937
Normal Pituitary Gland:
Helen M . N. Roppolo1
Richard E. Latchaw 1
Received May 14 . 1982; accepted after revi-
sion December 1 . 1982.
Presented at the XII Symposium Neurorad iolo-
gicum, Wa shington, DC , October 1982.
' Departm ent of Rad io logy, Unive rsity of Pitts-
burgh Schoo l of M ed ic in e, Pittsbu rgh, PA 1526 1 .
Add ress reprint req uests to H. M . N. Roppolo .
AJNR 4:937-944, July / August 1983
0 195-6 108 / 83 / 0404 - 0937 $00.00
© Ameri can Roen tg en Ray Society
2. Microscopic Anatomy-
CT Correlation
Pituitary microadenomas may present with subtle or no mass effect. They may
appear lucent, dense, or heterogeneous on computed tomographic (CT) images. The
normal pituitary gland may also have a nonhomogeneous CT appearance with inter-
mingled lucent and dense areas. This heterogeneity is related in part to microscopic
variation within the anterior and posterior lobes. Thirteen autopsy specimens of the
pituitary gland were examined by coronal CT and histologically sectioned in similar
coronal planes . The CT-Iucent and CT-dense areas of the anterior and posterior lobes
were correlated with corresponding areas on microscopic examination . To determine
the effects of contrast infusion during CT, density measurements of lucent and dense
areas in the anterior lobes of 26 normal contrast-enhanced pituitary glands in vivo were
compared with density measurements of adjacent vascular structures at the time of
scanning . Microscopic features corresponding to increased CT density in the anterior
lobe included increased tissue compactness and increased cellular granularity, both of
which usually occurred together in areas composed of tightly compacted and heavily
granulated acidophilic cells . Conversely , microscopic features corresponding to de-
creased CT density in the anterior lobe included decreased tissue compactness and
decreased cellular granularity, both of which frequently occurred together in areas
containing chromophobic and / or mildly to moderately granulated basophilic cells. The
degree of contrast enhancement within the anterior lobe appeared primarily to depend
on vascularity , which in turn often depended on the degree of tissue compactness . In
the posterior lobe, CT-Iucent areas appeared' to correspond to less compact and / or
less vascular neurohypophyseal tissue.
Computed tomography (CT) is particularly valuable for recognizing mi croad -
en om as in patients with normal serum hormone levels [1 -6]. CT can also help to
rule out microadenomas in patients who have suspicious serum ho rmon e levels
but in fact have other lesions . Sin ce small microadenomas may present with
subtle or no mass effect [7] and th erefore may be co nfused with normal glandular
tissue, a thorough understanding of th e CT appearance of th e no rm al pituitary
gland and its normal variation s is important [8].
Part 1 of this study (pp . 927 -9 3 5, thi s iss ue) discussed variations in CT density
within the pituitary gland ca used by gross stru ctural interrelations of the anteri or
lobe , pars intermedia, and posterior lobe. Thi s paper examines variations in CT
density resulting from mi c ros copi c anatomic features in the anterior and posterior
lobes .
Materials, Subjects, and Methods
Th e materi als, subjects, and scan nin g techni ques were described in part 1. Howeve r,
addition al meth ods we re used to evalu ate the CT-Iu ce nt and CT-dense areas within th e
anterior and posterior lobes and to de termine the effec ts of co ntrast enhance ment.
Foca l CT -lu ce nt areas in both th e au topsy spec imens and c linica l subjects were eva luated
fo r CT density, co nfiguration, height , and w idth; foca l CT-dense areas we re eva luated for
CT density. Th e CT density measuremen t for each foca l area was de termin ed by averag ing
938 ROPPOLO AND LATCHAW AJNR:4 , Ju l. / Aug . 1 S'd3

other, creating a repetitive pattern (figs. 28 and 2C). The

CT-Iucent areas corresponded to loosely packed chromo-
<: phobic cells and / or mildly to moderately granulated baso-
w
a: D E N SE "" [ AS . philic cell s with a few moderately to heavily granulated
« :::J
LU C E N T AR E A II "

acidophilic cells scattered throughout; the CT -dense areas

w I
corresponded to densely compacted and heavily granulated
In
a
-'
>-
l-
.'. /'
/'
/
acidophilic cells (fig . 2A).
ii) /'
a: z w
/' ~
In another, less frequent pattern, CT-dense areas were
-a
w
0 : /' located on both sides of the gland, lateral to centrally-
a: )~
w I- located CT-Iucent areas (figs . 38 and 3C) . Histologically
l-
Z
t) "
/'
/' .
