Diagnostik des hypophysären Mikroadenoms

Zusammenfassung

Die Diagnostik des hypophysären Mikroadenoms ist eine besondere Herausforderung für den Radiologen: Ein kleinvolumiges Organ, das in anatomisch und teilweise auch funktionell sehr enger Nachbarschaft zu einer Vielzahl von Nachbarstrukturen liegt, muss mit hoher Orts- und Kontrastauflösung abgebildet werden, um die oft nur wenige Millimeter großen Adenome zu erfassen.

Radiologische Methode der Wahl ist eindeutig die MRT. Spezielle Techniken wie die dynamische MRT oder die seitengetrennte venöse Blutentnahme aus dem Sinus petrosus inferior nach Hormonstimulation (Stufenkatheteruntersuchung) sind zusätzliche Hilfen bei der Suche nach einem Mikroadenom. Anatomische Varianten ohne Krankheitswert können dabei die Differenzialdiagnose erschweren.

Abstract

Radiologic diagnosis of microadenomas of the pituitary gland is challenging since the pituitary gland is a very small-volume organ in close neighborhood to many eloquent structures. Furthermore imaging necessitates high contrast and topographic resolution not to miss the often very subtle microadenomas.

Magnetic resonance imaging is the modality of choice providing multiplanar high contrast images of the pituitary gland and its adjacent structures. Special techniques like dynamic contrast enhanced imaging of the pituitary gland and bilateral inferior petrous sinus sampling are additional techniques to localize microadenomas. Additionally, anatomic variations can aggravate differential diagnosis.

Key words

pituitary gland - microadenoma - inferior petrous sinus sampling - MRI

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