Radiography Sella There is no relevant literature regarding the use of radiography in the initial evaluation of known or suspected hyperfunctioning pituitary adenoma. Variant 3: Adult. Diabetes insipidus. Initial imaging. Central causes of diabetes insipidus may be associated with abnormalities affecting the pituitary stalk and the hypothalamic-pituitary axis. Mass effect or neoplastic invasion may be present because of germ-line tumors, lymphoma, leukemia, Langerhans cell histiocytosis, metastasis, craniopharyngioma, meningioma, and Rathke cleft cyst, among others [2,15-17]. Inflammatory processes (ie, sarcoid, lymphocytic hypophysitis, granulomatous infiltration) occur in the sellar and suprasellar regions as well. Additionally, an empty sella may be seen with Neuroendocrine Imaging herniation of the subarachnoid space into the sella turcica; this is usually an incidental finding, close to 30% of patients may demonstrate some hypopituitarism upon testing [19]. CT Sella CT can detect solid lesions of the suprasellar cistern and may detect infiltrative lesions of the pituitary stalk but also may miss cystic tumors. Multiplanar reconstructions with thin sections and soft-tissue window settings are crucial to visualize the suprasellar cistern and pituitary stalk. CT with IV contrast helps to visualize the enhancing pituitary stalk and infiltrative lesions of the stalk, though MRI is considered the best first-line study. Dual-phase imaging with and without IV contrast is not indicated as an initial imaging study. CTA Head CTA may be part of operative planning or image guidance; however, CTA is not routinely used for initial evaluation of diabetes insipidus [20]. MRA Head There is no relevant literature regarding the use of MRA in the evaluation of diabetes insipidus.
Neuroendocrine Imaging. Radiography Sella There is no relevant literature regarding the use of radiography in the initial evaluation of known or suspected hyperfunctioning pituitary adenoma. Variant 3: Adult. Diabetes insipidus. Initial imaging. Central causes of diabetes insipidus may be associated with abnormalities affecting the pituitary stalk and the hypothalamic-pituitary axis. Mass effect or neoplastic invasion may be present because of germ-line tumors, lymphoma, leukemia, Langerhans cell histiocytosis, metastasis, craniopharyngioma, meningioma, and Rathke cleft cyst, among others [2,15-17]. Inflammatory processes (ie, sarcoid, lymphocytic hypophysitis, granulomatous infiltration) occur in the sellar and suprasellar regions as well. Additionally, an empty sella may be seen with Neuroendocrine Imaging herniation of the subarachnoid space into the sella turcica; this is usually an incidental finding, close to 30% of patients may demonstrate some hypopituitarism upon testing [19]. CT Sella CT can detect solid lesions of the suprasellar cistern and may detect infiltrative lesions of the pituitary stalk but also may miss cystic tumors. Multiplanar reconstructions with thin sections and soft-tissue window settings are crucial to visualize the suprasellar cistern and pituitary stalk. CT with IV contrast helps to visualize the enhancing pituitary stalk and infiltrative lesions of the stalk, though MRI is considered the best first-line study. Dual-phase imaging with and without IV contrast is not indicated as an initial imaging study. CTA Head CTA may be part of operative planning or image guidance; however, CTA is not routinely used for initial evaluation of diabetes insipidus [20]. MRA Head There is no relevant literature regarding the use of MRA in the evaluation of diabetes insipidus.