Y .. ..
these lucent and dense areas were the same as those seen
/
<: in the repetitive pattern (fig . 3A) .
..... /
In addition, in the mid part of the anterior lobes of unen-
hanced glands, CT-Iucent areas were often seen along the
VASCULAR CT DENSIT Y (H .U.)
superior border (fig . 38) . Histolog ically these areas con-
sisted of loosely packed fibrous tissue with a few acidophilic ,
(CAVERNOUS S INU S )
chromophobic, and / or basophilic cells embedded in a vas-
Fig. 1 .- Relati ve enh ancement of dense and lucent areas in anteri or lobe. cular stroma; they were contiguous posteriorly with similar
CT densities o f densest areas (circles) and most lucent areas (triangles ) in
anteri or lobe of contrast-enhanced pituitary gland plotted against CT density areas at the base of the infundibulum . These lucent areas
of densest area in adjacen t ca vernous sinus at time of sca nn ing . Line of least- were rare ly identifiable in enhanced glands, presumably
squares-fit for dense areas (solid line) has linear-regression correl ation because of their high degree of vascularity . The superior
coe ffi cient of 0.9 and slope of 1.1 ; line of least-sq uares-fit for lucent areas
(bro ken lin e ) has tinear- regression correlation coeffi c ient of 0 .9 and slope of borders of the most-enhanced glands were CT -dense
0 .69. throughout , which may reflect not on ly the above feature
but also the presence of intercavernous sinuses on their
surfaces and the presence of an enhancing diaphragma
multiple 4-pi xel values. In ord er to make th e pituitary density meas-
sell ae .
urements more valid , they were compared with th ose of ventricular
ce rebrospinal fluid (CSF). Since the latter values varied between 0 Often , CT sections through the anterior and mid parts of
and 12 H (H oun sfield units), th ey were standardized to 8 H and any the anterior lobe were relatively homogeneous. In these
differences from this value were ad ded to or subtracted from th e instances there was a re latively uniform degree of tissue
pitu itary measurements. compactness with cells of various degrees of granularity
To determine the effects of contrast infusion during CT, density either interspersed throughout or scattered as small foci of
measurements of lucent and dense areas in the anterior lobes of individual cell types .
normal contrast-enhanced pituitary glands in vivo were co mpared CT-Iucent areas were occasionally seen between the an-
with density measurements in vasc ular structures at the time of terior lobe and cavernous sinus, especially superiorly and
scanning (fig. 1 ). Th e CT density measuremen t in th e densest region
inferiorly (figs. 38 and 3C); these areas corresponded to
in th e adjacen t cavernous sinus was taken to represent the vascular
structures in each instance.
extraglandular areas of adipose and / or connective tissue .
The posterior parts of the anterior lobe usually were
re latively homogeneous and dense on CT (figs . 48 and 4C).
Results They corresponded histologically to the areas with the most
densely compacted and heavily granu lated acidophilic cel ls
Anterior Lobe
in the anterior lobe (fig . 4A) and were located superolateral
The CT-Iucent areas in the anterior lobes of the combined to the pars intermedia on both sides of the gland .
clinical and autopsy series (n = 39) had the following On either side of the midline in the mid and posterior parts
configurations : 49 % round , 28 % oval, 22 % elongated with of the anterior lobe, compact bands of dense connective
parallel sides, and 1 % elong ated but wedg e-shaped . They tissue and vessels referred to as fibrous cores [9] coursed
had a maximum height of 3 .2 mm and maximum width of in an anteroposterior direction (fig. 5). They did not differ
4.0 mm . significantly in CT density or in vascularity / unit volume from
On the unenh anced CT sections of our autopsy speci- the adjacent loosely packed glandular tissue and were not
mens, the two most significant histologic features contrib- discernible from adjacent areas on plain or contrast-en-
uting to a lucent as opposed to dense appearance were a hanced CT .
