Non-Contrast MRI Diagnostically Similar to Standard Protocol for Pediatric Pituitary Pathologies

Non-contrast pituitary MRI provides an equivalent diagnosis to standard contrast-enhanced imaging protocols for central precocious puberty (CPP), growth hormone deficiency (GHD), and short stature (SS).

In an award-winning poster presented at the ARRS 2021 Virtual Annual Meeting, Jennifer Huang, MD, a sophomore physician at Vanderbilt University, showed that using a non-contrast protocol can have implications for patient care.

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“Microadenomas, a common justification for contrast agent administration, may not affect the treatment of this patient population,” she said. “Minimal discomfort would be added for the few patients who would have to return for contrast enhanced MRI for a definitive diagnosis.”

For this study, Huang’s team conducted a retrospective review of 448 pediatric pituitary MRI studies – of patients with a mean age of 8.2 years – recorded for CPP, GHD and SS between 2010 and 2019. Two subspecialty trained pediatric neuroradiologists performed a blinded assessment of the non-contrasting images.

Of the MRIs, 35 percent were for CPP, 49 percent for GHD, and 16 percent for SS. Gadolinium contrast was used in all 448 MRI scans and 226 (50 percent) required sedation. Based on the team’s analysis, 136 scans (30 percent) were abnormal – of which 71 percent (97 scans) agreed with original reports of blinded assessment of non-contrasting images. And 79 percent of the 39 scans that showed a discrepancy had no clinical significance.

When the discrepancies were further explored, one was of uncertain significance and seven (five extraellar masses and two pituitary stem abnormalities) were visible on non-contrasting images, but required contrast to achieve definitive characterization.

Overall, said Huang, these results showed that the choice of non-contrast imaging can be of benefit to patients.

“In a large majority of patients, the shorter non-contrast study would save time, anesthesia, gadolinium and associated costs,” said the team.

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