Does an MRI of the brain to check the pituitary gland for hyperprolactinemia require contrast (Magnetic Resonance Imaging)?

From the Guidelines

Yes, an MRI of the brain to check the pituitary gland for hyperprolactinemia typically requires contrast. The standard protocol involves both non-contrast and contrast-enhanced images using gadolinium-based contrast agents, as recommended by the most recent guidelines 1. Contrast is particularly important for evaluating pituitary adenomas (which often cause hyperprolactinemia) because these small tumors enhance differently than normal pituitary tissue, making them more visible. Without contrast, small microadenomas (less than 10mm) may be missed as they can appear similar to normal pituitary tissue on non-contrast images.

The use of contrast agents in MRI for pituitary gland evaluation is supported by several studies, including those published in the Journal of the American College of Radiology 1. These studies emphasize the importance of contrast-enhanced MRI in detecting and characterizing pituitary adenomas, especially in cases of suspected hyperfunctioning pituitary adenoma.

Key points to consider when using contrast in MRI for pituitary gland evaluation include:

• The use of gadolinium-based contrast agents to enhance the visibility of pituitary adenomas
• The importance of informing patients about potential kidney problems or previous allergic reactions to contrast materials
• The role of neuroradiologists in interpreting MRI results
• The consideration of alternative imaging modalities in patients with severe kidney dysfunction

Overall, the use of contrast in MRI for pituitary gland evaluation is a crucial component of diagnosing and managing hyperprolactinemia, and should be guided by the most recent and highest-quality evidence available 1.

From the FDA Drug Label

Gadoteridol was evaluated in two multicenter trials of 310 evaluable patients suspected of having neurological pathology. After the administration of gadoteridol 0.1 mmol/kg IV, the results were similar to those described below [see Clinical Studies ( 14. 2)] . In comparison to non-contrast MRI, the number of lesions after 0.1 mmol/kg increased in 34% of patients.

The use of contrast (gadoteridol) in MRI of the brain to check the pituitary gland for hyperprolactinemia may be beneficial as it can improve visualization and provide additional diagnostic information in some cases 2. However, the FDA drug label does not directly address whether contrast is required for this specific purpose.

From the Research

MRI Brain Scan for Pituitary Gland

To check the pituitary gland for hyperprolactinemia using an MRI brain scan, the use of contrast is a significant consideration.

• The study 3 from 1987 compared Gadolinium-DTPA MR imaging, unenhanced MR imaging, and contrast-enhanced CT in patients with pituitary adenomas. It found that Gadolinium-DTPA MR imaging was promising for imaging adenomas but required modifications for the best detection of focal lesions.
• A later study 4 from 1993 investigated the use of MRI with Gadolinium injection (MRI G+) and CT scans in detecting microadenomas in hyperprolactinemic women. It concluded that MRI G+ was more efficient than CT scans but suggested using CT scans as the primary means due to cost and accessibility considerations.
• The study 5 from 2001 evaluated the usefulness of sequential sagittal and coronal plane images in dynamic gadolinium-enhanced MR imaging for pituitary adenomas. It found that combining sagittal and coronal dynamic enhanced MR imaging improved the detection of microadenomas.
• Another study 6 from 1996 used MRI to investigate pituitary microadenomas in patients with hyperprolactinaemia. It suggested using MRI in patients with prolactin levels more than 100 ng/ml and considered the presence of an adenoma in planning further therapy.
• More recently, the study 7 from 2015 tested the use of dynamic contrast-enhanced multisection CT for detecting MR imaging-occult functional pituitary microadenoma. It found that this method had better diagnostic performance than conventional pituitary-targeted MR imaging, especially for adrenocorticotropic hormone-secreting microadenomas.

Use of Contrast in MRI for Pituitary Gland

Based on these studies, the use of contrast in MRI for checking the pituitary gland for hyperprolactinemia appears to be beneficial for:

• Improving the detection of microadenomas 4, 5
• Enhancing the visualization of adenomas 3, 7
• Planning further therapy, especially in patients with high prolactin levels 6

However, the decision to use contrast should be made on a case-by-case basis, considering factors such as cost, accessibility, and the specific characteristics of the patient's condition.