Preliminary Diagnosis: Prolactinoma
I. What imaging technique is first-line for this diagnosis?
MRI imaging with contrast
II. Describe the advantages and disadvantages of this technique for diagnosing prolactinoma.
Advantages
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IV contrast and dynamic phase imaging is diagnostic and can accurately localize the area of abnormality.
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Can assess for secondary complications, such as mass effect on optic chiasm.
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Has superior anatomic resolution and does not expose the patient to ionizing radiation.
Disadvantages
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Prolactinoma is a clinical diagnosis. MRI can only diagnose a pituitary micro- or macro- adenoma.
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Expensive.
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Time consuming.
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Requires significant patient cooperation to minimize motion artifact.
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Contrast cannot be used in patients with kidney insufficiency (i.e., GFR < 30).
III. What are the contraindications for the first-line imaging technique?
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Patients with non-MR compatible hardware or foreign bodies.
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Gadolinium contrast is contraindicated in patients with a GFR ≤30.
IV. What alternative imaging techniques are available?
CT with IV contrast
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing prolactinoma.
Advantages
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Less expensive and a quicker imaging modality than MR.
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Can be used on sicker patients.
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Less prone to motion artifact.
Disadvantages
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Exposes the patient to ionizing radiation.
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Less sensitivity and specificity in detecting prolactinomas, as compared to MRI.
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Microadenomas may not be detected on CT.
VI. What are the contraindications for the alternative imaging techniques?
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Contraindicated in patients who are pregnant, especially during the first two trimesters.
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Relative contraindication to use of contrast in patients with renal failure.
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Relative contraindication to use of contrast in patients with contrast allergies.
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