International Journal For Multidisciplinary Research

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A Stepwise 1.5T MRI Algorithmic Approach to Differentiating Non-Adenomatous Sellar Masses from Pituitary Adenomas: A 30-Case Experience,

Author(s) Dr. Sravan Kumar Varra
Country India
Abstract Abstract
Background: Differentiating non-adenomatous sellar and juxtasellar lesions from classic pituitary adenomas remains a significant diagnostic challenge. While pituitary adenomas constitute the majority of sellar masses, misdiagnosing mimics can lead to inappropriate surgical interventions or delayed medical management.
Objective: To evaluate the diagnostic accuracy of a structured, stepwise 1.5T MRI algorithmic approach in differentiating non-adenomatous sellar and juxtasellar masses from pituitary adenomas.
Methods: A prospective, descriptive study was conducted over a 2-year period (November 2019 to October 2021) involving 30 patients presenting with clinical features indicative of sellar pathology at a tertiary care hospital. All patients underwent multiplanar 1.5 Tesla MRI brain protocols, including thin-section sagittal and coronal T1WI, T2WI, FLAIR, and post-contrast T1W sequences. A retrospective stepwise diagnostic algorithm based on morphology (cystic vs. solid), signal intrinsic characteristics, and contrast enhancement pattern was developed and applied to the cohort.
Results: Of the 30 patients, pituitary adenomas constituted only 33.3% (n=10) of the cases. The remaining 66.7% (n=20) consisted of non-adenomatous pathologies: craniopharyngiomas (13.3%, (n=4)), CNS tuberculomas (10.0%, (n=3), meningiomas (6.7%, (n=2), Rathke’s cleft cysts (6.7%, (n=2), empty sella (6.7%, (n=2), pituitary apoplexy (6.7%, (n=2), arachnoid cyst (3.3%, (n=1), epidermoid cyst (3.3%, (n=1), internal carotid artery aneurysm (3.3%, (n=1), hypothalamic hamartoma (3.3%, (n=1), and pilocytic astrocytoma (3.3%, (n=1). Females were predominantly affected (66.7%, (n=20), and headache was the most common clinical presentation (76.7%, (n=23). Applying a sequential morphological and signal-intensity flowchart correctly classified 100% of the non-adenomatous pathologies based on distinguishing features, such as the absence of a blood-brain barrier breach in hamartomas, diffusion restriction in epidermoids, and flow-voids in vascular aneurysms.
Conclusion: Utilizing a stepwise 1.5T MRI algorithm based on specific anatomical boundaries, intrinsic signal behaviors, and enhancement kinetics allows for accurate non-invasive differentiation of non-adenomatous sellar lesions from pituitary adenomas, effectively optimizing surgical planning and preventing therapeutic missteps.
Keywords Sellar lesions, Juxtasellar, Magnetic Resonance Imaging, Pituitary Adenoma, Tuberculoma, Mimics.
Field Biology > Medical / Physiology
Published In Volume 8, Issue 3, May-June 2026
Published On 2026-06-02
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E-ISSN 2582-2160
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