MRI with and without IV contrast adds additional information when new tumor is suspected in the setting of gross total tumor resection [86], surveillance of smaller known masses [64], and hormone-secreting microadenomas when there is an unexpected hormonal response to medical therapy. In patients with known tumors and normal hormone levels on dopamine agonist therapy, MRI follow-up may be unnecessary [96]. Inclusion of diffusion-weighted imaging may be considered as a tool to differentiate granulation tissue postoperative from residual or recurrent adenoma [97]. Surveillance after resection of nonadenoma sellar/suprasellar masses should be based on the tumor pathology and patient symptoms, generally requiring MRI without and with IV contrast. High-resolution pituitary protocols generally suffice for the assessment of Neuroendocrine Imaging cavernous sinus involvement or complication. MRI with IV contrast may only be performed for use in operative guidance and should not be considered for routine surveillance. Venous Sampling Petrosal Sinus There is no relevant literature regarding the use of venous sampling in the evaluation of the postoperative sella. Radiography Sella There is no relevant literature regarding the use of radiography in the evaluation of the postoperative sella. Variant 6: Child, males younger than 9 years of age; females younger than 8 years of age. Precocious puberty. Initial imaging. Central causes of precocious puberty are often idiopathic; however, this may be related to intracranial neoplasms, trauma, infection, hydrocephalus, and some syndromes with premature gonadotropin-releasing hormone production that is due to infiltration or extrinsic mass effect [98-103]. The appropriateness of imaging in the setting of precocious puberty is debated. Imaging should always follow hormonal studies that suggest a central origin of precocious puberty [104,105].
Neuroendocrine Imaging. MRI with and without IV contrast adds additional information when new tumor is suspected in the setting of gross total tumor resection [86], surveillance of smaller known masses [64], and hormone-secreting microadenomas when there is an unexpected hormonal response to medical therapy. In patients with known tumors and normal hormone levels on dopamine agonist therapy, MRI follow-up may be unnecessary [96]. Inclusion of diffusion-weighted imaging may be considered as a tool to differentiate granulation tissue postoperative from residual or recurrent adenoma [97]. Surveillance after resection of nonadenoma sellar/suprasellar masses should be based on the tumor pathology and patient symptoms, generally requiring MRI without and with IV contrast. High-resolution pituitary protocols generally suffice for the assessment of Neuroendocrine Imaging cavernous sinus involvement or complication. MRI with IV contrast may only be performed for use in operative guidance and should not be considered for routine surveillance. Venous Sampling Petrosal Sinus There is no relevant literature regarding the use of venous sampling in the evaluation of the postoperative sella. Radiography Sella There is no relevant literature regarding the use of radiography in the evaluation of the postoperative sella. Variant 6: Child, males younger than 9 years of age; females younger than 8 years of age. Precocious puberty. Initial imaging. Central causes of precocious puberty are often idiopathic; however, this may be related to intracranial neoplasms, trauma, infection, hydrocephalus, and some syndromes with premature gonadotropin-releasing hormone production that is due to infiltration or extrinsic mass effect [98-103]. The appropriateness of imaging in the setting of precocious puberty is debated. Imaging should always follow hormonal studies that suggest a central origin of precocious puberty [104,105].