Parasellar T2 Dark Sign on MR Imaging in Patients with Lymphocytic Hypophysitis

Y. Nakata; N. Sato; T. Masumoto; H. Mori; H. Akai; H. Nobusawa; Y. Adachi; H. Oba; K. Ohtomo

doi:10.3174/ajnr.A2201

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Fig 1.
MR images of LYH (case 1) in a 38-year-old woman with partial hypopituitarism and diabetes insipidus. This patient had an 11-month history of headache, vomiting, polyuria, and polydipsia; transsphenoidal biopsy was performed and LYH proved histologically. A, Coronal T2-weighted image (TR/TE/NEX = 3500/120 ms/3) shows a large pituitary mass compressing the optic chiasm. A dark-signal-intensity area is seen in the cavernous sinus and sellar floor (arrow). B, Coronal contrast-enhanced T1-weighted image (TR/TE/NEX = 650/16 ms/3) shows a large pituitary mass with homogeneous enhancement. Bilateral cavernous sinuses are swollen, with poor enhancement. The left ICA in the left cavernous sinus is narrowed (arrow).
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Fig 2.
MR images of LYH (case 3) in a 70-year-old man with panhypopituitarism without diabetes insipidus. His chief complaint was general fatigue, and he was followed up for >5 years. Replacement therapy (glucocorticoid, levothyroxine) was performed. A, Coronal T2-weighted image (TR/TE/NEX = 2260/100 ms/3) shows the relatively large pituitary gland. A dark-signal-intensity area is seen around the pituitary gland. The inner portions of the bilateral cavernous sinuses show low signal intensity. B, Coronal T1-weighted image (TR/TE/NEX = 660/11.2 ms/3) shows the relatively large pituitary gland and stalk. A low-signal-intensity area is seen around the pituitary gland. The stalk shows high signal intensity, suggesting that it is storing antidiuretic hormone (arrow). C, Coronal contrast-enhanced T1-weighted image (TR/TE/NEX = 600/9.9 ms/3) shows homogeneous enhancement in the pituitary gland and the stalk. The area around the pituitary gland and bilateral cavernous sinuses shows poor enhancement.
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Fig 3.
Serial MR images of LYH (case 4) in a 36-year-old man. Partial diabetes insipidus was observed in the early stage, and partial hypopituitarism was revealed later during the follow-up and treated by replacement therapy. A, The first coronal T2-weighted image (TR/TE/NEX = 3500/120 ms/3) shows the pituitary gland. Very thin dark-signal intensity areas on the upper edge of the pituitary gland (arrows) are seen. B, The first coronal contrast-enhanced T1-weighted image (TR/TE/NEX = 650/16 ms/3) shows a large pituitary gland with homogeneous enhancement. This section is slightly behind A. The large stalk with homogeneous enhancement slightly compresses the optic chiasm. C, The second coronal T2-weighted image (TR/TE/NEX = 3500/120 ms/3) 2 months after the first study shows a large pituitary gland and stalk. The previously noted thin dark-signal-intensity areas on the upper edge of the pituitary gland (arrows) were thicker than those in the first study. D, The third coronal T2-weighted image (TR/TE/NEX = 3500/120 ms/3) 8 months after the first study shows a large pituitary gland. The stalk is decreased in size. Dark-signal-intensity areas on the upper edge of the pituitary gland have thickened. The dark-signal-intensity area is enlarged and involves the right cavernous sinus; the right ICA in the cavernous sinus is narrower (arrow) than that in the previous study.
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Fig 4.
MR images of pituitary adenoma (case 5) in a 54-year-old woman. Acromegaly and partial hyperpituitarism were observed. She was treated with transsphenoidal resection, and the proved pathologic diagnosis was GH-secreting pituitary adenoma. A and B, Coronal T2-weighted images (TR/TE/NEX = 3500/120 ms/3) show a large pituitary mass destroying the sellar floor and extending in the sphenoid sinus. The upper portion of the mass is mixed low intensity, and the lower portion shows mixed high signals. Large arrows indicate small dark-signal-intensity areas in the pituitary mass. A low-signal-intensity margin is seen in the medial aspect of the upper pituitary mass (small arrow). C and D, Coronal contrast-enhanced T1-weighted images (TR/TE/NEX = 600/9.9 ms/3) show heterogeneous enhancement in the pituitary mass. Arrows indicate enhanced focal areas in the pituitary mass, which correspond to the dark-signal-intensities on the T2-weighted images in A and B.