View Full Version : Pituitary MRI
Thought people may be interested to see my pituitary MRI.
No report from the radiologist yet, but it's interesting to watch. To me it would appear that my scoliosis and hunchback has effected the contents of my skull, things don't appear symmetrical :ack2:
http://www.youtube.com/watch?v=rvvTooiVP1Q
I'll post my Adrenal MRI tomorrow :cool:
n00bs
03-15-2010, 11:29 AM
Interesting 2 months and i get to enjoy one of these.. how was the tunnel thing? Suffering panic disorder i dont like to be closed in. How did you find it?
If you have any kind of panic, definately seek sedation.
I don't have problems with small spaces, but even for me today's scan was pushing the limits.
It didn't seem so bad on Friday with the Adrenal scan though. I think that it was the whole helmet thing around your face that does it.
pmgamer18
03-15-2010, 12:56 PM
Yes do take some Xanax I had too.
Dadnatron
03-15-2010, 02:26 PM
The assymetry you have is congenital. It is called Plagiocephaly, and if you see, on your Axial images, you have a very slight (within normal limits) flattening of the back right (which is bottom left of the picture as you look at it) of your skull. Otherwise your images look essentially normal.
You had a 'dynamic' contrast pituitary scan in which they gave you the injection and took several of the same small set of pictures through the pituitary. We do this in order to evaluate for areas which enhance (show contrast lightening) at different stages. The normal pituitary will enhance homogeneously and pituitary adenomas will typically enhance at a slower rate. Therefore, if you have one, you will see a spot in the pituitary which is 'darker' than the rest.
If you look at the coronal images, (the ones which look like you were cutting from ear to ear in a head to toe way) you will see that in the very center, above the big black hole (which is the sphenoid aircells) there is an area, which on the repeating images, gets 'whiter and whiter'. This is the pituitary gland with the little white thing angling up to the brain which is the pituitary stalk or Infundibulum. You can see that the entire gland enhances homogeneously, and although there is a little assymetry, this is simply associated with how you are built and NOT an issue with function or tumor.
This post is NOT for diagnosis.
pmgamer18
03-15-2010, 02:34 PM
A lot of people like myself have a pituitary problem that does not show up on the MRI with or without contrast.
Dadnatron
03-15-2010, 02:38 PM
A lot of people like myself have a pituitary problem that does not show up on the MRI with or without contrast.
Absolutely true. All the MR does is discern common causes of PHYSICAL problem. ie, masses in the pituitary often explain hormonal imbalance. However, lack of mass does not rule them out.
MR doesn't look at FUNCTION well. NOT AT ALL with pituitary and only in the infant stages of motor control. Perhaps in 50 years, we will have enough understanding and good enough equipment, that we will be able to tag 'chemicals' and watch as they 'do their thing' in the body.
pmgamer18
03-15-2010, 02:46 PM
I tell men that have good level of E2 with low T and low LH and FSH to get an MRI to rule out a tumor and you would not believe how many of them have tumors.
Yet some Dr.'s will tell them no them labs don't warrant an MRI.
Absolutely true. All the MR does is discern common causes of PHYSICAL problem. ie, masses in the pituitary often explain hormonal imbalance. However, lack of mass does not rule them out.
MR doesn't look at FUNCTION well. NOT AT ALL with pituitary and only in the infant stages of motor control. Perhaps in 50 years, we will have enough understanding and good enough equipment, that we will be able to tag 'chemicals' and watch as they 'do their thing' in the body.
Dadnatron
03-15-2010, 02:52 PM
I tell men that have good level of E2 with low T and low LH and FSH to get an MRI to rule out a tumor and you would not believe how many of them have tumors.
Yet some Dr.'s will tell them no them labs don't warrant an MRI.
Yes... but a non-functioning adenoma is essentially meaningless. Therefore, just as NOT seeing a mass doesn't mean something ISN'T wrong... SEEING an adenoma doesn't mean something is wrong as well.
The MR is used to help with verification and treatment planning. As in Prolactinomas treated with Bromocriptine, you can actually see the efficacy of the treatment both in labs, symptoms, AND MR imaging. However, the least of these is MR.
As I tell my patients... "I treat Patients... Not pictures."
If the person has no labs which are problematic, then 'knowing' he has or does NOT have an adenoma is not useful information. And truthfully, can be damaging, because people tend to exibit their findings. ie, people with tumors, be they benign or malignant tend to have MORE PROBLEMS after they have been told they have the tumor than before. Especially with pituitary adenomas... you aren't going to treat it unless it is giving you problems. If you don't have hormonal imbalance and it isn't pushing on your optic chiasm... then knowing you have it only serves to cause stress in most people. If you are having true symptoms... then that is a whole different ball of wax.
pmgamer18
03-15-2010, 05:45 PM
Yes this is what I am taking about men with low T good E2 and low LH and FSH need to know. I did not know I was Hypopituitary for the first 23 yrs I was on TRT and I never felt good on it. It was when Dr. John helped me in a post to get my Dr. to let me try HCG it's a long story but when I tried it my TT levels doubled so I was not Primary after this they went over my old labs and found they were screaming this pituitary problem I got sick after an auto accident. When I hit my head into the roof of the car.
