Imaging

Prolactinoma

Preliminary Diagnosis: Prolactinoma

I. What imaging technique is first-line for this diagnosis?

MRI imaging with contrast

II. Describe the advantages and disadvantages of this technique for diagnosing prolactinoma.

Advantages

  • IV contrast and dynamic phase imaging is diagnostic and can accurately localize the area of abnormality.

  • Can assess for secondary complications, such as mass effect on optic chiasm.

  • Has superior anatomic resolution and does not expose the patient to ionizing radiation.

Disadvantages

  • Prolactinoma is a clinical diagnosis. MRI can only diagnose a pituitary micro- or macro- adenoma.

  • Expensive.

  • Time consuming.

  • Requires significant patient cooperation to minimize motion artifact.

  • Contrast cannot be used in patients with kidney insufficiency (i.e., GFR < 30).

III. What are the contraindications for the first-line imaging technique?

  • Patients with non-MR compatible hardware or foreign bodies.

  • Gadolinium contrast is contraindicated in patients with a GFR ≤30.

IV. What alternative imaging techniques are available?

CT with IV contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing prolactinoma.

Advantages

  • Less expensive and a quicker imaging modality than MR.

  • Can be used on sicker patients.

  • Less prone to motion artifact.

Disadvantages

  • Exposes the patient to ionizing radiation.

  • Less sensitivity and specificity in detecting prolactinomas, as compared to MRI.

  • Microadenomas may not be detected on CT.

VI. What are the contraindications for the alternative imaging techniques?

  • Contraindicated in patients who are pregnant, especially during the first two trimesters.

  • Relative contraindication to use of contrast in patients with renal failure.

  • Relative contraindication to use of contrast in patients with contrast allergies.

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