Pituitary macroadenoma, with invasion of the left cavernous sinus

Pituitary-macroadenoma-Jan-2013.jpg

Image 1

Clinical History: 
A 58 year old woman presenting with a visual field defect (bitemporal hemianopsia)

Diagnosis:
Pituitary macroadenoma, with invasion of the left cavernous sinus

MR Technique: 
2D 2 mm coronal sections are presented through the pituitary, FSE T2-weighted and GRE (FLASH) T1-weighted in type, with TR/TE = 4000/84 and 250/2.6. Acquisition times were 3:20 and 4:48. The scans were acquired at 3 T using a Siemens Tim Trio MR system.

Imaging Findings:
An enhancing soft tissue mass fills and expands the sella, extending suprasellar to splay and compress the optic chiasm. The mass is somewhat dumbbell in shape, being constricted slightly at the level of the diaphragm sella. Abnormal soft tissue extends into the left cavernous sinus and encases the cavernous carotid on the left. There are multiple enhancing linear structures within the lesion, suggestive of a highly vascular tumor. The mass also splays and is immediately adjacent to the carotid termini bilaterally.