It was after this I started to get sick and when my Dr. sent my labs to a Dr. he knows that is up on Pituitary Problems he got back to us telling us my labs were screaming a pituitary problem.
Then they started to treat my Thyroid, Adrenals, low Aldosterone, Ferritin and Iron levels now I just started on Growth Hormone last Dec. I had to have heart bypass sugary about 16 months ago Dr.'s feel low Growth Hormone levels did not help my heart.
So if the Dr.'s don't know you have a pituitary problem things get over looked like they did with me. I seen many Dr.'s Endo's you name them they all missed this. It's been 28 yrs now long hard yrs.
Yes... but a non-functioning adenoma is essentially meaningless. Therefore, just as NOT seeing a mass doesn't mean something ISN'T wrong... SEEING an adenoma doesn't mean something is wrong as well.
The MR is used to help with verification and treatment planning. As in Prolactinomas treated with Bromocriptine, you can actually see the efficacy of the treatment both in labs, symptoms, AND MR imaging. However, the least of these is MR.
As I tell my patients... "I treat Patients... Not pictures."
If the person has no labs which are problematic, then 'knowing' he has or does NOT have an adenoma is not useful information. And truthfully, can be damaging, because people tend to exibit their findings. ie, people with tumors, be they benign or malignant tend to have MORE PROBLEMS after they have been told they have the tumor than before. Especially with pituitary adenomas... you aren't going to treat it unless it is giving you problems. If you don't have hormonal imbalance and it isn't pushing on your optic chiasm... then knowing you have it only serves to cause stress in most people. If you are having true symptoms... then that is a whole different ball of wax.
lazydrake
03-15-2010, 06:14 PM
I am scheduled for the pituitary mri on Wednesday morning. I am not looking forward to getting in that tunnel. Tight places doesn't bother me but putting that metal helmet thing over my head kind of freaks me out. Looks like something out of a horror movie.
How long does it last?
How loud is it in the tunnel? Do they give you ear protection?
I have worked myself up over it, might have to take something before I go.
n00bs
03-15-2010, 08:01 PM
I tell men that have good level of E2 with low T and low LH and FSH to get an MRI to rule out a tumor and you would not believe how many of them have tumors.
Yet some Dr.'s will tell them no them labs don't warrant an MRI.
Dont say that!! thats what i have :(
Thanks for the report dadnatron, good to see you're up to scractch on your radiology interpretation :thumbup1:
We'll see what the radiographers report comes back with.
I'll post my adrenal mri later today.
I am not looking forward to getting in that tunnel. Tight places doesn't bother me but putting that metal helmet thing over my head kind of freaks me out. Looks like something out of a horror movie.
How long does it last?
How loud is it in the tunnel? Do they give you ear protection?
I have worked myself up over it, might have to take something before I go.
Ask your doctor for some sedation. With that you should be fine. During the pituitary mri you don't have to do anything except stay still. With the adrenal MRI you have to control your breathing when they tell you to. You can fall asleep for the pit mri if you want!
It lasted 40-45 minutes for me. It is very loud, but you wear earplugs.
Actually, the noises because soothing after a while, lol.
medgerton
03-15-2010, 10:58 PM
I am scheduled for the pituitary mri on Wednesday morning. I am not looking forward to getting in that tunnel. Tight places doesn't bother me but putting that metal helmet thing over my head kind of freaks me out. Looks like something out of a horror movie.
How long does it last?
How loud is it in the tunnel? Do they give you ear protection?
I have worked myself up over it, might have to take something before I go.
You don't have to wear a helmet. At least I didn't. There was a plastic jig right over my eyes. I don't remember how big it was but it was not a helmet. Also, I wore earphones and got to select the station to listen. I just didn't open my eyes the whole time and it was OK.
You don't have to wear a helmet. At least I didn't. There was a plastic jig right over my eyes.
Certainly feels like a helmet though!
n00bs
03-16-2010, 12:35 AM
10mg valium here we come! :thumbup:
SecondaryHypo
03-16-2010, 04:02 AM
...
Howdy SecondaryHypo,
I presume you've had experience looking at MRIs, given your name!
