Imaging the Cavernous Sinus

Question 1

What is the main modality for the cavernous sinus?

Answer 1

MRI (better for soft tissues - pituitary)

Some large pathologies are visible on CT

Question 2

What colour is
1. Hypointense
2. Isointense
3. Hyperintense
on MRI?

Answer 2

1. Black
2. Gray
3. White

Question 3

For the pituitary, do we use T1 or T2 weighted images?

Answer 3

T1 (best for normal and hemorrhage)

T2 can bed used to look for pathology related to edema

Question 4

What colour is the
1. Anterior
2. Posterior
pituitary going to be?

Answer 4

1. Gray

2. White (vesicles have bright NT)

Question 5

Pituitary Macroadenoma

Answer 5

Most common sellar mass in adults
May be functioning
Greater than 1 cm
Grows beyond the sella producing mass effect (vision changes, cranial neuropathies)
Grows slowly

Question 6

Pituitary Microadenoma

Answer 6

Minority of all pituitary adenomas
Can pose imaging and management challenges
Hard to identify on anything other than dedicated pituitary imaging
Less than 10 mm in size
Diagnosed as a result of abnormal hormone profiles

Question 7

Pituitary apoplexy

Answer 7

Acute clinical syndrome
Presents with headache, visual defects/ophthalmoplegia, altered mental status, variable endocrine deficiencies
Caused by either hemorrhage or infarction of pituitary
Can present benign or catastrophic