Pituitary tumors: advances in neuroimaging

Pediatric pituitary tumors, albeit relatively infrequent, can significantly alter the quality of life of affected children. Accurate diagnostic differentiation is essential for both safe and effective disease management. Recent advances in neuroimaging have enabled the neuroradiologist to study the pituitary region in greater detail than ever before. Magnetic resonance imaging (MRI) represents the examination method of choice for evaluating hypothalamic-pituitary-related endocrine diseases due to its ability to provide strongly contrasted high-resolution, multiplanar and spatial images. Specifically, MRI allows the detection of the pituitary lesions responsible of the clinical picture and offers useful information about the relationship with adjacent anatomical structures in order to plan the medical or surgical strategy. A rigorous imaging exam technique is necessary in order to obtain images of high diagnostic quality. Advanced MR techniques, including diffusion-weighted imaging and MR spectroscopy, may be helpful in particular cases. Computerized tomography (CT) has a complementary role in the identification of intralesional calcifications or to better evaluate bone structures prior to trans-sphenoidal surgery. The aim of this work is to provide an overview of the most relevant neuroradiological features of pituitary region tumors and to propose an appropriate and accurate differential diagnosis.