Non-Contrast Pituitary MRI for Pediatric Pathologies has Same Diagnostic Yield as Contrast-Enhanced Protocol

A Scientific Electronic Exhibit presented at the ARRS 2021 Virtual Annual Meeting found non-contrast pituitary MRI for central precocious puberty (CPP), growth hormone deficiency (GHD), and short stature (SS) has similar diagnostic yield compared to the standard contrast-enhanced protocol.

“Microadenomas, a common justification for contrast administration, may not influence management in this patient population,” wrote first author Jennifer Huang, MD, of Vanderbilt University in Nashville, TN, adding “minimal inconvenience would be added for the few patients who would need to return for contrast-enhanced MRI for definitive diagnosis.”

Huang and colleagues performed a retrospective review of pediatric pituitary MRI studies from 2010–2019 for CPP, GHD, or SS, then a blinded review of non-contrast images was performed by two subspecialty-trained pediatric neuroradiologists.

Analyzing data from the 448 MRIs obtained for CPP (35%), GHD (49%), or SS (16%), the mean age was 8.2 years (range, 9 months to 17 years). All 448 (100%) scans were performed with gadolinium contrast, while 226 (50%) required sedation. Of the 136 (30%) abnormal studies, there was 71% concordance (n = 97) with the original reports on the blinded review of non-contrast images. Of the 39 discrepancies, 79% (n = 31) were of no clinical significance (e.g., pars intermedia cyst), and 1 was of uncertain significance. The remaining 7 (18%) discrepancies were visible on non-contrast images but required contrast for definitive characterization. Ultimately, 5 were extrasellar masses, and 2 were pituitary stalk abnormalities.

“In a large majority of patients, the shorter non-contrast examination would provide savings in time, anesthesia, gadolinium, and associated costs,” the authors of this Magna Cum Laude ARRS Annual Meeting Scientific Electronic Exhibit concluded.