Pituitary MRI Protocol

Plain Study Protocol includes:

• SCOUT Three plane low resolution scouts
• T2_CORONAL TurboSE T2 coronals positioned through the sella or lesion.Place the rear slice through the Basilar artery.
• Sagittal and Coronal T1-W spin-echo (3-mm slices)

Pituitary with contrast enhancement (3-mm slices)

• Isotropic_MPRAGE- Used for multi-planar reformatting.
• Post Contrast- Sagittal T1-W spin-echo
• Post Contrast-Coronal T1-W FAT SAT 
• Post Contrast Axial whole brain 

Optional Sequences

PD+T2_BRAIN 

Sequence copied form the Standard brain examination for a general overview of the brain in patients with a non specific indication for Pituitary MRI

T2_SAGITTAL

For enhanced display of cystic lesions if they are not clearly visible on the MP RAGE images

Multi-planar Reconstructions

For more detailed instructions see "Creating & Filming MPRs for Pituitary Examinations"

• Create 12 sagittal and 12 coronal T1 weighted images.
• Slice Thickness 1 or 2 mm for micro-adenomas, 3 mm or 4 mm for macro-adenomas.
• Use Double Oblique prescription on an axial work image to ensure that the planes are anatomically true.
• Define the sagittal locations from the right to the left, and the coronals from posterior to anterior to ensure easy filming in the proper direction.

Dynamic Contrast Pituitary 

To identify small (>3mm) secreting pituitary adenomas so that a partial resection of the pituitary may be used rather than total.

Preparation & Kit

• 20G Jelco
• 10 ml Saline
• Minimum volume extension tube
• Tape and tourniquet
• 2 x 10 ml syringes

Set up the jelco with the extension tube filled with saline. The contrast is injected rapidly (2 ml/sec) at the beginning of the second scan, and followed by a saline flush of 5-10 mls.

Contrast Doses (Half dose) Dynamic Contrast Pituitary 

40 kg	4 mls		80 kg	8 mls
50 kg	5 mls		90 kg	9 mls
60 kg	6 mls		100 kg	10 mls
70 kg	7 mls		110 kg	11 mls

TECHNIQUE

Perform a standard plain pituitary exam first unless done recently.

Rapid_T1_Coronal_51297

This is a series of TSE T1 coronal images intended to be used with a fast injection of half dose contrast. The injection is rapidly given at the start of the 2^nd measurement. There is a 10 second pause between the first (precontrast) scan and the start of the continuous string of post contrast measurements to prepare the injector and give a countdown.

Pituitary M Time curve analysis

Perform this analysis for each slice covering the gland. 

Review the images sequentially for any subjective appearance of delayed enhancement.

• Select Evaluate Mean/Curve
• On the 3^rd post contrast view, set up 4 adjacent circular ROIs that cover the pituitary gland from right to left. Enter the appropriate image image numbers to make a set of enhancement curves.

This is a series of TSE T1 coronal images intended to be used with a fast injection of half dose contrast. The injection is rapidly given at the start of the 2^nd measurement. There is a 10 second pause between the first (precontrast) scan and the start of the continuous string of post contrast measurements to prepare the injector and give a countdown.

READ MORE ABOUT:

Pituitary MRI Protocol

MRI Brain Reference Lines

Standard MRI Brain Protocol