusion: Standard views of the pituitary gland can be obtained by image reconstruction and formatting to standard coronal, sagittal, and axial anatomic landmarks. Since MRI can acquire imaging data in multiple planes, patient positioning is also less critical.

Neurology

Pituitary gland

radiographic evaluation

sella turcica

The pituitary gland is located within the sella turcica, a cup-shaped cavity in the sphenoid bone. The sphenoid air sinus lies below and anterior to the sella turcica. Above the pituitary gland is the cerebrospinal fluid (CSF) space, the suprasellar apparatus, which contains the optic chiasm. The lateral walls of the pituitary fossa are formed by cavernous sinuses that contain the internal carotid arteries as well as a number of cranial nerves: cranial nerves III, IV, and VI as well as the first and second divisions of cranial nerve V. The pituitary gland is connected via the pituitary stalk to the hypothalamus, a thin sheet of tissue that forms the floor of the anterior portion of the third ventricle. The appearance and size of the pituitary gland changes during life. At birth, it is typically spherical in shape and exhibits high signal on T1-weighted images (1).

By about 6 weeks of age, this high signal decreases, and the anterior pituitary tissue exhibits a signal similar to that of the brain. However, the posterior pituitary tissue retains a bright signal on T1-weighted sequences. The so-called “posterior pituitary bright spot” is a normal appearance thought to be due to the high neurophysin content (which is not found in anterior pituitary tissue).

The size of the pituitary gland varies with age and sex. On average, it is 3–8 mm in height but is generally larger in females than in males, The height increases during adolescence due to normal physiological hypertrophy (2). There is also a slight increase in size seen during the sixth decade in females. The most striking physiological changes are seen during pregnancy when the gland gradually enlarges to its maximum height immediately after birth when it may be 10 mm in height (3).

Embryologically, the anterior and posterior lobes of the pituitary gland are distinct. The anterior lobe is formed by a fold of oral ectoderm known as Rathke’s pouch. The posterior lobe is formed by a projection of neuroectoderm from the diencephalon. Between the anterior and posterior lobes is a non-vestigial middle lobe known as the pars intermedia. This is the likely location of small, non-functional Rathke cysts.

Pituitary lesions were detected, Study location: Al-Mouwasat University Hospital (Endocrine Departments + Surgery + Radiology), Study type: Retrospective cross-sectional study

Study duration: From February 2020 to December 2023, focusing on cases that underwent MRI of the pituitary gland and radiological images, Patient files diagnosed with various lesions were studied at Al-Mouwasat University Hospital, Number of patient samples: 286 patients

Inclusion criteria

Pituitary lesion diagnosed by radiology (simple images - CT images - MRI images)

Exclusion criteria

Pituitary lesions and normal radiological images, Patients whose medical history included a pituitary lesion and were excluded due to the lack of radiological investigations, Patients diagnosed with a suspected pituitary tumor and no radiological investigation was performed

Statistical analysis: The data was completed from the forms into an Excel file, simple statistics were conducted, the results were summarized, and the descriptive statistics were reviewed based on percentages and graphical shapes in addition to measures of central tendency [arithmetic mean and standard deviation]. To test the statistical relationships between the basic characteristics, we used methods The following statistics: Pearson's chi-square test to compare categorical variables with a normal distribution.

The number of patients who underwent a lateral skull radiograph was 250 patients. We found that 82% of the patients had a normal simple image, and 18% had an abnormal sella turcica. Among the 18%, there was an enlargement of the sella turcica in 42% of the cases, calcifications in 17%, 5% destruction and erosion of the anterior clinical processes, 7% destruction and erosion of the posterior clinical processes, 22% erosion of the anterior-posterior clinical processes, 13% deformity of the sella turcica, and 12% calcifications around the sella turcica. We found that 7% of the lesions were intracranial hypertonia. We found through CT imaging that 76% of the patients had a normal sella, 12% had a mass within the sella turcica, 25% of the cases had a mass around the sella turcica, 23% had mass calcifications, and 25% of the cases had calcification of the clinical processes. An MRI was performed. For 286 cases, we found that the MRI was normal in 7% of patients. As for the contrast medium injection method, 1–2% mmol/kg of gadolonium was injected in 65% of patients, and 1–2% mmol/kg of rapid dynamic was injected in 35% of patients. We found that only 44% of cases showed enlargement. Among the enlargements, we found that homogeneous pituitary enlargement was 36%, while heterogeneous pituitary enlargement was 64%.

When studying the enlargement at the level of the anterior pituitary lobe, we found that the percentage of enlargement on the right side of the anterior lobe was 45%, the percentage of enlargement on the left side of the anterior lobe was 45%, and the percentage of enlargement on both sides of the anterior lobe was 30%. By studying the pituitary stalk, the normal thickness is considered to be 6 mm or less, and it was in 88% of patients. The percentage of thickening in the pituitary stalk was 12%. When studying the posterior lobe, we found that the percentage of migration in the space around the sella was 92%, the percentage of duplication of the posterior lobe of the pituitary gland was 4%, and the percentage of fragmentation in the posterior lobe was 4%. When studying the anterior pituitary lobe, we found that the percentage of pituitary infarction was 15%, and the percentage of an empty sella turcica was 23%.

