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MRI Results of Pituitary Tumor- What exactly is it saying?
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MRI Results of Pituitary Tumor- What exactly is it saying?

Due to high Prolactin levels I was sent for an MRI. I got a copy of the report and the scan on a disc today from the imaging office. My OB/GYN got the report back but would not tell me anything...only referred me to a neurosurgeon. Anyone able to understand this? I do understand the 5mm microadenoma but not the 7.5 one or any of the enhanced, stuff. Any information would be greatly appreciated cause it's been 2 weeks and will be another 2 weeks before I see the Neurosurgeon.

EXAM: MRI Brain scan with attention to the pituitary without and with contrast

HISTORY: The patient presents with diagnosis of elevated prolactin levels and examination is requested to rule out pituitary tumor. patient also complains of sinus pressure behind nasal area.

TECHNIQUE: Multiplanar and multiecho images were obtained including postcontrast T1 images following intravenous injections of 20 mL of Magnevist. Thin-section views were obtained through the sella pre and post contrast.

FINDINGS: Precontrast sigittal and axial T1 images reveal normal-appearing ventricles with no mass effect. There is a prominent bright signal area in the posterior aspect of the pituitary gland to the left of the midline. This apparently represents a prominent pars nervosa. On the thin-section sagittal and coronal views through the sella there is again noted the oval bright signal area in the pituitary gland to the left of the midline measuring about 7.5 mm in maximum diameter. There also appears to be a slight bulge of the right side of the gland with area of hypo intensity on the right side measuring about 5 mm.

Axial and coronal views through the brain reveal no abnormal signal focus. The gray-white matter junction appears normal. Axial T2 images with FLAIR technique again reveal no abnormal signal focus. On the T2 images the area of bright signal on T1 is low in the signal on the at T2 images and FLAIR sequence and the area in the right side of the gland is bright in signal.

Axial diffusion-weighted images reveal no areas of restricted diffusion.

Postcontrast views through the brain reveal enhancements of normal vascular structures with no enhancing lesions. Thin-section Postcontrast views through the sella reveal enhancements of the pituitary stalk which is midline. The lesion in the right side of the pituitary gland is enhanced and the bright signal area in the posterior gland on the left is obscured by the enhancing pituitary parenchyma.

IMPRESSION:
1. Oval bright signal area in the posterior aspect of the gland asymmetric to the left apparently representing prominent asymmetric pars nervosa.
2. Small hypointense 5mm lesion in the right side of the gland which enhances to the postcontrast views. This could represent microadenoma. Microadenomas are usually hypoenhancing. The enhancement could be due to the large relative dose of contrast and/or could be related to the timing of the imaging postcontrast. Recommend followup study in six months.


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Impression:

1. The left side of your posterior lobe is enlarged: 7.5mm

2. A 5mm lesion on the right side of the posterior lobe: may be a microadenoma - small tumour

Enhancement means the contrast material that was injected has passed through the blood-brain barrier.  An intact blood-brain barrier will prevent leakage of contrast material. When you see an area that in enhanced, this could be due to any number of causes such as active inflammation, new blood vessels, lesions, tumours, or pressure overload.

A prolactin level of over 150 - 200 ng/ml is almost always due to a prolactinoma (prolactin secreting pituitary tumour). 80 to 90% of prolactinoma patients can be treated successfully with a dopamine agonist drugs.
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Thank you... That's kinda what I understood. I figured it was a prolactinoma cause I have had some 'female' issues and thats when she found the high prolactin. The only thing that worries me is my levels were all normal about 6 months ago as I had my little girl exactly a year ago. So everything checked out fine after that and I have never had any issues. I hope this doesn't mean that I have only had it about 6 months...if so that seems like it would be growing awfully quick.

I am a little confused on the enhancements on the left lobe. Could this mean part of the same tumor that could possibly be 12.5 making it still a simple but large prolactinoma or is this for sure two seperate things?

Also, if they are separate, what would be things to cause the active inflammation, new blood vessels, lesions, tumours, or pressure overload. I have had issues lately with my words not coming out right and just being 'scatter brained'. I am a 911 dispatcher and have noticed that when talking on the radio I have been having frequent problems getting things to come out right and went so far as to be joking around with my supervisor the other day...went to call her a 'crazy lady' and called her a RED LIGHT! No joking...so stupid that it was actually funny. Could any of this be related or pretty much just coincidence?

Sorry to ask so many questions but a little worried...
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UPDATE:
Went to the doctor today for my 'sinus' problems in the back of my nasal area. He didn't find anything and ordered a CT scan. He doesn't think it has anything to do with the tumors though.....we will see Tuesday when I go to the neurosurgeon!
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UPDATE:
Went to the doctor today for my 'sinus' problems in the back of my nasal area. He didn't find anything and ordered a CT scan. He doesn't think it has anything to do with the tumors though.....we will see Tuesday when I go to the neurosurgeon!
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