low or mod erate degree of tissue compactness (table 1, Except for the above-mentioned vascu lar areas on the
areas 8 vs . C and E vs . F) and a low degree of cellular superior border of the mid part of the anterior lobe, the
granularity (table 1 , areas A and 8). degree of vascularity appeared to be similar throughout the
Frequent CT patterns emerged as a result of the anatomic anterior lobe or to be greater in some regions of increased
relations of the CT-dense and CT-Iucent areas to each other. tissue compactness. Such regions of increased tissue com-
These patterns were similar in unenhanced and enhanced pactness were usually CT-dense in their unenhanced state
g lands. In th e anterior and mid parts of the anterior lobe, and , being more vascular, had the greatest potential for
CT-Iucent and CT-dense areas of similar configuration often vascular contrast enhancement. Therefore, the relative con-
alternated with each other from one side of the gland to the trast between unenhanced dense areas and lucent areas
AJNR:4, Jul. / Aug . 1983 PITUITARY MICROSCOPIC ANATOMY-CT CORRELATION 939

TABLE 1: CT Density-Histologic Correlation in Autopsy Specimens of Normal Pituitary Glands

(n = 13)

Tissue Characteristics CT Density (Houn sfield units)

Pituitary Region :
Hi stologic Area Degree of Predom in ant
Rang e Mean ± SO
Compactness Tiss ue Type

Anterior lobe:
A . Loose Chromophobes 24-45 33 .90 ± 6.45
B .......... . ... Loose Heavily granulated aci-
dophils 41-51 45.43 ± 3.51
C .............. Dense Heavily granulated aci-
dophils 57-69 62.33 ± 3.47
D ... Moderate Heavily granulated ba-
sophils 56' 56'
E .... .. . .. ..... Moderate Fibrous connective tis-
sue 21-36 31.14 ± 6.04
F ...... Dense Fibrous connective tis-
sue 37-45 40 .00 ± 5.91
G ............. Moderate Chromophobic microad-
enoma 34' 34'
H ........ . ... Dense Moderately granulated
acidophilic microad-
enoma 54' 54'
Pars intermedia:
I ..... Dense Colloid cysts 23-50 36.63 ± 10.21
Posterior lobe:
J ............ Loose and / or
poorly vascular Neurohypophysis 26-51 35.43 ± 4.65
K .. Dense and / or
highly vascular Neurohypophysis 44-62 49.75 ± 5.49
Note .-A-K differentiate areas according to their particular histologic composition.
, One specimen only.

A B
Fig . 2.-Anterior part of anterior lobe. A, Coronal histologic section (H
and E stain). B, Closely corresponding CT section of specimen . Strongly
staining areas in A (farge black arrows) are densely compacted tissue with
heavily granulated acidophilic cells; they correspond to CT -dense areas in B,
(large white arrows). Weakly staining areas in A (small arrows) are loosely
c
packed tissue with ch romophobi c and / or mildly to moderately granulated
basophilic cells ; they correspond to CT-Iucent areas in B (small arrows). C,
Contrast-enhanced coronal CT scan in normal patient with sim ilar CT -dense
(farge arrows) and CT-Iucent (sma ll arrows) areas.

would be expected to be preserved or increased with con-
trast infusion, if contrast enhancement is based solely on
vascularity.
To determine how contrast infusion actually affected CT
density within the anterior lobe, the density measurements
of the lucent and of the densest areas, respectively, were
correlated with the density measurements of adjacent vas-
cular structures at the time of scanning (represented by the
densest region in the adjacent cavernous sinus). Separate
linear relations were found (fig. 1). For each unit-increase in
CT density of the adjacent sinus , the CT density of the
lucent areas increased less than that of the densest areas
(fig . 1). Thus their CT density difference increased with
increasing contrast enhancement. The difference in CT den-
940 ROPPOLO AND LATCHAW AJ NR :4, Jul. / Aug 1983

A 8
Fig . 3. -Midd le pari of anteri or lobe . A, Co ronal hi slo log ic secti on (H and
E slain) . B, Close ly correspond ing CT section of spec im en . Strong ly sta ining
areas in A (large arrows) are densely compac ted ti ssue w ith heavily g ranu-
lated ac idophilic cell s; they co rrespond to CT -dense areas in B (large arrows).