We found that the percentage of adenoma less than 10 mm was 40%, and the percentage of a pituitary adenoma greater than 10 mm was 27%. When studying the macroadenoma signal, we found that the percentage of adenoma signal was heterogeneous 755, and homogeneous 25%. The percentage of giant pituitary tumors that lead to compression of the pituitary stalk was 13%, which causes deviation of the pituitary stalk was 25%, and the percentage of Tumors touching the optic chiasm 43%, tumors compressing the optic chiasm 52%, tumors compressing the optic chiasm severely 13%, giant tumors extending to the sphenoid sinus touching the roof 12%, protrusion within the sphenoid body 8%, tumors invading the cavernous sinus on the right or left side 4%, tumors invading the cavernous sinuses on both sides 7%, hemorrhagic pituitary tumor 12%, multiple hemorrhagic foci 9%, tumor containing cystic components 14%, and with regard to the size of the large pituitary adenoma, we found that the tumor size from 1-1.5 cm was 40%, the tumor size from 1.5-2 cm was 42%, the tumor size of 2–3 cm was 18%, the percentage of pituitary dwarfism was 18%, the small adenoma appeared with hypodense density in 10%, and the tumor appeared The large gland with high density was 14%. We also found that Rathke's cyst cases that were accompanied by clinical symptoms were 50%, and those that were not accompanied by symptoms were 50%. By studying Rathke's cyst, we found that there were 100% organized rounded edges, 85% high signal in the second time, 5% low signal in the second time, 10% normal signal in the second time, and 3% Rathke's cyst enhancement. The percentage of tumors containing fibrosis foci in our study patients was 10%. We also found that among the patients who had high signal lesions in the first time, 7.5% were pregnant, 60% were women in the menopausal stage, 30% were bleeding within the pituitary parenchyma, and 1.5% were unknown lesions. The causes of diabetes insipidus were due to previous surgical intervention on the sella 45%, craniopharyngeal tumor 13%, and giant pituitary adenoma 15%. And hypophysitis 15%, meningitis 25%, and patients with Covid-19 were monitored and we found that the number of cases was 76, and the percentage of the presence of a large pituitary tumor in patients was 5%, and the presence of a large bleeding tumor was 5%, and the percentage of bleeding within the glandular parenchyma was 40%, and the percentage of pituitary infarction was 40%, and the percentage of cases of hypophysitis with hypothalamus inflammation was 10%.

Pituitary gland infection is not limited to a neurological infection in the context of Covid-19 infection, which is called neurological Covid. Covid vaccines also carry the risk of neurological manifestations, i.e. neurological manifestations as a complication or side effect. Neurological manifestations specific to pituitary diseases remain the least common infections in Covid-19. It was found that pituitary infections in the context of Covid-19 appear either during the Covid crisis or due to its occurrence as a subsequent complication, depending on the patient's condition, pathological and immune complications. Through research published in PubMed and Google Scholar [4–5] focusing on pituitary infection in Covid, the total number of articles that focused on this topic from January 2020 to the end of 2021 was 15 articles, and the number of cases mentioned in the total 15 studies was 17 patients, 10 males and 7 females, ages from 20 to 75 years, and the number of cases in which pituitary infection occurred after the vaccine (only two cases)

Among the 17 cases of pituitary gland infection in Corona, 14 had pituitary infarction (Pituitary appendicitis) and 3 cases had pituitary inflammation (Hynonhysis). Pituitary adenoma was observed in 13 of the 17 cases. There were 2 deaths. The pituitary gland and the hypothalamus were considered preferred locations for infection with Covid. Factors predisposing to pituitary infection with Covid were mentioned: diabetes - obesity - Euphrates fractures, and these cause an exacerbation of pituitary dysfunction.

The emergence of pituitary apoplexy was approved as one of the complications of Corona in the bumped in 2022, and the cases mentioned as a complication of the Modernq vaccine, and what is meant by long-term infection with Corona is the extension of the infection in (5–11) weeks, causing pituitary insufficiency in addition to the appearance of other neurological symptoms, including fatigue and muscle weakness - sleep disorders - fatigue - stress - decreased concentration - hair loss - contraction.

Ethics approval and consent to participate

The Research Ethics Committee at Al-Sham Private University and the Ethical Committees at Al Mouwasat University Hospital approved the study protocol. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or Similar ethical standards.

Consent for publication

Not applicable.

Availability of data and materials:

All data related to this paper’s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request.

Convict of interest:

The authors declare that they have no convict of interest.

Funding:

This research received no specific grant from ASPU or any other funding agency in the public, commercial or non-pro t sectors.

Acknowledgments

We are thankful to the management of Al- Sham Private University for their support in the eld of medical training and research, we also want to thank the administration of Al Mouwasat University Hospital and the resident doctors, we would also like to thank Dr. Khalid Khattab for his help and supervision in the paper.

Dietrich RB, Lis LE, Greensite FS, Pitt D. Normal MR appearance of the pituitary gland in the first 2 years of life. Am J Neuroradiol 1995; 16:1413-1419 [PMC free article] [PubMed]
Tsunoda A, Okuda O, Sato K. MR height of the pituitary gland as a function of age and sex: especially physiological hypertrophy in adolescence and in climacterium. Am J Neuroradiol 1997; 18:551-554 [PMC free article] [PubMed]
Dinc H, Esen F, Demirci A, Sari A, Resit Gumele H. Pituitary dimensions and volume measurements in pregnancy and post-partum. MR assessment. Acta Radiol 1998; 39:64-69 [PubMed]
Finstener J. Neurological side effect at covid vacciuatiur. ACT Neurolo Sicee 2022 ;145(1). 5-9
Teneja c etal. progressive pituitary apoplexy iu a patenfwith covid J N eurd Suvg Rep 2022, 83 (1) e8- e12

The authors declare no competing interests.

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Radiological evaluation of pituitary lesions by CT, plain radiography and MRI

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Abstract

Introduction

Methods and Material

Results

Discussion

Declarations

References

Additional Declarations

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