Kunal S Patel1, Sanjay Dhawan2, Renzhi Wang3, Bob S Carter4, James Y Chen5,6, Clark C Chen7. 1. Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA. 2. Department of Neurosurgery, University of Minnesota, D429 Mayo Memorial Building, 420 Delaware St. S. E., MMC96, Minneapolis, MN, 55455, USA. 3. Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China. 4. Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 5. Department of Radiology, UC San Diego Health System, University of California, San Diego, La Jolla, CA, USA. 6. Department of Radiology, San Diego Veterans Administration Health System, San Diego, CA, USA. 7. Department of Neurosurgery, University of Minnesota, D429 Mayo Memorial Building, 420 Delaware St. S. E., MMC96, Minneapolis, MN, 55455, USA. ccchen@umn.edu.
Abstract
BACKGROUND: Non-functioning pituitary adenomas (NFAs) are the most common pituitary tumors. There is significant variability in clinical practice in terms of post-operative imaging evaluation. The objective of this manuscript is to provide an exhaustive review of published articles pertaining to the post-operative imaging evaluation of NFAs. METHODS: The MEDLINE database was queried for studies investigating imaging for the post-operative evaluation of pituitary adenomas. From an initial search of 5589 articles, 37 articles were evaluated in detail and included in this review. RESULTS: Magnetic resonance imaging (MRI) is the gold standard for post-operative monitoring of NFAs, although functional imaging modalities may improve identification of residual tumor in conjunction with MRI. The residual tumor can be distinguished from post-operative changes by experienced practitioners using high-resolution MRI in the immediate post-operative setting (within 1 week of surgery). However, continued imaging evolution in the appearance of residual tumor or resection cavity is expected up to 3 months post-operatively. CONCLUSIONS: Post-operative imaging appearance of the pituitary gland, optic apparatus, and pneumocephalus patterns, correlated with the clinical outcomes. Long-term, lifetime follow-up is warranted for NFA patients who underwent surgical resection.
BACKGROUND: Non-functioning pituitary adenomas (NFAs) are the most common pituitary tumors. There is significant variability in clinical practice in terms of post-operative imaging evaluation. The objective of this manuscript is to provide an exhaustive review of published articles pertaining to the post-operative imaging evaluation of NFAs. METHODS: The MEDLINE database was queried for studies investigating imaging for the post-operative evaluation of pituitary adenomas. From an initial search of 5589 articles, 37 articles were evaluated in detail and included in this review. RESULTS: Magnetic resonance imaging (MRI) is the gold standard for post-operative monitoring of NFAs, although functional imaging modalities may improve identification of residual tumor in conjunction with MRI. The residual tumor can be distinguished from post-operative changes by experienced practitioners using high-resolution MRI in the immediate post-operative setting (within 1 week of surgery). However, continued imaging evolution in the appearance of residual tumor or resection cavity is expected up to 3 months post-operatively. CONCLUSIONS: Post-operative imaging appearance of the pituitary gland, optic apparatus, and pneumocephalus patterns, correlated with the clinical outcomes. Long-term, lifetime follow-up is warranted for NFA patients who underwent surgical resection.
Entities:
Keywords:
Computed tomography; Magnetic resonance imaging; Non-functioning pituitary adenomas; Post-operative