The nasal blockages caught my attention too, it appears as if one nostril is completely blocked - I believe it has been this way for 15 years! (I'm 24)
Here are some fancy high resolution images (Well, not as high res as I was lead to believe they would be!)
http://img23.imageshack.us/img23/6321/13520734.th.jpg (http://img23.imageshack.us/i/13520734.jpg/)
http://img188.imageshack.us/img188/4559/89746956.th.jpg (http://img188.imageshack.us/i/89746956.jpg/)
http://img717.imageshack.us/img717/8466/76471868.th.jpg (http://img717.imageshack.us/i/76471868.jpg/)
http://img20.imageshack.us/img20/1601/57958370.th.jpg (http://img20.imageshack.us/i/57958370.jpg/)
http://img17.imageshack.us/img17/6449/67771790.th.jpg (http://img17.imageshack.us/i/67771790.jpg/)
http://img188.imageshack.us/img188/9660/67144013.th.jpg (http://img188.imageshack.us/i/67144013.jpg/)
http://img85.imageshack.us/img85/497/75183505.th.jpg (http://img85.imageshack.us/i/75183505.jpg/)
Note the nasal polyps (I think) in the posterior nasopharynx, on both sides, Left larger than Right, seen at time 00:27 and 00:28 and 1:04.
(note: The polyps are in coronal sections so the right of the screen as you look at it, is the left side of the patient.)
http://www.allergy.org.au/content/view/135/1/
Treatment of nasal polyps
Treatment options include:
- Cortisone tablets will shrink nasal polyps temporarily, but can't be taken long term because of side effects.
40mg HC/7.5mg Prednisolone hasn't shrunk mine!
Dadnatron
03-16-2010, 09:46 AM
Note the nasal polyps (I think) in the posterior nasopharynx, on both sides, Left larger than Right, seen at time 00:27 and 00:28 and 1:04.
(note: The polyps are in coronal sections so the right of the screen as you look at it, is the left side of the patient.)
Those are the posterior aspect of the inferior turbinates. Normal size variance as both baseline as well as variant mucosal engorgement.
Dadnatron
03-16-2010, 09:56 AM
Howdy SecondaryHypo,
I presume you've had experience looking at MRIs, given your name!
The nasal blockages caught my attention too, it appears as if one nostril is completely blocked - I believe it has been this way for 15 years! (I'm 24)
At the time of the MR, the cycle of mucosal engorgement favored enlargement of the left nasal mucosa, resulting in NORMAL variant engorgement of the left inferior and middle turbinates.
If you look at time 13sec up in the left corner with writing you will see Im:1/20 on the 5th line down. This is image 1 of 20 images. Se:5/8 means sequence 5 of 8 total.
Therefore, you would talk about Image 1 of series 5. On this image, looking within the nasal vault, you will see that the left side has 'more' lighter tissue than the right. You nasal septum is midline, so you don't have a baseline deviation of consequence. The inferior turbinate, which is the lighter gray tissue, is engorged and the corresponding finding on the right (which is left on the pitcture... think of looking at the images as if you are standing at feet of the person, looking up towards the top of their head from their toes.) the LEFT inferior turbinate has no significant engorgement (of blood).
It is normal to rotate or switch back and forth between sides. Sometimes, people will have a smaller nasal vault on one side or the other, simply because they are built that way either from septal deviation or because of other inner variant anatomical structures. Although they go through the same type of engorgement cycle, when one side 'engoreges' they have less room, so they notice the 'blockage' more on one side or another. it is one of those things you don't recognize when it is NOT there... but see it when it IS there.
Dadnatron
03-16-2010, 09:56 AM
http://www.allergy.org.au/content/view/135/1/
Treatment of nasal polyps
Treatment options include:
- Cortisone tablets will shrink nasal polyps temporarily, but can't be taken long term because of side effects.
40mg HC/7.5mg Prednisolone hasn't shrunk mine!
its because they AREN'T Polyps.
Hi Dadnatron,
very informative posts, thank you. I can tell that you have been doing this for a long time.
I actually had surgery 6 years ago to correct a deviated septum. The surgery did nothing and I could breathe no better afterwards than before.
Given that having a blocked nose has been a permant issue for me, what could be the cause?
Cheers.
SecondaryHypo
03-16-2010, 01:32 PM
its because they AREN'T Polyps.
Sorry. I was wrong. They aren't polyps. Got it.
I wasn't sure, that is why I wrote "I think" they are polyps.
My mistake...
Stumbled across this website
http://www.radiologyassistant.nl/en/485d7745cc720
"Sella Turcica and Parasellar Region"
Very good reference
Also the American Journal of Roentgenology
http://www.ajronline.org/cgi/search?andorexactfulltext=and&resourcetype=1&disp_type=&sortspec=relevance&author1=&fulltext=pituitary&pubdate_year=&volume=&firstpage=