Weakly stain ing areas in A (small arrow) are loosely packed ti ssue with
c hromophobic and / or mildly to moderately granu lated basophili c ce lls; they
correspond to CT-luce nt areas in B (small arrow ). Wea kl y staining areas
alo ng superior surface 01gland in A (arrowh ead ) are vascu lar, loosely pac ked
libro us ti ssue with few g landu lar cells; they correspo nd to CT -lucent areas in
C
B (arrowhead) . Anot her wea kl y stain ing area in A (curved arrow ) is ex tra-
glandu lar ad ipose and fibrous tiss ue, corres ponding to CT-Iucent area in B
(c urved arrow ). C, Contrast-enhan ced coronal CT sca n in normal pat ient
demon strates similar CT-de nse (wh ite arrows ) and CT-Iuce nt (small arrow )
areas wi thin anterior lobe. Most-luce nt area located cent rally (short thic k
arrow ) probably corresponds to coll oid cyst in anteri o r- most pars interm ed ia.
Lucent area located laterall y (c urved arrow) probably correspo nds to ext ra-
glandul ar fat and / or connec ti ve tissue.

~~~;~~j;
'.'.
~.

4A 48 4C
Fig . 4 .-Mi d reg ion of gland . A, Coro nal histo logic section (M asson tric hrome stain). B,
Closely correspo nding CT section of specimen . St rong ly stainin g posteri o r parts of an terior
lobe in A (larg e arrows ) are densely compac ted tissue with heavil y granulated ac id ophilic
cells; th ey corres pond to CT-dense areas in B (large arrows ). Weakly stai ning anteri o r part
of posteri or lobe in A (arrowhead ) is compact and high ly vasc ul ar neurohypophysea l ti ssue,
corresponding to central CT-dense area in B (arrowhead ). Coll oid-cyst-co ntai ning pars
interm edia in A (small arrows ) separates th e two lo bes; it c orrespo nds to CT-Iucent areas in
B (small arrows). C, Contrast-enh anced coronal CT sca n in norm al patient shows less
en hancement of posteri o r parts o f anteri or lo be (large arrows ) than of mo re vascu lar anteri or
part of posteri o r lobe (arrowhead ). CT -lucent pars intermedia (small arro w) is see n o n on ly
o ne side in thi s pati ent.

Fig . 5 .-Coronal hi sto log ic section (PAS-o rang e G stain) o f anteri o r lobe of au topsy
specimen w ith symmetric fibrous cores (arro ws ).
5
AJNR:4, Jul. / Aug . 1983 PITUITAR Y MICROSCOPIC ANATOM Y-CT CORRELATION
TABLE 2: CT Densities of Lucent and Dense Areas in Contrast-
Enhanced Normal Pituitary Glands in vivo (n = 26)
CT Density (H ounsfie ld unit s)
Pituit ary Region: Contrast-Enhan ced
Areas
Rang e M ean ± SO
Anterior lobe:
Lucent 34-95 55.70 ± 18.30
Dense 44 -1 17 74.89 ± 20.11
Pars intermedia:
Lucent 19-58 37 .60 ± 11 .34
Posterior lobe:
Lucent 35-60 46 .19±9.00
Dense 64-131 83.25 ± 21.00
si ty between the lucent and th e densest areas was greatest
when the density of th e cave rn ous sinus was th e hi ghest
(fig . 1).
Pars Intermedia
The CT-Iucent are as in the pars inte rm ed ia region s of the
combined c lini cal and autopsy se ries (n = 39) had th e
following configurations: 47 % elong ated with parallel sid es,
16% elongated but wedge-sh aped, 3 0 % round , and 7%
oval. Their maximum height was 5.2 mm and the max imum
width was 3.0 mm. There was a high er percentage of
elongated lucent areas in the pars interm edia than in th e
anterior lobe. The lucent areas of th e pars also had a greater
maxi mum height and a lesser maxim um width than th ose of
th e anterior lobe . These features refl ect th e narrow and
elongated configuration of th e pars its el f , as discussed in
part 1 of this study.
On histologi c exam inatio n, in all but one instance, the
lu ce nt appearance of the pars intermed ia co rrespond ed to
the presence of large and / or frequent co ll oid cysts. In the
singl e exce ption the luce nt appearance was re lated to an
area of fibrosis with cavitation .
In our unenhanced autopsy specimens , the mean and
range of CT densiti es of the colloid cysts (tabl e 1, area I)
were similar to th e mean and rang e of CT densities of the
areas of loosely packed c hromophobi c ce lls in the anterior
lobe (table 1, area A) as well as to the mean and range of
CT densities of the less vasc ul ar and / or loosely packed
neurohypophyseal tissue of the posterior lobe (table 1 , area
J). The mean CT density of th e co lloid cysts wa s also simil ar
to th at of the c hromophobic microadenoma (tabl e 1 , area
G) .
In our contrast-enhanced clinical series (table 2), th e
mean and the range of CT densities of th e lucent are as
within th e pars intermedi a were similar to those seen in our
un enhanced autopsy population (table 1, area I) . Thi s indi-
cates their failure to enhance and reflects their avascular
nature. Their contrast- enhanced mean density was less than
the co ntrast-enhanced mean density of the luce nt areas in
th e anterior and posterior lobes (table 2), thus helping to
id entify their nature. Moreover, after contrast infusion th e
luce nt areas of th e pars interm ed ia were mo re easily distin-
941
g ui shed from the adjacent tissue than were lucent areas in
other regions . Thi s was attributab le to several factors: (1)
Since the lucent areas of th e pars intermedia did not en-
hance, unlike most lu ce nt areas in other regions, the density
difference between th em and the adjace nt ti ss ue inc reased;
(2) the regions adjacent to the pars intermed ia normall y
were the most-dense reg ion s of the anteri or and posterior
lobes (figs. 48 and 4C), providing maximum avail ab le con-
trast; and (3) the cysts of the pars intermedia often were
better marginated than th e poorly defined lucent areas in
ot her regions.
Posterior Lobe
CT exa mination of the posterior lobe frequently demon-
strated multiple round lu ce nt areas interm in g led with dense
areas. The maximum height of th ese luce nt areas was 3 mm
and the maximum width was 2.2 mm .
On hi sto logic exam ination, bund les of homog eneous-ap-
pearing neurohypophyseal tissu e were seen with various
degrees of vascularity and compactness (fig. 6) . The more
lu ce nt areas on CT examination co rresponded to th e less
compact and / or less vascu lar bundles on hi stologic exam-
ination (table 1 , area J). Conversely , the denser areas on
CT exa min ation co rresponded to th e mo re co mpact and / or
more vasc ul ar bundles on hi sto logic exa min ati on (tabl e 1,
area K).
The most anteri or part of the posterior lobe usually co r-
respond ed to both compact and vascular neurohypophyseal
tissue (fig . 4A). It was generally the most vascul ar region of
the posterior lobe, receiving vessels directly from superior
and inferior vascular networks on the im mediately adjacent
g land ular surface [9 -11]. On coronal CT examination, both
with and without contrast enhancement, this region usually
co rrespo nded to a very dense and homogeneous cen tra l
area, sometim es flanke d on either sid e by a luce nt pa rs
interm ed ia (fig s. 48 and 4 C) . After co ntrast enhanceme nt it
was typi ca lly the most CT -dense area of the entire gland.
Th e more posterior parts of the posterior lobe co rre-
sponded to bundles of neurohypophyseal tissue with variou s
degrees of compactness and vascularity (fig. 6A). Overall,
this tissue was less vascular than that in the anterio r part of
this lobe. On CT exam ination it frequ ently had a
" multicystic " appearance (figs . 6 8 and 6 C) , with th e luce nt
"cystic " areas co rresponding to the less compact and / or
less vascu lar neurohypophyseal tissue.
In our un enh anced autopsy specime ns, the mean CT
density of th e lu ce nt areas in th e posterior lobe (tabl e 1,
area J) was si mil ar to th at of the lu cent areas in th e anteri or
lobe (table 1, area A) and pars intermedia (table 1, area I).
In the contrast- enhanced c lini cal subjects, however , th e
mean CT density of luce nt areas in the posterior lobe was
less than that of th e lucent areas in the anterior lobe but
greater than those in th e pars (table 2).
In our unenhanced autopsy spec im ens , the mean CT
density of the dense areas of the anterio r lobe (table 1 , area
C) was greater than that of th e dense areas of the posterior
942 ROPPOLO AND LATCHAW
A B
Fig . 6.-Posteri or lobe embedded in dorsum sellae. A, Coronal hi sto logic
seclion (H and E stain) . B, Closely corresponding CT section of specimen.
Bundles of neurohypophyseal ti ssue in A contain areas of greater (large
arrows) and lesser (small arrows) compactness; these areas correspo nd to
lobe (table 1, area K) . In the contrast-enhanced clinical
subjects , however, this relation was reversed ; that is, the
mean CT density of dense areas in the posterior lobe was
greater than that of dense areas in the anterior lobe (table
2). Presumably this reflected the high degree of vascularity
seen in the dense areas of the posterior lobe.
Microadenomas
Two asymptomatic microadenomas found in our autopsy
specimens provided direct information about their CT-his-
tologic correlation. The first microadenoma appeared lucent
on CT and was composed of sheets of moderately com-
pacted chromophobic cells with no detectable granulation .
Glandular follicles with central lumina containing a colloid
substance were scattered throughout. The second microad-
enoma corresponded to a relatively dense area on CT that
could not be differentiated from the adjacent tissue. This
microadenoma was composed of densely compacted and
moderately granulated acidophilic cells . Its relatively more
dense appearance was attributed to its increased granular-
ity, increased tissue compactness, and absence of colloid
material as compared with th e first mic roadenoma (tabl e 1 ,
areas G and H). Both microadenomas contained less fibrous
tissue and were less vascular than the other reg ions of the
anterior lobe.
Discussion
Retrievable parts of microadenomas excised at surgery
often are structurally distorted, incomplete , and fragmented .
For this reason, it is hazardous to attempt to correlate the
histologic appearance of surgical specimens with the pre-
surgical CT appearance of the structurally intact tumor. As
a result, it is difficult to increase our diagnostic acumen for
microadenomas by studying surgical material alone . We
AJNR :4, Jul. / Aug . 1983
CT-dense (large arrows) and CT-Iucent (small arrows) areas, respecti vely, in
B. C, Contrast-enhanced coronal CT scan in normal patient with similar CT-
dense (large arrows ) and CT-Iucen t (small arrows) areas.
approached the problem of diagnosing pituitary microad-
enomas by attempting first to understand and define the CT
appearance of the normal pituitary gland.
Our results show that the CT density of normal pituitary
tissue depends primarily on its degree of compactness,
granularity, and vascularity and on the presence or absence
of colloid cysts. Typical CT patterns (fig . 7) may result from
various combinations of these factors in different parts of
the gland . Pattern distortion with associated asymmetry
suggests an abnormality . This is true particularly if the
suspected abnormality is a lucent area located in the ante-
rior lobe and > 3.2 mm high or> 4 mm wide .
Since there is a difference between the degree of contrast
enhancement of the CT -lucent areas as compared with the
densest areas , the question arises as to the source of this
enhancement, that is, the relative contributions of the vas-
cular versus the interstitial compartment. Theoretically,
since the pituitary gland resides outside the blood-brain
barrier, contrast media can rapidly equilibrate between the
intravascular and extravascular interstitial spaces [12 , 13].
The degree of tissue enhancement then depends on the
volumes of these compartments, the diffusibility of the spe-
cific contrast agent, the dose and rate of administration , and
the state of hydration, age, renal function, and body habitus
of the patient [14 , 15].
Our results demonstrate that the lucent areas in the an-
terior lobe, which usually consist of loosely packed tissue,
increase less in density with increasing vascular contrast
concentration than the densest areas, which usually consist
of densely compacted tissue (fig . 1). As previously
discussed , the more compact anterior-lobe tissue may have
a hig her co ncentration of vessels than at least some of the
less compact tissue, hence, a greater potential for vascular
enhancement. The more compact tissue generally appears
also to have less available interstitial space. Thus, it is likely
that vascular enhancement is primarily responsible for the
greater increase in CT density of the dense as compared
AJNR:4 , Jul. / Aug . 1983 PITUITARY MICROSCOPIC ANATOMY-CT CORRELATION
A enhancement. The unenhanced acidophilic microadenoma ,
B than the more compact acidophilic mic roadenoma . This
c Other potentially CT-Iucent areas in the anterior lobe have
o Knowledge of normal structural patterns within the pitui-
Fig . 7 .-Diagrammatic representation of normal CT pattern s frequ ently
formed by CT-Iucent (small arrows) and CT-dense (large arrows) areas. A
and B, Sections through anterior lobe only ; C, Through the region of gland
involving parts of anterior lobe , pars intermedia , and posterior lobe; D,
Through posterior lobe .
with the lucent areas after contrast infusion. Looking at this
from another perspective, the amount of available interstitial
space in the CT -lucent areas of the anterior lobe and / or
their diffusion capabilities do not appear sufficient to coun-
teract the effects of vascularity on contrast enhancement.
Unlike the anterior-lobe lucent areas , whose degree of
enhancement increases in proportion to the concentration
of contrast agent in adjacent vascular structures (fig. 1), the
lucent areas of the pars intermedia demonstrate little or no
enhancement. This implies that transcellular diffusion of
contrast into the colloid cysts in this region does not occur
to any significant degree [1 6, 17] during the usual scanning
time. Minimal increases in CT density, which may be ob-
served on occasion, probably result from partial-volume
943
averaging with adjacent enhancing tissue.
Two clinically " silent " microadenomas were found in the
anterior lobes of our autopsy specimens. One was an ac i-
dophilic and the other a chromophobic microadenom a. Th e
chromophobic microadenoma was lucent on CT. Since it
was hypovascular compared with adjacent tissue and had
sparse interstitial tissue, this microadenoma could be ex-
pected to remain lucent, at least initially, after contrast
however, was isodense on CT . Since it was also hypovas-
cular and had sparse interstitial tissue , it theoretically could
be expected to become less dense than its adjacent, more
vascular tissue , at least initially, after contrast enhancement.
There is evidence to suggest that on delayed scans th e
relative concentration of contrast agent in some microad-
enomas may be greater than in adjacent tissue owing to
sequestration or delayed concentration [18].
The chromophobic microadenoma was more vasc ular
raises the possibility of a vascular basis for the finding s of
Sakoda et al. [17] , who report greater overall enhancement
of prolactin-secreting adenomas (wh ich are usually c hrom-
ophobic) as compared with growth-hormone-secreting ad-
enomas (which are usually acidophilic) . However, because
of their lower initial density, the prolactin-secreting adeno-
mas in the series reported remained relatively less den se
than their growth-hormone-secreting counterparts, even
though they enhanced more [1 7].
been reported by other investigators [19-21] after histologi c
reviews of autopsy specimens . They include areas of infarc-
tion with fibrosis , old hemorrhage, and hypovascular metas-
tases. We have a single clinical example of biopsy-proven
metastatic adenocarcinoma , which extended from the orbit
into the cavernous sinus immediately adjacent to the lateral
aspect of the pituitary gland . It was hypodense relative to
the nearby pituitary tissue.
tary gland is helpful not only in detecting abnormal fo cal
areas but also in differentiating these focal abnormalities
from abnormal glandular hyperplasia. In our very limited
experience, abnormal hyperplastic glands have not dem-
onstrated a definite distortion of structural patterns . They
have tended to increase the overall size of th e gl and , caus-
ing a superior convexity on its surface and / or bony erosion
of the sellar floor. Theoretically, since certain regions of the
pituitary gland contain specific cell types , selective regions
may be stimulated in glandular hyperplasia to increase in
compactness and / or vascularity and / or to alter their degree
of granularity. This could result in a selective increase in
either CT-dense or CT-Iucent areas simulating mi croaden-
omas . Conditions linked to glandular hyperplasia include
the use of L-dopa antagonists [1 , 5, 6], hypothyroidism [2-
5], and hypogonadism .
In summary, although normal pituitary glands often appear
heterogeneous on CT , th ey frequently exhibit predictable
and symmetric structural pattern s. Di stortion of these struc-
tural patterns , especially by abnormally large CT -lucent
944 ROPPOLO AND LATCHAW
areas, suggests th e prese nce of a mi croadenoma, eve n in
th e abse nce of mass effect.
11 .
ACKNOW LEDGMENTS 12 .
We th ank A. Julio Martin ez for neuropa th olog ic assistance in th e
hi stolog ic review of specimens ; Deborah J . Clark for manu script
13.
prepara ti on; and Ronald Dupin for tec hnic al assistance in th e CT
scannin g of autopsy specimens .
14.
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