Solid masses are more easily defined compared to cystic lesions, which may be confused with cerebral spinal fluid in the suprasellar cistern. CT features of selected suprasellar masses may aid in their characterization. Tumor invasion of the cavernous sinuses can be difficult to detect and may be aided by IV contrast as an adjunctive test. Dual-phase imaging with and without IV contrast is not indicated as an initial imaging study. Thin-section acquisition with multiplanar reformatting is essential and vastly improved over direct coronal imaging. This can also aid intraoperative navigation and provide greater osseous detail for anatomy in the sphenoid sinus prior to trans-sphenoidal surgery. CTA Head CT angiography (CTA) is indicated when vascular lesions, such as aneurysm, are suspected, though these rarely cause clinical symptoms referable to the hypothalamic pituitary axis. Cavernous sinus invasion by pituitary masses can be better detected with CTA compared with noncontrast CT. CTA may be part of operative planning or image guidance; however, CTA is not routinely used for initial evaluation [20]. MRA Head MR angiography (MRA) can be a useful adjunct to pituitary MRI and can reliably depict vascular lesions, such as aneurysms [21,22], though these rarely cause clinical symptoms referable to the hypothalamic pituitary axis. Displacement or encasement of vessels in the suprasellar region can be better defined with MRA for surgical planning; however, MRA is not routinely used for initial evaluation. MRI Sella MRI using high-resolution pituitary protocols is the preferred diagnostic imaging modality for evaluation of the pituitary and sellar regions [1,2,23-28]. Anatomy and pathologies involving the pituitary gland, infundibulum, optic chiasm, and vascular structures are reliably depicted and can be characterized on both precontrast and postcontrast imaging, particularly with the aid of high-resolution, focused field-of-view sequences targeted for sellar and parasellar assessment [29-63].
Neuroendocrine Imaging. Solid masses are more easily defined compared to cystic lesions, which may be confused with cerebral spinal fluid in the suprasellar cistern. CT features of selected suprasellar masses may aid in their characterization. Tumor invasion of the cavernous sinuses can be difficult to detect and may be aided by IV contrast as an adjunctive test. Dual-phase imaging with and without IV contrast is not indicated as an initial imaging study. Thin-section acquisition with multiplanar reformatting is essential and vastly improved over direct coronal imaging. This can also aid intraoperative navigation and provide greater osseous detail for anatomy in the sphenoid sinus prior to trans-sphenoidal surgery. CTA Head CT angiography (CTA) is indicated when vascular lesions, such as aneurysm, are suspected, though these rarely cause clinical symptoms referable to the hypothalamic pituitary axis. Cavernous sinus invasion by pituitary masses can be better detected with CTA compared with noncontrast CT. CTA may be part of operative planning or image guidance; however, CTA is not routinely used for initial evaluation [20]. MRA Head MR angiography (MRA) can be a useful adjunct to pituitary MRI and can reliably depict vascular lesions, such as aneurysms [21,22], though these rarely cause clinical symptoms referable to the hypothalamic pituitary axis. Displacement or encasement of vessels in the suprasellar region can be better defined with MRA for surgical planning; however, MRA is not routinely used for initial evaluation. MRI Sella MRI using high-resolution pituitary protocols is the preferred diagnostic imaging modality for evaluation of the pituitary and sellar regions [1,2,23-28]. Anatomy and pathologies involving the pituitary gland, infundibulum, optic chiasm, and vascular structures are reliably depicted and can be characterized on both precontrast and postcontrast imaging, particularly with the aid of high-resolution, focused field-of-view sequences targeted for sellar and parasellar assessment [29-63].