MRI of the sella turcica in Moscow: diagnosis of pituitary tumors
The sella turcica is a depression in the body of the sphenoid bone of the skull that houses the pituitary gland, the pea-sized central gland of the endocrine system. Despite its small size, the pituitary gland controls the thyroid gland, adrenal glands, and sex glands, regulates growth, and controls water-salt metabolism.
Pathological changes in the sella turcica—primarily pituitary tumors (adenomas)—impair hormone production and can compress the optic chiasm, causing visual impairment.
MRI of the sella turcica is the most informative imaging method for the pituitary gland and parasellar structures. CT is inferior to MRI in soft tissue resolution, although it is superior in assessing bone changes.
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Pituitary adenoma classification
| Adenoma type | What it secretes | Clinical manifestation |
|---|---|---|
| Prolactinoma | Prolactin | Menstrual disturbances, galactorrhea, infertility, decreased libido in men |
| Somatotropinoma | STH (growth hormone) | Acromegaly in adults, gigantism in children |
| Corticotropinoma | ACTH | Cushing's disease: obesity, striae, hypertension |
| Thyrotropinoma | TSH | Thyrotoxicosis with normal TSH |
| Gonadotropinoma | LH/FSH | Often asymptomatic; Discovered by chance |
| Nonfunctioning adenoma | Appears only during growth (chiasmal compression, hypopituitarism) |
Microadenoma — less than 10 mm; macroadenoma — 10 mm or more.
How is an MRI of the sella turcica performed?
The examination protocol includes thin slices (1–2 mm) in the sagittal and coronal planes, which allows for the detection of microadenomas as small as 2–3 mm.
MRI with contrast (gadolinium):
Contrast is administered intravenously. Adenomas accumulate contrast more slowly than normal pituitary tissue, making them easier to detect. It is used in most cases to detect microadenomas and assess vascularity.
Duration: 20–30 minutes.
Sensation: painless. A brief sensation of warmth may occur during contrast administration.
General information
Preparation for an MRI of the sella turcica
Standard MRI (without contrast):
- No special preparation required
- Remove metal objects (jewelry, hairpins, glasses, hearing aids, watches)
- Inform the patient about the presence of metal implants, a pacemaker
MRI with contrast (gadolinium):
- It is advisable to refrain from eating for 2 hours before the examination
- Inform the patient about an allergy to gadolinium (rare)
- In case of impaired renal function (CKD) - consultation before contrast; With an SCF <30 ml/min, there is a risk of nephrogenic systemic fibrosis (a rare complication).
- During pregnancy, only under strict indications, without contrast.
If an MRI is performed for a prolactinoma: it is optimal to have a blood test for prolactin on the same day (or the day before) to compare the hormonal and imaging results.
FAQ
Are sella turcica MRI and brain MRI the same thing?
My prolactin levels are elevated—do I need an MRI?
How often should an MRI be performed if a microadenoma has been diagnosed?
Is an MRI with gadolinium dangerous?
What does "empty sella turcica" mean?
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Indications for MRI of the sella turcica
Endocrinological:
Neurological and ophthalmological:
Surgical and oncological: