Brain Tumor Res Treat.  2024 Jan;12(1):40-49. 10.14791/btrt.2023.0046.

Suggestion of Follow-Up Period in Nonfunctioning Pituitary Incidentaloma Based on MRI Characteristics

• Jung H
• Yang SY
• Cho KT

• KMID: 2552337
• DOI: http://doi.org/10.14791/btrt.2023.0046

Abstract

Background
For patients diagnosed with asymptomatic, non-functional pituitary incidentaloma (PI), periodic follow-up is generally proposed. However, the recommended follow-up period differs among existing guidelines and consensus is lacking. Thus, this study aimed to suggest follow-up periods for PI based on MRI characteristics.
Methods
Between 2007 and 2023, 245 patients who were diagnosed with PI were retrospec- tively assessed. Their mean clinical and neuroradiological follow-up periods were 74.2 and 27.3 months, respectively. Their baseline clinical and neuroradiological characteristics were analyzed. These 245 patients were divided into two groups: those with PI size progression and those without PI size progression. Additionally, neuroradiological features of each group were analyzed according to presumptive diagnoses of PI.
Results
PI size increased in 33 of 245 patients. For the remaining 212 patients, PI size de- creased or stayed unchanged. Of the 33 patients with PI size progression, ten underwent surgery. Stalk deviation (p<0.001) and lesion enhancement (p=0.001) were significantly more observed in those with PI size progression than in those without PI size progression. MRI morphological factors were not related to changes in PI size in the presumptive Rathke’s cleft cyst group. In the presumptive pituitary adenoma group, absence of tumor enhancement (p<0.001) and stalk deviation (p<0.001) were significantly associated with tumor reduction and progression, respectively.
Conclusion
Our findings support an additional guideline for patients with asymptomatic non-func- tional PI without stalk deviation and enhancement. For these patients, the clinical and neuroradiological follow-up periods could be reduced.

Keyword

Pituitary diseases; Pituitary neoplasms; Central nervous system cyst; Magnetic resonance imaging; Follow-up studies

Figure

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  Fig. 1 Participant flow diagram. PI, pituitary incidentaloma.

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  Fig. 2 A pituitary incidentaloma (PI) in a 44-year-old male patient undergoing investigations for dizziness. The PI increased over 43 months. The initial size of the PI was 10 mm (A) and 18 mm at 43 months (B). The initial image of coronal T1-weighted with enhancement showed stalk deviation to the left.

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  Fig. 3 A pituitary incidentaloma (PI) in a 60-year-old female patient undergoing vision testing. The size of the PI decreased over 42 months. The initial PI size was 11 mm. At 42 months, the lesion remarkably regressed. The sagittal T1-weighted section showed hyperintense signal (A) and the sagittal T2-weighted section showed hypointense signal (B). T1-weighted with enhancement showed thin rim enhancement (C).

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