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Neuroradiology: Practical Tips for Endocrinologists

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Prof Niranjan Khandelwal, Chandigarh    20 November 2018

  1. Sellar dimensions on plain radiograph – Anteroposterior diameter: 17 mm (range 5-16 mm); depth: 13 mm; width: 16 mm (range 10-15 mm); area on lateral view: 130 sq.mm; volume: 1,092 cumm (mean 599 cumm).
  2. Elster’s rule for pituitary gland height on MRI (maximum height in mm) – Infants and children: 6; men and postmenopausal women: 8; women of childbearing age: 10; women in late pregnancy and postpartum: 12.
  3. Imaging approach – Recognize the normal sellar/parasellar region contents; determine the abnormality/lesion; place the abnormality in the appropriate space (sellar/parasellar) – Lesion epicenter; characterize the lesion based on imaging features (solid, cystic, mixed, calcifications, etc.); make a set of imaging differentials.
  4. MRI protocol – Cavernous sinus: T2WI brain; FLAIR brain; pre and post-contrast 3D T1 SPGR/MPRAGE; 3D heavily T2 weighted (CISS/SPACE); T2 cor (optional); T1 FS cor post gad (optional). Sella: T1FS sag pre/post gad; T2 sag; T1 cor pre/post gad; T2 cor; dynamic (microadenomas).
  5. Arachnoid cyst – Lack of fenestration of Liliequist membrane; may occur secondary to adhesions; asymptomatic/hydrocephalus/hypopituitarism/seizures; smooth cyst, no enhancement.
  6. Tuber cinereum hamartoma – Slow growing heterotopias; precocious puberty/gelastic seizures; nonenhancing, non-calcified, isointense to grey matter, bright on T2; sessile/pedunculated.
  7. Pituitary hypoplasia – Absent/thread-like stalk; small adenohypophysis; ectopic posterior pituitary bright spot.
  8. Persistent craniopharyngeal canal – Congenital skull base defect; Sellar floor to nasopharynx; Associations: hamartomas, duplication of pituitary gland/stalk, callosal dysgenesis, facial dysmorphisms.
  9. Tolosa Hunt syndrome – Idiopathic steroid responsive inflammation; painful ophthalmoplegia; enhancing soft tissue at orbital apex, may extend along tentorium.

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